An evaluation of preemployment drug testing

A 7-year study of workplace drug testing in two major cities in Türkiye

BACKGROUND

Workplace Drug Testing (WDT) is a worldwide practice that is crucial in anti-drug efforts. This study aimed to provide compherensive information about the WDT applications in Türkiye with data obtained from two major cities in two different regions of Türkiye.

METHODS

The retrospective assessment of forensic toxicological analysis results in urine, hair or urine&hair samples collected from 220 WDT cases in İzmir (3rd largest city) and Adana (5th largest city) from 2016 to 2022 years was carried. The screening and confirmation analysis were performed with immunoassay and liquid chromatography-tandem mass spectrometry (LC-MS/MS), respectively.

RESULTS

Cases with a positive result from one of urine or hair tests were accepted as positive. 20.5% (n = 45) of the cases were detected positive, and most applicants were identified as drivers (84.4%, n = 38). Urine samples of 23.5% (n = 52) were screened by immunoassay, and THC (n = 1) and opiate (n = 1) were detected. In the LC-MS/MS analysis, benzodiazepines were detected most in urine as a single substance, while cannabinoids and codeine were detected in the hair. Multidrug combinations used in treatment were detected in urine and hair. It was detected both alone and among the substances accompanying cannabinoids and amphetamines.

CONCLUSIONS

This study presents 7-year WDT results of two different major cities in Türkiye. The method of WDT application differs across the country so a standard procedure should be performed. In our country, where zero tolerance against substance use is adopted, the detection of illegal and controlled substances in cases clearly shows that WDT practice should be routinized.

Cannabis use and work-related injuries: a cross-sectional analysis

BACKGROUND

Although the association of cannabis use with automobile accidents has been well-studied, the impact of cannabis on workplace safety and injuries is less clear.

AIMS

The purpose of this study was to examine the relationship between work-related injury and cannabis use in the past year.

METHODS

We performed a cross-sectional analysis of the Canadian Community Health Survey (2013-16) of working individuals. We used multiple logistic regression modelling to calculate the odds of experiencing a work-related injury (defined as non-repetitive strain injury) among workers who reported using cannabis more than once during the prior 12 months as compared to non-users. We repeated the analysis among participants working in high injury risk occupational groups only.

RESULTS

Among the 136 536 working participants, 2577 (2%) had a work-related injury in the last 12 months. Of these 2577 who had a work-related injury, 4% also reported being a cannabis user in the same period. We found no association between past-year cannabis use and work-related injury (odds ratio for work injury among users 0.81, 95% confidence interval 0.66-0.99). The association was unchanged in the subgroup analysis limited to high injury risk occupational groups.

CONCLUSIONS

We found no evidence that cannabis users experienced higher rates of work-related injuries. While awaiting prospective studies, occupational medicine practitioners should take a risk-based approach to drafting workplace cannabis policies.

Random drug and alcohol testing for preventing injury in workers

BACKGROUND

Drug- and alcohol-related impairment in the workplace has been linked to an increased risk of injury for workers. Randomly testing populations of workers for these substances has become a practice in many jurisdictions, with the intention of reducing the risk of workplace incidents and accidents. Despite the proliferation of random drug and alcohol testing (RDAT), there is currently a lack of consensus about whether it is effective at preventing workplace injury, or improving other non-injury accident outcomes in the work place.

OBJECTIVES

To assess the effectiveness of workplace RDAT to prevent injuries and improve non-injury accident outcomes (unplanned events that result in damage or loss of property) in workers compared with no workplace RDAT.

SEARCH METHODS

We conducted a systematic literature search to identify eligible published and unpublished studies. The date of the last search was 1 November 2020. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, two other databases, Google Scholar, and three trials registers. We also screened the reference lists of relevant publications known to us.

SELECTION CRITERIA

Study designs that were eligible for inclusion in our review included randomised controlled trials (RCTs), cluster-randomised trials (CRTs), interrupted time-series (ITS) studies, and controlled before-after (CBA) studies. Studies needed to evaluate the effectiveness of RDAT in preventing workplace injury or improving other non-injury workplace outcomes. We also considered unpublished data from clinical trial registries. We included employees working in all safety-sensitive occupations, except for commercial drivers, who are the subject of another Cochrane Review.

DATA COLLECTION AND ANALYSIS

Independently, two review authors used a data collection form to extract relevant characteristics from the included study. They then analysed a line graph included in the study of the prevalence rate of alcohol violations per year. Independently, the review authors completed a GRADE assessment, as a means of rating the quality of the evidence.

MAIN RESULTS

Although our searching originally identified 4198 unique hits, only one study was eligible for inclusion in this review. This was an ITS study that measured the effect of random alcohol testing (RAT) on the test positivity rate of employees of major airlines in the USA from 1995 to 2002. The study included data from 511,745 random alcohol tests, and reported no information about testing for other substances. The rate of positive results was the only outcome of interest reported by the study. The average rate of positive results found by RAT increased from 0.07% to 0.11% when the minimum percentage of workers who underwent RAT annually was reduced from 25% to 10%. Our analyses found this change to be a statistically significant increase (estimated change in level, where the level reflects the average percentage points of positive tests = 0.040, 95% confidence interval 0.005 to 0.075; P = 0.031). Our GRADE assessment, for the observed effect of lower minimum testing percentages associating with a higher rate of positive test results, found the quality of the evidence to be 'very low' across the five GRADE domains. The one included study did not address the following outcomes of interest: fatal injuries; non-fatal injuries; non-injury accidents; absenteeism; and adverse effects associated with RDAT.

