Historical Overview of Workplace Drug Testing Programs

Drug abuse is a widespread phenomenon is the US especially in the 1960s and has been problematic since then. In the early 1970s, the US government increased its efforts to address the problems related to drug abuse such as creating an office to coordinate with prevention education, rehabilitation, treatment, training and researched conducted in all the federal agencies. The oversight and coordination of the ‘War on Drugs’ is now being performed by the ONDCP – Office of National Drug Control Policy. In the year 1971, the government of US implemented a nationwide survey to find the primary source of statistical information on illegal drug use. Initially named as the NHSDA – National Household Survey on Drug Abuse, it was changed to the NSDUH – National Survey on Drug Use and Health in 2002. The data is collected via interviews and sample questionnaires in the population. This survey has documented that many illegal drug users are either full or part time employed.

In the 1960s and 1970s, the military recognized an increase in the use of heroin amongst its personnel which served in the Vietnam War and implemented a drug testing program on the returning troops. The military program was then expanded to personnel which were on active duties and thereby, enhanced to become the first large scale drug testing regime. The US Navy, Air Force and Army implemented programs for urine specimen testing, especially in the military laboratories which used various procedures and techniques. Many positive drug tests were used as medical cases and no punitive consequences were known. In May 1981, a Marine Corps jet had crashed abroad having the aircraft carrier Nimitz, which caused the death of fourteen crew members while injuring 48 other members. Many crew members which were tested positive for marijuana after the accident, thereby emphasizing that drug abuse is prevalent in the armed forces. Also, the Department of Defense (DoD) implemented a no tolerance policy which treated the positive drug tested as an offense that is punishable. After this, a dramatic drop was seen in the positive rates in the military drug testing programs. Currently, the six military drug test laboratories conducted DoD testing. The AFIP –Armed Forces Institute of Pathology operated the DoD Drug Testing Quality Assurance Laboratory which performs and checks the quality of the DoD Program via certification, inspection and proficiency testing of the drug testing laboratories.

The military’s efforts and their success eradicate drug abuse which is evident by the Department of Defense Surveys of Health Related behavior among active duty military personnel. These self report surveys, administered over the past 25 years to more than 160,000 active-duty military personnel across all military branches, show that illicit drug use among military personnel has decreased significantly and has remained low. The proven success of the military drug-testing program, along with advances in immunoassay techniques for high-throughput drug screening, facilitated the expansion of drug testing to workplaces in the United States.

The Federal Railroad Administration (FRA) issued regulations and implemented drug and alcohol testing of railroad employees in 1986. The FRA regulations were developed in response to recommendations of the National Transportation Safety Board (NTSB), made in 1983 after several transportation accidents involving drug or alcohol use. Many companies in safety sensitive industries (e.g., oil, chemical, transportation, and nuclear energy followed with their own workplace drug-testing programs.

As the use of workplace drug testing increased during the 1980s numerous lawsuits were filed, challenging the scientific validity of drug-testing results and asserting violations of employees’ rights. The need for drug-testing standards and oversight became more and more obvious. The US Government took action to address this issue in 1986 when noting the effects of drug abuse on workplace safety and productivity, President Reagan issued an Executive Order announcing the Federal Drug-Free Workplace Program. All federal agencies were required to develop a plan for achieving a drug-free workplace, including employee drug testing. HHS was given the authority to develop the scientific and technical guidelines to be used by the federal drug-testing programs. The subsequent Supplemental Appropriations Act of 1987 further directed HHS to establish comprehensive standards for all aspects of laboratory drug testing, including an accreditation program for laboratories performing drug testing for federal workplace programs.

In addition to the scientific and technical requirements and processes for the accreditation program, the HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs (first published in 1988 include specimen collection procedures, review, and reporting procedures for Medical Review Officers (MRO), and requirements for employee access to drug testing records and for maintaining confidentiality of drug-testing information. Many private-sector employers choose to have their specimens tested by HHS-accredited laboratories and specify that their specimens be tested using procedures that are compliant with the strict forensic and scientific standards established by HHS. Since the Mandatory Guidelines were implemented, one other accreditation program has been established for workplace drug-testing laboratories in the United States, as discussed below.

Drug testing has been commonplace among US workplaces for many years. In a 2004 survey of US companies (n = 503), 62.6% of respondents reported that they conducted workplace drug testing of new hires, current employees, or both. The 2006 NSDUH found that 42.9% of respondents who worked full time, equating to more than 47 million adults reported that their employer tests for illicit drug or alcohol use during the hiring process. A total of 29.6% of respondents who worked full time, equaling to more than 32 million adults, reported that their employer conducts random drug testing.

It may be difficult to quantify the effects of workplace drug-testing programs in terms of workplace productivity safety, and employee health. There are few papers on this subject in the peer-reviewed, scientific literature. A 1996 report on the Navy’s drug-testing program found the program at that time to be cost-effective, to deter drug abuse, and to detect drug users. Other studies have shown that drug testing can reduce workplace injuries and accidents, depending on the industry. Based on recent NSDUH findings, workplace drug testing serves as a deterrent to employment by illicit drug users. Current or long-term illicit drug users are less likely to report working for an employer with either pre employment or random drug testing. It is not possible to determine whether the observed deterrent effect is caused by illicit drug users ceasing to use drugs or by drug users choosing to work for employers that do not conduct drug testing.

One laboratory corporation, Quest Diagnostics, Inca publishes a yearly Drug Testing Index based on statistical analyses of its workplace drug test results, which may serve as an indicator of the effectiveness of drug free workplace programs. Results are categorized as “Federally mandated, safety sensitive workforce”, “general U.S. workforce,” and “Combined U.S. workforce”. Table 16-1 shows the decrease in drug-positive rates for these 3 categories.

Since 2002, the positive testing rate for all drugs in the ‘federally mandated safety-sensitive workforce’ has decreased from 2.5% to 1.8 %. The Quest Drug Testing Index data have shown an overall decrease in positive testing rates for all drugs since 1988, when the company began this project, although rates for some drugs {e.g., amphetamines, benzodiazepines, cocaine) have fluctuated slightly in some years.

Drug abuse continues to be a major problem in the United States. The 2006 NSDUH estimates that 74.9 % of current illicit drug users aged 18 or older, equating to 13.4 million adults, were employed either full- or part time.

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