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

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.

Concordance of self-reported drug use and saliva drug tests in a sample of emergency department patients

The purpose of this study was to assess the concordance of self-reports of cannabis, cocaine and amphetamines, and the utility of these, with a saliva point of collection drug test, the DrugWipe 5+, in an emergency department (ED) setting.

METHODS

A random sample of people admitted to either of two emergency departments at hospitals in British Columbia, Canada were asked to participate in an interview on their substance use and provide a saliva test for detection of drugs.

ANALYSES

Concordance of self-reports and drug tests were calculated. Prior DrugWipe 5+ sensitivity and specificity estimates were compared against a gold standard of mass spectrometry and chromatography (MS/GC). This was used as a basis to assess the truthfulness of self-reports for each drug.

RESULTS

Of the 1584 patients approached 1190 agreed to participate, a response rate of 75.1%. For cannabis, among those who acknowledged use only 21.1% had a positive test and 2.1% of those who reported no use had a positive test. For cocaine and amphetamines respectively, 50.0% and 57.1% tested positive among those reporting use, while 2.1% and 1.3%, respectively reported no use and tested positive. Self-reports of cannabis and amphetamines use appear more truthful than self-reports of cocaine use.

Relation of supervisor social control to employee substance use: considering the dimensionality of social control, temporal context of substance use, and substance legality

OBJECTIVE

Research on supervisor social control provided little evidence for a relation to employee alcohol use, and only one study explored illicit drug use. Based on past research, several hypotheses were developed that the relation between supervisor social control and substance use depends on (a) the dimension social control (contact vs. enforcement), (b) the temporal context of substance use (on the job vs. off the job), and (c) substance legality (alcohol vs. illicit drugs).

METHOD

Data came from a national probability sample of U.S. workers. Supervisor social control represented both supervisor contact and supervisor enforcement. Measures of alcohol and illicit drug use each assessed several dimensions of off-the-job use (overall use, overall impairment, and use after work) and on-the-job use (use before work, use during the workday, and impairment during the workday).

RESULTS

As hypothesized, the results did not support a relation of supervisor contact to off-the-job or on-the-job alcohol use and illicit drug use. Supervisor enforcement was unrelated to off-the-job alcohol use but was negatively related to on-the-job alcohol use. Supervisor enforcement was negatively related to both off-the-job and on-the-job illicit drug use.

CONCLUSIONS

These findings help clarify the generally unsupportive findings from past research for a relation between supervisor social control and employee alcohol use, as well as extend this line of research to include illicit drug use. The results suggest that to fully understand the relation of supervisor social control to employee substance use, one must consider the dimension of supervisor social control, temporal context of substance use, and substance legality.

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.

Physical and social availability of alcohol for young enlisted naval personnel in and around home port

BACKGROUND

Heavy alcohol consumption rates are higher in the young adult military enlisted population than among civilians of the same age. The literature on alcohol availability, both generally and specifically with respect to work-related drinking, establishes clear links between ease of access, alcohol consumption rates and alcohol-related problems.

METHODS

In this paper, a qualitative analysis of 50 semi-structured interviews with U.S. Navy personnel was combined with quantitative findings from a mail survey of 713 young enlisted men and women in order to shed light on alcohol availability and its correlates in the home port environments of young adult enlisted personnel. The interviews were analyzed by two anthropologists seeking recurring themes or topics related to alcohol availability. These qualitative data were contextualized by descriptive statistics of the survey responses regarding ease of obtaining alcohol on and around naval bases, and from friends in and out of the Navy.

RESULTS

Findings associated with social and physical availability of alcohol include low prices in Navy Exchange base stores, frequent barracks parties, drink promotions in bars surrounding bases, and multiple opportunities for underage drinking despite age limits on alcohol purchases and official efforts to deglamorize alcohol use in the Navy. Both qualitative and qualitative findings suggest that respondents found alcohol and opportunities to drink overwhelmingly available in both on-base and off-base settings, and from friends both in and out of the Navy.

CONCLUSION

There is qualitative and quantitative evidence for extensive physical and social availability of alcohol in and around bases for young adults in the military. Policy implications include raising the presently tax-free alcohol prices in base stores and enforcing existing policies regarding underage drinking, particularly the provision of alcohol by people of legal drinking age, and by bars in and around bases. Cooperative preventive efforts with surrounding communities also offer promising ways for bases to reduce alcohol availability for young adult servicemembers.

Variations of alcohol impairment in different types, causes and contexts of injuries: results of emergency room studies from 16 countries

OBJECTIVE

The purpose of this paper is to document alcohol impairment (based on a blood alcohol content (BAC) of at least 80 mg%) for different types, causes and location contexts of injuries.

DESIGN AND SETTING

Data from 45 studies with 11,536 injury patients were merged to determine variations in the percent of alcohol impairment among injury patients. In each study, emergency room (ER) injury patients were given a short interview on the circumstances of their injury and BAC was measured.