AUTHORS' CONCLUSIONS

In the aviation industry in the USA, the only setting for which the eligible study reported data, there was a statistically significant increase in the rate of positive RAT results following a reduction in the percentage of workers tested, which we deem to be clinically relevant. This result suggests an inverse relationship between the proportion of positive test results and the rate of testing, which is consistent with a deterrent effect for testing. No data were reported on adverse effects related to RDAT. We could not draw definitive conclusions regarding the effectiveness of RDAT for employees in safety-sensitive occupations (not including commercial driving), or with safety-sensitive job functions. We identified only one eligible study that reflected one industry in one country, was of non-randomised design, and tested only for alcohol, not for drugs or other substances. Our GRADE assessment resulted in a 'very low' rating for the quality of the evidence on the only outcome reported. The paucity of eligible research was a major limitation in our review, and additional studies evaluating the effect of RDAT on safety outcomes are needed.

Economic Effects of Adolescent to Adult Patterns of Cannabis Use: Full-Time Employment and Employment Stability

Research has yet to examine stability in employment as a function of cannabis use once an individual transitions into full-time work. Using data from the Rochester Youth Development Study, trajectories of cannabis use spanning ages 14 to 30 were identified among a sample of predominantly minorities (>80%; 68% African American). After hard-classifying individuals by patterns of cannabis use, probabilities of full-time employment and conditional probabilities of full-time employment were calculated and compared across patterns of use. Abstention or rare cannabis use was associated with a higher likelihood of full-time employment compared with other cannabis use patterns. Full-time employment stability was high for each pattern of cannabis use (>89%) and differences decreased with age and prior periods of employment. The results indicate that patterns of cannabis use spanning adolescence to adulthood have limited impact on the ability to retain full-time employment once employed and are interpreted in light of growing legalization of cannabis use.

Altered States or Much to Do About Nothing? A Study of When Cannabis Is Used in Relation to the Impact It Has on Performance

As more local, state, and national governments change laws regarding the legality of cannabis use, it is essential for organizations to understand how the workplace may be influenced by these changes. The current study begins to answer this question by examining the relationship between three temporal-based cannabis measures and five forms of workplace performance. Using data from 281 employees and their direct supervisors, our results indicate that cannabis use before and during work negatively relate to task performance, organization-aimed citizenship behaviors, and two forms of counterproductive work behaviors. At the same time, after-work cannabis use was not related (positively or negatively) to any form of performance as rated by the user’s direct supervisor. We discuss methodological, theoretical, and practical implications for researchers, organizations, and governmental agencies concerned with cannabis use.

Abuse of Licit and Illicit Psychoactive Substances in the Workplace: Medical, Toxicological, and Forensic Aspects

About one-third of adult life is spent in the workplace. The use of psychoactive substances is a major preventable cause of morbidity and mortality. The consumption of psychoactive substances during or outside working hours greatly increases the frequency and severity of labor accidents, as well as the workers’ poor general state of health and productivity, implying higher costs for enterprises. It is the responsibility of organizations to ensure the safety and health of their workers. These cannot be limited to traditional routine clinical exams, as other aspects also have an impact on health. Thus, prevention and intervention in the consumption of psychoactive substances (e.g., ethanol, opioids, central nervous system stimulants or depressants, hallucinogens, Cannabis derivatives, dissociative substances, and inhalants) in labor activity should be considered as an investment of organizations and not as a cost, in view of the professional, personal, and family advantages for workers and employers, with a potential impact on productivity, security, health, and quality of life at work. Despite the extensive literature on the subject, each article generally focuses on one or another aspect of a very specific nature, not tackling the problem in a holistic way by confronting clinical, safety, and legal issues. This article presents a reflection on the legal, laboratorial, clinical, ethical, forensic, and safety concerns related to the consumption of psychoactive substances in the workplace, and can be a cross-cutting contribution to occupational medicine, forensic medicine, and insurance medicine, as well as for entrepreneurs, lawyers, judges, workers, and technicians from the public and private sectors that develop projects in this area. This discussion is based on general principles established internationally and highlights the role of the occupational healthcare system and other decision-making actors in the prevention and supervision of workplace psychoactive consumption.

Systematic Review of Cannabis Use and Risk of Occupational Injury

Aim: A range of nations, including countries of the European Union, Australia, and the Americas have recently implemented or proposed reforms to how they control cannabis use, thereby departing from traditional approaches of criminal prohibition that have dominated throughout most of the twentieth century. Given these policy developments and the widespread global use of cannabis, it is critically important to understand the possible risks associated with cannabis use in relation to major societal harms. Methods: This systematic review investigates the potential link between cannabis use and occupational injury. Consequently, it appraises all available current literature from five databases, following Cochrane and PRISMA guidelines. Results: Seven of the 16 reviewed studies show evidence supporting a positive association between cannabis use and occupational injury. One study shows evidence supporting a negative association and the remaining eight studies show no evidence of a significant relation. None of the studies assessed cannabis-related impairment. Only three of the reviewed studies show clear evidence that cannabis use preceded the occupational-injury event. Conclusion: The current body of evidence does not provide sufficient evidence to support the position that cannabis users are at increased risk of occupational injury. Further, the study quality assessment suggests significant biases in the extant literature are present due to potential confounding variables, selection of participants, and measurement of exposures and outcomes. Future high-quality evidence will be needed to elucidate the relation between cannabis use and occupational injury.

Illicit drug use and work in a model therapeutic workplace

BACKGROUND

The link between illicit drug use and impaired employee performance in the workplace has been assumed, but the relation has not been demonstrated clearly in research. This study was an evaluation of the relations between cocaine and opiate use, attendance, and performance in a job skills training program in a population with high rates of drug use.

METHODS

Out-of-treatment injection drug users (N = 42) attended a model therapeutic workplace where they could earn a maximum pay of around $10 per hour, 4 h every weekday, for 30 weeks. At the workplace, participants could complete practice trials on computer-based typing and keypad training programs. Participants were asked to provide urine samples thrice weekly, which were tested for opiates and cocaine.

RESULTS

Participants worked for more hours on a program that resulted in a flat hourly wage when their urine was negative for opiates and cocaine than when their urine was opiate and cocaine positive. Attendance was positively associated with opiate-negative samples during the study. When participants attended the workplace, however, their performance was not related to drug use. Participants completed the same number of practice trials, performed at the same accuracy, and typed at the same speed when they were positive and negative for cocaine and opiates.

CONCLUSIONS

Contrary to common expectations, this study failed to show that the use of opiates or cocaine affected in-training performance, even though opiate and cocaine use predicted reduced attendance under some circumstances.

Police Drug Testing, Hair Analysis, and the Issue of Race Bias

Poice agents have beg to use hair analysis as a drug-screening tool in both officer recruitment and officer monitoring. This has been controversial because of a putative racial bias associated with human hair specimens, especially focused on cocaine. However, little empirical evidence has been offered to substantiate this claim. To asses this issue, Hoffin (1999, p. 613) analyzed recruitment cohort data from a major metropolitan police department ( N - 1,80) for cocaine ad marijuana hair assays, contrasting recruits by race. Hoffman's conclusion, based on comparison of odds ratios and relative rates for positive assy outcomes, was that there was "no evidence that one group (i.e., race) was more adversely affected by hair testing compared to urine testing." This article reports on research seekig to replicate Hoffman's results concerning hair analysis by utilizing a similar analytic approach with a much larger data set ( N - 40,000) and examining a different major metropolitan police department. This research is disnct form the Hoffman study in two ways: The assessment was exclusively of cocaine prevalence, and the subjects were who job applicants but sworn police officers. The findings reported here support Hoffman's conclusion that there is no statically significant race bias attributable to hair analysis, at least as applied to cocaine.

Are You Positive? The Relationship of Minority Composition to Workplace Drug and Alcohol Testing

Although testing for alcohol and drug use is common in the U.S. workplace, relatively little is known about the characteristics of workplaces that test and about the consequences to persons tested. This paper describes the link between drug and alcohol testing and the minority composition of worksites. The data come from a 1999 survey of 264 union officials in the telecommunications industry. These preliminary data suggest minority worksites were more likely to perform pre-employment and just-cause testing and less likely to perform random drug testing, even after considering workplace characteristics such as normative use of drugs. A similar but weaker association was found for alcohol testing.

Urine Collection Jars versus Video Games: Perceptions of Three Stakeholder Groups toward Drug and Impairment Testing Programs

The use of drug testing in the workplace is a controversial practice. Scholars, practitioners, unions, and organizations have therefore begun to explore whether there are alternative approaches to reduce counterproductive behaviors at work. We investigated the perceptions of labor relations experts, drivers of transportation vehicles, and users of public transportation services toward drug and impairment testing programs in the workplace. Impairment testing was viewed as more favorable in terms of combating and controlling counterproductive behaviors at work than drug testing. Perceptions of fairness, effectiveness in detecting impaired performance, and the potential to enhance a safer working environment were higher in the impairment testing condition as compared to the drug testing condition. Perceived invasiveness was lower in the impairment testing condition relative to the drug testing condition. Labor relations experts showed the least enthusiasm for both drug testing and impairment testing programs.

Employee assistance programs, drug testing, and workplace injury

INTRODUCTION

Little is known about the effects of employee assistance programs (EAPs) on occupational injuries.

MATERIALS AND METHODS

Multivariate regressions probed a unique data set that linked establishment information about workplace anti-drug programs in 1988 with occupational injury rates for 1405 establishments.

RESULTS

EAPs were associated with a significant reduction in both no-lost-work and lost-work injuries, especially in the manufacturing and transportation, communication and public utilities industries (TCPU). Lost-work injuries were more responsive to specific EAP characteristics, with lower rates associated with EAPs staffed by company employees (most likely onsite). Telephone hotline services were associated with reduced rates of lost-work injuries in manufacturing and TCPU. Drug testing was associated with reductions in the rate of minor injuries with no lost work, but had no significant relationship with lost-work injuries.

PRACTICAL APPLICATIONS

This associational study suggests that EAPs, especially ones that are company-staffed and ones that include telephone hotlines, may prevent workplace injuries.

The state of interventions to address substance-related disorders in South African workplaces: implications for research, policy, and practice

Substance abuse in South Africa is highly prevalent and continues to be a major cause of mortality and a risk factor for both communicable and non-communicable diseases. The employer costs associated with substance abuse remain high owing to rising health costs, accidents, absenteeism, and workers’ compensation claims placing the organisation and its employees at risk for harm. This article describes the status of current policy, prevention, and treatment interventions to address substance abuse in the South African workplace. Key issues highlighted are the need for research into the extent and impact of substance abuse in the South African workforce, the promotion of substance abuse policies that are comprehensive in nature, and the need to upscale prevention and treatment initiatives through a move away from a traditional labour approach to addressing substance-related disorders in the workplace to the adoption of a more public health approach. Cost-effectiveness of substance abuse interventions is explored alongside the importance of ensuring that employers, practitioners, and other role players engage with the evidence of what works using international standards as the basis.