RESULTS

Injury severity, measured by number of body regions injured was significantly associated with BACs over 80 mg%. The highest percentage of injury type to involve alcohol was head injury/concussion. In terms of causes of injuries, patients with alcohol impairment were significantly more likely to be involved in violence than any other cause (i.e., vehicle, falling, poisoning or burns). Finally, injuries occurring at a bar or restaurant were significantly more likely to involve alcohol impairment than any other setting.

CONCLUSIONS

The results demonstrate considerable variation in the circumstances where alcohol is involved in injuries. These results may be useful for the development of prevention initiatives.

Prevalence and factors related to Canadian workplace health programs

BACKGROUND

This study documented the prevalence and factors related to workplace health programs in Canada, including Employee Assistance Programs (EAPs), drug testing programs, and Health Promotion Programs (HPPs).

METHODS

A representative sample of 565 Human Resources Managers at worksites with 100 or more employees across Canada completed a questionnaire on the worksite characteristics and the types of programs at their workplace (response rate = 79.8%).

RESULTS

EAPs were established in 67.8% of sampled worksites (95% CI: 63.9%-71.7%). The proportion of worksites with EAPs varied significantly across work sectors (p<0.001) but not across regions of Canada. Worksites with EAPs had significantly (p<0.001) fewer visible minorities and had more unionized employees (p<0.001) than worksites without EAPs. For drug-testing programs, about 10.3% of Canadian worksites have them (95% CI: 7.8%-12.8%). Significant differences were noted across regions (p<0.001) with Alberta most likely to have such programs (25.4%) and Ontario least likely (4.6%). Also, safety-sensitive worksites and those with United States ownership were significantly (p<0.05) more likely to have drug testing. The most common type of HPP was fitness programs (29.4%) and the least common was day/elder care programs (5.5%). Fitness programs were most common in the Eastern provinces and least common in Quebec.

CONCLUSIONS

Overall, Canadian worksites favour a health promotion and treatment approach over a deterrence approach for addressing health and substance use issues in the workplace. Workplace health programs were related to several factors that have created an uneven system of health promotion, treatment and deterrence in Canadian worksites.

Dangerous to your health: the role of chronic drug use in serious injuries and trauma

OBJECTIVES

This study estimated the differential risks of serious injury or trauma for a community-based sample of chronic drug users (CDUs; n = 926) and a matched group of nondrug users (NDUs; n = 553). The study also estimated whether CDUs and NDUs differed in their utilization of health care services for serious injury or trauma.

MATERIALS AND METHODS

Data were collected in 1996 and 1997 through community outreach activities in Miami-Dade County, Florida. The analysis estimated the effects of drug use on (1) any lifetime serious injury or trauma, (2) any serious injury or trauma during the past 12 months, and (3) utilization of health care services for serious injury or trauma. All analyses were gender specific and the models were also estimated with a measure of problematic alcohol use in addition to CDU. To examine the potential endogeneity of drug use, various specification tests were conducted.

RESULTS

For females, CDUs experienced significantly more serious injury, trauma, or both (both lifetime and past year) than nonusers. Drug use status was not a significant predictor of serious injury or trauma (lifetime and past year) for males. Regardless of gender, conditional on experiencing any serious injury or trauma during the past year, CDUs and NDUs did not differ in their utilization of health care services. Various statistical tests determined that CDU was exogenous in all specifications and the findings were largely unchanged when problematic alcohol use was included in the models.

CONCLUSIONS

The elevated risk for serious injury or trauma for female CDUs renders these persons vulnerable to severe medical problems. Specific training in substance abuse issues may be necessary if health care providers are to identify, engage, knowledgeably serve, and refer CDUs for appropriate services.

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.

Demographic and substance use factors related to violent and accidental injuries: results from an emergency room study

OBJECTIVE

The primary goal of this study was to identify demographic and substance use factors associated with violent injuries, accidental injuries, and medical conditions or illnesses (non-injured).

METHOD

Data were examined from a sample of 1701 admissions to emergency rooms at two Canadian hospitals. These patients were interviewed and provided urine samples to detect the presence of drug metabolites for alcohol, THC, benzodiazepines, barbiturates, morphine, and codeine.

RESULTS

Those with violent injuries were significantly (P<0.0001) more likely to be male and have lower incomes compared with both the accidental injury and non-injury groups. About 37% of violent injuries occurred at a bar or restaurant, which was significantly more than 3% for accidental injuries and 2% for non-injuries (P<0.00001). The violent injury group was significantly more likely than the other two groups to report feeling the effects of alcohol at the time of the injury and to report negative consequences of alcohol use (P<0.00001). Furthermore, about 42% of those with violent injuries had a blood alcohol level (BAL) over 80 mg% compared to only 4% with accidental injuries (P<0.00001) and 2% of non-injuries (P<0.00001). In terms of drug tests for other substances, the violent injury group was significantly more likely to test positive for benzodiazepines than the accidental injury group (P<0.01) while all between group comparisons for other drugs were not significant.