How effective is drug testing as a workplace safety strategy? A systematic review of the evidence

The growing prevalence of workplace drug testing and the narrow scope of previous reviews of the evidence base necessitate a comprehensive review of research concerning the efficacy of drug testing as a workplace strategy. A systematic qualitative review of relevant research published between January 1990 and January 2013 was undertaken. Inclusion criteria were studies that evaluated the effectiveness of drug testing in deterring employee drug use or reducing workplace accident or injury rates. Methodological adequacy was assessed using a published assessment tool specifically designed to assess the quality of intervention studies. A total of 23 studies were reviewed and assessed, six of which reported on the effectiveness of testing in reducing employee drug use and 17 which reported on occupational accident or injury rates. No studies involved randomised control trials. Only one study was assessed as demonstrating strong methodological rigour. That study found random alcohol testing reduced fatal accidents in the transport industry. The majority of studies reviewed contained methodological weaknesses including; inappropriate study design, limited sample representativeness, the use of ecological data to evaluate individual behaviour change and failure to adequately control for potentially confounding variables. This latter finding is consistent with previous reviews and indicates the evidence base for the effectiveness of testing in improving workplace safety is at best tenuous. Better dissemination of the current evidence in relation to workplace drug testing is required to support evidence-informed policy and practice. There is also a pressing need for more methodologically rigorous research to evaluate the efficacy and utility of drug testing.

Substance abuse prevention in the workplace: Recent findings and an expanded conceptual model

The majority of heavy drinkers and users of illicit drugs are employed adults, yet there is a dearth of sophisticated substance abuse prevention efforts in the workplace. This article reviews the approaches to worksite-based substance abuse prevention and presents the results of a field test of a prevention program aimed at the individual worker. Based on these findings and other theoretical perspectives from the literature, an expanded conceptual model for workplace substance abuse prevention is presented.

Drug violations and aviation accidents: findings from the US mandatory drug testing programs

AIMS

To assess the role of drug violations in aviation accidents.

DESIGN

Case-control analysis.

SETTING

Commercial aviation in the United States.

PARTICIPANTS

Aviation employees who were tested for drugs during 1995-2005 under the post-accident testing program (cases, n = 4977) or under the random testing program (controls, n = 1 129 922).

MEASUREMENTS

Point prevalence of drug violations, odds ratio of accident involvement and attributable risk in the population. A drug violation was defined as a confirmed positive test for marijuana (≥50 ng/ml), cocaine (≥300 ng/ml), amphetamines (≥1000 ng/ml), opiates (≥2000 ng/ml) or phencyclidine (≥25 ng/ml).

FINDINGS

The prevalence of drug violations was 0.64% [95% confidence interval (CI): 0.62-0.65%] in random drug tests and 1.82% (95% CI: 1.47-2.24%) in post-accident tests. The odds of accident involvement for employees who tested positive for drugs was almost three times the odds for those who tested negative (odds ratio 2.90, 95% CI: 2.35-3.57), with an estimated attributable risk of 1.2%. Marijuana accounted for 67.3% of the illicit drugs detected. The proportion of illicit drugs represented by amphetamines increased progressively during the study period, from 3.4% in 1995 to 10.3% in 2005 (P < 0.0001).

CONCLUSIONS

Use of illicit drugs by aviation employees is associated with a significantly increased risk of accident involvement. Due to the very low prevalence, drug violations contribute to only a small fraction of aviation accidents.

Use of alcohol and drugs by Norwegian employees: a pilot study using questionnaires and analysis of oral fluid

Background

The use of alcohol and drugs may affect workplace safety and productivity. Little is known about the magnitude of this problem in Norway.

Methods

Employee recruitment methods with or without individual follow-up were compared. The employees filled in a questionnaire and provided a sample of oral fluid. Samples were analysed for alcohol, ethyl glucuronide (EtG; a biological marker of recent large alcohol intake), psychoactive medicinal drugs and illegal drugs.

Results

Participation rates with and without individual follow-up were 96% and 68%, respectively. Alcohol was negative (≤0.1 mg/ml) in all samples, but 21.0% reported the intake of alcohol during the last 24 h. EtG was positive (>2.2 ng/ml) in 2.1% of the samples. In-efficiency or hangover at work during the past year was reported by 24.3%, while 6.2% had been absent from work due to the use of alcohol. The combination of self-report and analytical testing indicated that medicinal or illegal drugs had been used during the last 48 h by 5.1% and 1.7% of the participants, respectively; while only 4.2% and 0.4% admitted the use in the questionnaire.

Conclusions

Self-reported data suggest that hangover after drinking alcohol appears to be the largest substance abuse problem at Norwegian workplaces, resulting in absence and inefficiency at work. Analysis of oral fluid revealed that the use of illegal drugs was more common than drinking alcohol before working or at the workplace. The analysis of oral fluid may be a valuable tool in obtaining additional information on alcohol and drug use compared to using questionnaires alone.

Testing for cannabis in the work-place: a review of the evidence

BACKGROUND

Urinalysis testing in the work-place has been adopted widely by employers in the United States to deter employee drug use and promote 'drug-free' work-places. In other countries, such as Canada, testing is focused more narrowly on identifying employees whose drug use puts the safety of others at risk.

AIMS

We review 20 years of published literature on questions relevant to the objectives of work-place drug testing (WPDT), with a special emphasis on cannabis, the most commonly detected drug.

RESULTS

We conclude (i) that the acute effects of smoking cannabis impair performance for a period of about 4 hours; (ii) long-term heavy use of cannabis can impair cognitive ability, but it is not clear that heavy cannabis users represent a meaningful job safety risk unless using before work or on the job; (iii) urine tests have poor validity and low sensitivity to detect employees who represent a safety risk; (iv) drug testing is related to reductions in the prevalence of cannabis positive tests among employees, but this might not translate into fewer cannabis users; and (v) urinalysis has not been shown to have a meaningful impact on job injury/accident rates.

CONCLUSIONS

Urinalysis testing is not recommended as a diagnostic tool to identify employees who represent a job safety risk from cannabis use. Blood testing for active tetrahydrocannabinol (THC) can be considered by employers who wish to identify employees whose performance may be impaired by their cannabis use.

Work-place alcohol and other drug testing: a review of the scientific evidence

In this paper, scientific evidence for alcohol and other drug testing programs is compared to determine whether each approach is justifiable for improving work-place safety. Three types of studies are reviewed: laboratory, epidemiological and evaluation studies. Laboratory studies show that alcohol use decreases psycho-motor performance; however, for other drugs, some drugs deteriorate performance while others have little effect. Epidemiological studies in the work-place have not provided conclusive evidence that a strong causal link exists between either alcohol or other drug use and work-place injuries/accidents. Evaluation studies have not shown that either drug or alcohol testing significantly reduces work injuries/accidents. Other types of scientific evidence provide some justification of alcohol testing, but not for other drug testing. Alcohol use is much more common than other drug use in industrialized countries, suggesting that alcohol may be more related to industrial accidents than other drugs. As well, epidemiological studies suggest that alcohol is a major factor for traffic collisions, but research is inconclusive for other drugs. Finally, alcohol testing is more justifiable than drug testing because the results of alcohol tests closely correlate with psycho-motor performance while drug tests do not.

The physician-owned occupational health department

This article provides a process to evaluate the likelihood of establishing a financially viable occupational medicine program (OMP), and discusses opportunities in which the occupational medicine clinic can partner with employers to help them to reduce the occurrence of work-related injuries and provide a safer work environment. Not all germane topics are discussed-employers must address safety and ergonomic issues within the workplace as well as those that a successful OMP is designed to address. However, the OMP should be a readily available resource for any of these issues. Common occupational challenges and opportunities also are examined.

Cannabis, motivation, and life satisfaction in an internet sample

Although little evidence supports cannabis-induced amotivational syndrome, sources continue to assert that the drug saps motivation 1, which may guide current prohibitions. Few studies report low motivation in chronic users; another reveals that they have higher subjective wellbeing. To assess differences in motivation and subjective wellbeing, we used a large sample (N = 487) and strict definitions of cannabis use (7 days/week) and abstinence (never). Standard statistical techniques showed no differences. Robust statistical methods controlling for heteroscedasticity, non-normality and extreme values found no differences in motivation but a small difference in subjective wellbeing. Medical users of cannabis reporting health problems tended to account for a significant portion of subjective wellbeing differences, suggesting that illness decreased wellbeing. All p-values were above p = .05. Thus, daily use of cannabis does not impair motivation. Its impact on subjective wellbeing is small and may actually reflect lower wellbeing due to medical symptoms rather than actual consumption of the plant.

A community based investigation of the association between cannabis use, injuries and accidents

There are well documented acute and chronic effects of cannabis use. However, less is known about any effects on safety within the context of work and everyday life. The aim of the study was to examine any association between cannabis use and injuries and accidents. A postal questionnaire survey was conducted among people selected at random from the electoral registers of Cardiff and Merthyr Tydfil. Cannabis use was associated with both minor injuries and accidents, particularly among those with high levels of other associated risk factors. Cannabis use was associated with a significant detrimental impact on safety. It is possible that this is linked to an amplification of other risk factors associated with accidents and injuries. This has potentially wide reaching implications particularly in the context of other work and lifestyle characteristics.

Adolescent substance abuse: a simplified approach to drug testing

Treatment of adolescent substance abusers is difficult. Treatment programs at multiple levels, from inpatient facilities to outpatient support groups, usually are available. Some of the most encouraging results have come from programs that involve family therapy in addition to individual treatment. 22 Knowing what resources are available, as well as the referral processes based on a particular patient's healthcare plans, facilitates access and makes dealing with these issues in a busy outpatient setting much easier. Frequent follow-up with an adolescent after a treatment program has been initiated to monitor for compliance and relapse can ensure a better drug-free outcome. Knowing the extent of the adolescent drug abuse problem should encourage providers to incorporate some type of screening into their routine care of adolescents. None of these methods is 100% sensitive, and incorporating each component into the process where appropriate likely is the best approach. Knowing risk and protective factors for drug use is helpful for both recognition of candidates for screening and counseling of parents regarding drug use prevention.

Drug abuse among workers in Brazilian regions

OBJECTIVE: Many business organizations in Brazil have adopted drug testing programs in the workplace since 1992. Rehabilitation, rather than layoff and disciplinary measures, has been offered as part of the Brazilian employee assistance programs. The purpose study is to profile drug abuse among company workers of different Brazilian geographical regions. METHODS: Urine samples of 12,700 workers from five geographical regions were tested for the most common illicit drugs of abuse in the country: marijuana, cocaine, and amphetamine. Enzyme multiplied immunoassay technique (EMIT) and gas chromatography coupled with mass spectrometry (GC/MS) were the techniques utilized for urine testing. The distribution of collected urine samples according to geographical regions was: 72.0% southeast, 13.8% northeast, 7.9% south, 5.7% central west and 0.6% north. RESULTS: Of all samples analyzed, 1.8% was found to be positive for drugs: 0.5% from the south region, 1.1% from northeast, 1.2% from central west, 1.3% from north, and 2.2% from southeast. Of these, 59.9% was marijuana, 17.7% cocaine, 14.6% amphetamine, and 7.7% associated drugs. CONCLUSIONS: The distribution of drugs found in the samples shows a regional variation. Marijuana, however, was found in all regions. Cocaine was seen only in central west and southeast regions. Amphetamine was found in northeast, central west, and southeast regions.

Pre-employment urine drug testing of hospital employees: future questions and review of current literature

BACKGROUND

Patient safety and optimisation of worker performance are high current priorities. Arguments over employee drug testing have been debated over the past two decades.

AIMS

To review prior information to reveal how current principles and practices regarding pre-employment drug testing of health care workers evolved, and to explore pressing current and future issues.

METHODS

A literature search of Medline from 1980 to 1999 was performed. This yielded seven citations that reported results of pre-employment drug testing of health care workers, which we critically reviewed.

RESULTS

The process by which a rational testing process was developed for pre-employment urine drug screening in the health care field is illustrated. Also depicted are some important principles, inequities, and shortcomings of the system. The range of positive tests was wide, from 0.25% to 12%. Testing was not always applied uniformly to all health care workers. It became apparent that positive tests also require medical review to determine if they were truly due to illicit substance use.

CONCLUSIONS

Although pre-employment drug testing programmes in the health care industry have been firmly in place for many years, it is unclear whether such strategies have achieved their stated purposes. The next step is to study whether such programmes are effective at accomplishing specific goals, such as decreasing absenteeism, turnover, accidents, and medical errors, in order to justify continuing pre-employment testing versus changing to an alternative testing strategy.

To test or not to test: do workplace drug testing programs discourage employee drug use?

Workplace drug testing programs are often met with intense criticism. Despite resistance among labor and consumer groups and a lack of rigorous empirical evidence regarding effectiveness, drug testing programs have remained popular with employers throughout the 1990s and into the current century. The present study analyzed nationally representative data on over 15,000 US households to determine whether various types of workplace drug testing programs influenced the probability of drug use by workers. The study estimated several empirical specifications using both univariate and bivariate probit techniques. The specification tests favored the bivariate probit model over the univariate probit model. Estimated marginal effects of drug testing on any drug use were negative, significant, and relatively large, indicating that drug testing programs are achieving one of the desired effects. The results were similar when any drug use was replaced with chronic drug use in the models. These results have important policy implications regarding the effectiveness and economic viability of workplace anti-drug programs.

Do drug-free workplace programs prevent occupational injuries? Evidence from Washington State

OBJECTIVE

To evaluate the effect of a publicly sponsored drug-free workplace program on reducing the risk of occupational injuries.

DATA SOURCES

Workers' compensation claims data from the Washington State Department of Labor and Industries covering the period 1994 through 2000 and work-hours data reported by employers served as the data sources for the analysis.

STUDY DESIGN

We used a pre-post design with a nonequivalent comparison group to assess the impact of the intervention on injury risk, measured in terms of differences in injury incidence rates. Two hundred and sixty-one companies that enrolled in the drug-free workplace program during the latter half of 1996 were compared with approximately 20,500 nonintervention companies. We tested autoregressive, integrated moving-average (ARIMA) models to assess the robustness of our findings.

PRINCIPAL FINDINGS

The drug-free workplace intervention was associated (p < .05) with a statistically significant decrease in injury rates for three industry groups: construction, manufacturing, and services. It was associated (p < .05) with a reduction in the incidence rate of more serious injuries involving four or more days of lost work time for two industry groups: construction and services. The ARIMA analysis supported

CONCLUSIONS

The drug-free workplace program we studied was associated with a selective, industry-specific preventive effect. The strongest evidence of an intervention effect was for the construction industry. Estimated net cost savings for this industry were positive though small in magnitude.

Antecedents of Counterproductive Behavior at Work: A General Perspective

Counterproductive work behaviors have predominantly been investigated at relatively narrow levels, with the focus limited to subsets of the behavioral domain as well as to specific explanatory approaches. This study took a broader perspective with respect to both dependent and independent variables. A sample of German employees from 2 organizations reported on their levels of general counterproductive behavior (GCB). In predicting GCB, M. R. Gottfredson and T. Hirschi's (1990) theory of self-control as a general explanation for deviant acts was tested and compared with several alternative approaches. Results from simple and moderated hierarchical multiple regression analyses involving 24 predictors of GCB strongly support hypotheses derived from self-control theory. Little support is found for any effects on individual differences in GCB beyond the direct and conditional impact of internal control.

Relationships between urinalysis testing for substance use, medical expenditures, and the occurrence of injuries at a large manufacturing firm

Drug use among employees continues to be a serious concern for American employers. Over 80% of the large employers in the United States use some form of testing to detect drug use, but this practice is controversial and the cost-effectiveness of drug testing remains largely unknown. This study begins an empirical investigation of the consequences of drug testing by estimating its impact on medical care expenditures and injury rates at a large manufacturing firm in 1996-1999. Multiple regression analyses of a pooled cross-sectional time-series data set were used to separate the impact of drug testing from other factors and to help find the optimal level of testing that was associated with minimum medical expenditures. Results indicated that medical expenditures would be minimized when 42% of the employees in a calendar quarter were drug tested. This implies that, on average, employees should be tested 1.68 times a year. The results also indicated that doubling the testing rate would reduce the odds of incurring any injuries on the job by over half, but the injury rate was already so low that this impact was very small. Hopefully the results of this study will inform the policy debate over drug testing by focusing on real data, as opposed to supposition or political considerations that seem to dominate many discussions.

Drug testing, drug treatment, and marijuana use: a fairness perspective

The authors conducted a random statewide telephone survey of 1,484 individuals to study the relationship between marijuana use (in terms of participants' history of marijuana use) and reactions to drug testing and to study 2 hypothetical drug-treatment policies. Job safety sensitivity was related to perceived fairness of drug testing for the participant's job, and more recent marijuana use was associated with more negative reactions. Safety sensitivity was related to perceived fairness of drug treatment. Organizations with voluntary treatment were more attractive than ones with monitored treatment. Marijuana use interacted with drug treatment policy type in predicting reactions to drug treatment. Results suggest that organizations should consider job and employee characteristics when developing a drug treatment policy.

Substance use in the construction industry: a comparison of assessment methods

Most users of illicit drugs are employed adults, with substance use rates especially high in the construction industry. In an effort to shed light on the nature and extent of drug use among construction industry workers, and to compare drug use assessment methods, substance use among construction workers, 60% of whom were apprentices, across six sites was assessed by questionnaire, urinalysis, and hair analysis. Nearly 17% of the participants reported current drug use, although drug use differed dramatically by site. Drug use rates also differed by respondent characteristics, participation rates, and assessment method. The strengths and weaknesses of each assessment method are discussed, along with the rationale for combining methods.

Prospective relationships between drug problems and work adjustment in a community sample of adults

The prospective relationships between drug problems and work adjustment (e.g., job instability, job satisfaction) were examined in a community sample of 470 adults. Polydrug problems (alcohol, marijuana, and cocaine problem drug use) were both predictors and consequences of work adjustment. In partial support of the impaired functioning theory, polydrug problems predicted reduced job satisfaction 4 years later. Supporting the work-related strain theory, early job instability predicted polydrug problems 4 years later. In support of the theory of general deviance, low social conformity predicted later job instability. Finally, supporting social support theory, early support for drug problems reduced polydrug problems and increased job satisfaction 4 years later.

Methodological issues in workplace substance abuse prevention research

Substance abuse among working adults represents billions of dollars in preventable health care costs and industry financial loss. Therefore, it is imperative to develop and test effective substance abuse prevention programs for the workplace. However, applied workplace substance abuse prevention research is fraught with numerous methodological challenges. This article highlights a number of these challenges, which include (1) reaching a broad audience with prevention messages, (2) handling the concerns of the employer, (3) collecting substance use data in the workplace, (4) accessing and using records-based data, and (5) linking survey and records-based data. Using examples from the authors' ongoing research assessing a workplace health promotion and substance abuse prevention program, funded by the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention, the authors address these challenges.

Hair analysis for drugs of abuse. Hair color and race differentials or systematic differences in drug preferences?

There is currently a debate in the literature on chemical drug analysis concerning the contribution of biophysical attributes associated with specimens and specimen donors to assay outcome. In recent years this debate has focused on hair analysis, but has in the past also been raised in urinalysis interpretation. In this article we examine several aspects of that controversy. First, we present data regarding the effects of hair color on the distribution of positive hair testing results for three drug classes. We compare these results to negative hair samples from comparable donors. This data is derived from head hair from preemployment donors that was classified according to seven visual color categories. We determined the distribution of colors for hair samples devoid of any of three assayed drugs (amphetamines, cocaine, and cannabinoids). Subsequently, this distribution was compared with the distributions for hairs that had tested positive for amphetamines, cocaine or cannabinoids. We examined a total of 2000 randomly selected samples; 500 negative hair samples and 500 positive samples for each of three drugs: cannabinoids, cocaine, and amphetamine. We also evaluated ethnic/racial factors in relation to positive urinalyses for various ethnic/racial groups. We examined approximately 4000 urine specimens from two different groups, each constituting around 2000 specimens. In addition to ethnicity/race and urinalysis outcome, we also examined the relationship between the hair color distributions of urine donors and the corresponding urinalysis results for the three drug classes. We also compared them to drug-negative samples. Our summary impression is that the observed outcome patterns were largely consistent with differences in drug preferences among the various societal groups. There was little evidence of a pattern attributable to hair color bias alone or selective binding of drugs to hair of a particular color. Likewise, there was no discernible pattern associated with race or ethnicity that would lend support to a "race effect" in drug analysis.

Drug Use, Workplace Accidents and Employee Turnover

A number of studies presume that illicit drug use and heavy alcohol use increase the risk of work-related accidents and employee turnover. The results of these studies are inconsistent, however, with several reporting a significant association between employee drug use and accidents, and others finding no association. A more consistent result is that drug use is associated with employee turnover, especially an increased risk of termination and resignation. A significant limitation is that most of this research has relied on regional or industry-specific samples. Thus, whether their results generalize to the U.S. workforce is unknown. Using data from a large, representative sample of the U.S. population, we provide a detailed analysis of the relationships among drug use, work-related accidents, and employee turnover. The results indicate that various measures of drug use are not associated with work-related accidents. However, several types of drug use are related to the risk of being fired or resigning from a job in the previous year. Moreover, the risk of being fired varies by occupation.

Marijuana and Job Performance: Comparing the Major Streams of Research

Though some estimate that marijuana use has cost U.S. companies billions of dollars in lost productivity, the relationship between use of marijuana and job performance is far from clear. In this paper, I review studies on this topic from four different methodological perspectives and discuss models to account for their apparently contradictory findings. This discussion suggests hypotheses for future research addressing possible reasons for inconsistencies in past findings.

Illicit Drug Use and Labor Market Outcomes: A Review of Economic Theory and its Empirical Implications

In this paper, I outline the economic theory pertinent to the analysis of the effect of drug use on labor market outcomes. I argue that the complex behavioral links that underlie the relationship between drug use and labor market outcomes make it necessary to explicitly model the process that determines both of these outcomes. Only then can effective empirical strategies be developed that will yield credible estimates of the causal effect of drug use on labor market outcomes. Economic theory is well suited to this task since at its core it is a behavioral model of individual choice. I also discuss some methodological strategies that can be used to address the empirical problems associated with estimating such a structural model.

Comparison of lifestyle and substance use factors related to accidental injuries at work, home and recreational events

The purpose of this study was to examine whether risk factors vary for injuries that occur at work, at home, at recreational events and at multiple settings. Three major types of factors were investigated: lifestyle factors such as sleep, stress and exercise; substance use; and demographic characteristics. Data were obtained from a household survey of 882 Ontario adults. In order to determine whether different factors were related to different kinds of accidental injuries, chi 2 tests were conducted among five injury groups: no injuries; work; home; recreational; and multiple injury episodes (i.e. at least two separate injury episodes in two different settings). The first set of comparisons were conducted between those with zero injuries and each of the aforementioned four injury groups. Those with multiple injury episodes were significantly more likely than those with no injuries to be single, under the age of 30, and have lifestyle problems (i.e. sleep problems, financial problems and a desire for counselling) and substance use/problems (i.e. cigarettes, alcohol, licit and illicit drugs). For comparisons between each of the work, home and recreational injury groups and no injury group, eight factors were significant altogether, but no single factor was significantly related to more than one injury group. Contrasts between all combinations of injury group pairs (i.e. excluding the no injury group) indicated that risk factors for those with multiple injury episodes differed significantly from those with home and recreational injuries for several characteristics. This exploratory study provides some support that risk factors may vary, depending on the injury group.

A structured instrument for estimating the economic cost of drug abuse treatment. The Drug Abuse Treatment Cost Analysis Program (DATCAP)

Drug abuse treatment programs need to know the cost of the services they provide. Indeed, continued public and private funding is now being linked to cost and performance measures, and programs can use financial data to improve organizational efficiency. However, one of the dangers of promoting cost studies at treatment programs is that most program staff are not technically prepared to perform a cost analysis and little user-friendly information is available to offer assistance. Furthermore, not all cost methods are consistent, which can lead to noncomparable estimates that are difficult to use for policy or planning purposes. Our paper tries to fill this gap in the research literature and provide treatment programs with a much-needed technical assistance tool. Specifically, we present a structured and scientifically-based instrument for estimating the economic cost of treatment services. The Drug Abuse Treatment Cost Analysis Program (DATCAP) is described in detail along with a companion instrument to analyze treatment financing; the Drug Abuse Treatment Financing Analysis Program (DATFin). The components of both instruments are outlined and findings from a variety of actual case studies are presented. Lastly, we discuss the DATCAP User's Manual, which will enable individual programs to begin collecting the necessary data and estimating economic costs at their own clinics.

The Role of Drugs in Workplace Injuries: Is Drug Testing Appropriate?

In the past decade, many employers have adopted drug-testing programs to reduce workplace injuries. However, little scientific evidence shows that drug use is a significant and substantial cause of total workplace injuries. The purpose of this study was to empirically assess the role of drugs and alcohol in causing workplace injuries. Questionnaires were received from 882 Ontario employees in a household survey. Results showed that many variables were significantly related to job injuries. The variables were ranked according to the relative importance of each variable's contribution to total job injuries. Alcohol problems, licit drug use, and illicit drug use ranked 7, 11, and 12 respectively among a group of 12 significant variables. In order to examine the likelihood that drug use was a cause of job injuries, the relationship between job injuries and alcohol problems, licit drug use, and illicit drug use was examined across categories of third variables. For age, the relationship between drug use and injuries remained strong for the youngest age group, but disappeared for the oldest age group. Logistic regression analysis confirmed the plausibility of noncausal explanations of job injuries for illicit drug use, but not for alcohol problems or licit drug use. Overall, the results indicated that illicit drug use does not appear to be a major cause of job injuries. The implications of these results for drug-testing programs are discussed.

Impairment Testing: Issues and Convergence with Employee Assistance Programs

Drug testing is an increasingly popular corporate response to substance using employees. It has, however, some significant shortcomings as a means of identifying and controlling substance use. In this article, the authors describe and discuss drug-testing policies and procedures, and conclude that drug testing became popular in the 1980s largely as a workplace response to broader cultural and governmental concerns, rather than actual increase in the prevalence of substance use. Issues related to the implementation of performance testing as an alternative to drug testing are discussed. Finally, the authors consider the areas of distinction and convergence between drug and performance testing and employee assistance programs.

Prediction of Substance Use in the Workplace: Unique Contributions of Personal Background and Work Environment Variables

Relationships of personal and job factors with employee substance use in a sample of municipal workers were assessed. Logistic regression results showed that personal and job domains each significantly predicted substance use at and away from work, although the best fit was provided by a model including both domains. The profile of the employee most likely to be a substance abuser was a young male with low self-esteem and an arrest history, who came from a family with substance abuse problems, and associated with substance-using peers. The drug-using employee was also likely to be estranged from work and to work under risky job conditions.

Methods for assessing drug use prevalence in the workplace: a comparison of self-report, urinalysis, and hair analysis

A random sample of 1,200 employees of a steel manufacturing plant were randomly assigned to four different self-report methods of assessing illicit drug use: 1) Individual interview in the workplace, 2) group-administered questionnaire in the workplace, 3) telephone interview, and 4) individual interview off the worksite. Urine specimens were collected and analyzed on all 928 subjects participating in the study, and hair analysis was conducted on 307 of the subjects. Although self-reports produced the highest drug use prevalence rate, analyses combining the results of the three assessment methods showed that the actual prevalence rate was approximately 50% higher than the estimate produced by self-reports. The group-administered questionnaire condition produced prevalence rates that were roughly half those of the other self-report methods. The findings cast doubt on the validity of self-reports as a means of estimating drug use prevalence and suggest the need for multiple assessment methods.