Medicines and drug testing in the workplace

Drug testing at work is rapidly becoming the standard in the United States. For drug testing to fulfill its promise as a vital part of the effort to end the drug abuse epidemic, it is essential that the tests be reliable so that people who are not using drugs are not falsely accused and that legitimate medical use of controlled substances not expose employees to harassment or labeling as drug abusers. To merit employee confidence, workplace drug testing needs to be made part of a program that includes these basic elements: (1) a clear and comprehensive policy; (2) secure collection; (3) chain-of-custody procedures; (4) retained positive samples; (5) an initial screening test; (6) a sophisticated confirmatory test; (7) a medical review officer; (8) a retest of retained positive samples in disputed cases; and (9) a system of quality control. In addition, this drug testing program needs to be built on a solid foundation that distinguishes between legitimate use of prescribed medicines and nonmedical drug use. This differentiation is the primary responsibility of the medical review officer.     

Alternative specimens for workplace drug testing

Recent advances in analytical techniques have enabled the detection of drugs and drug metabolites in alternative biological specimens for the purposes of workplace testing. A wide variety of specimens are available, each providing valuable information concerning prior or current drug use. The present focus is on oral fluid (saliva), hair, and sweat. An extensive evaluation by the Division of Workplace Programs of the Department of Health and Human Services is underway to determine the utility of these specimens in federally regulated programs. In future years, the testing of alternative specimens will expand our ability to understand the patterns of drug use and will become routine in all areas of forensic toxicology.     

European guidelines for workplace drug testing in urine

These European Guidelines for Workplace Drug Testing in Urine have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). The first version of these urine guidelines was published in 2002. Since then, the guidelines have been followed by many laboratories in different European countries and their role has been essential particularly in countries lacking legislation for workplace drug testing. In 2014, the EWDTS started a guidelines updating project and published a new version of the urine guidelines in 2015. Here we represent this updated version of the urine guidelines. The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing should use these guidelines as a template for accreditation. Copyright © 2017 John Wiley & Sons, Ltd.     

A snapshot of workplace drug testing in Italy

The Italian Decree on Health and Safety at Work (81/08) prescribes mandatory drug tests for jobs which pose safety hazards to others. Workplace drug testing is performed in accordance with the Provision of the Government-Regions Conference, 2008. The aim of our survey was to examine the prevalence of drug use and the main drug findings in a sample of Italian workers performing hazardous jobs. From September 2009 to February 2011, 551 urine samples were collected in 42 Italian companies. Sample collection was carried out at the workplace by qualified laboratory personnel sent from the Institute of Occupational Medicine of the Catholic University (UCSC) of Rome. The workers to be tested were informed the day before, as the law requires. The samples were checked for adulteration, coded, and sent immediately to the laboratory of the UCSC Forensic Toxicology Analytical Unit. The screening test was an immunoassay. The positive samples proceeded to the confirmatory analysis with liquid chromatography-tandem mass spectrometry (LC-MS/MS). The urine samples were analyzed for cannabis, opiates, amphetamines, methamphetamines, cocaine, methadone, and MDMA. Out of 16 samples .9% screened positive; only 4 of them (0.7%) were confirmed with the LC-MS/MS. Confirmed results included cocaine (2 samples), cannabis (1 sample), both cocaine and cannabis (1 sample). The prevalence of positive samples was lower than expected. Such finding cannot be explained by a low reliability of the testing procedure but could be due to test scheduling. More positive cases might be found performing short-notice random testing.     

Regulatory aspects of workplace drug testing in Europe

Workplace drug testing in Europe is governed by a patchwork of legislation--or lack of it. Other difficulties are caused by language, currency and a host of other factors, including the difficulty in defining 'safety critical'. The European Workplace Drug Testing Society's (EWDTS) history and objectives are briefly outlined. Some of the problems peculiar to testing in Europe are discussed. Finally, some of the legislation in the different countries is described.     

The medical review officer and workplace drug testing

Rational drug-testing programs attempt to balance the need for accuracy of the process with the need to preserve the rights and dignity of the people being tested. U.S. Department of Transportation regulations prescribe the specifics of how urine specimens are to be collected, how to inform the specimen donor of the process to which he or she will be subjected, and certification of laboratories by the National Institute of Drug Abuse. These guidelines are an effort to assure that each collection site and each laboratory testing the urine of employees adheres to certain basic standards of quality control.     

European guidelines for workplace drug and alcohol testing in hair

Guidelines for Legally Defensible Workplace Drug Testing have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). They are based on the 2010 version published by Pascal Kintz and Ronald Agius (Guidelines for European workplace drug and alcohol testing in hair. Drug Test. Anal. 2010 , 2, 367) and in concordance with the Society of Hair Testing guidelines (Society of Hair Testing guidelines for drug testing in hair. Forensic Sci. Int. 2012 , 218, 20‐24). The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing use these guidelines as a template for accreditation. Copyright © 2016 John Wiley & Sons, Ltd.     

Guidelines for European workplace drug and alcohol testing in hair

Drug and alcohol abuse is a concern for many European companies, especially those having safety‐critical jobs. It is not uncommon for European companies to establish a drug policy with little or no provision for drug testing. The European Union (EU) has launched a number of initiatives in its fight against drugs. There is, however, no specific EU legislation and no generally accepted guidelines. Since the outcome of workplace drug testing (WDT) can have serious consequences for the employee, it is of utmost importance that WDT be performed in a defined quality standard and in a legally secured way. In order to fulfil this, the European Workplace Drug Testing Society (EWDTS) has formulated WDT guidelines in order to ensure that the entire drug testing process is of high quality, accredited, and legally defensible, hence giving accurate and reliable information about employee drug use while respecting the privacy of the employee. The aim of this paper is to present the recently formulated guidelines for workplace drug testing in hair. Copyright © 2010 John Wiley & Sons, Ltd.     

Guidelines for European workplace drug testing in oral fluid

Over the past decade, oral fluid has established itself as a robust testing matrix for monitoring drug use or misuse. Commercially available collection devices provide opportunities to collect and test oral fluid by the roadside and near-patient testing with both clinical and criminal justice applications. One of the main advantages of oral fluid relates to the collection of the matrix which is non-invasive, simple, and can be carried out under direct observation making it ideal for workplace drug testing. Laboratories offering legally defensible oral fluid workplace drug testing must adhere to national and international quality standards (ISO/IEC 17025); however, these standards do not address issues specific to oral fluid testing. The European Workplace Drug Testing Society (EWDTS) recognizes the importance of providing best practice guidelines to organizations offering testing and those choosing to use oral fluid drug testing to test their employees. The aim of this paper is to present the EWDTS guidelines for oral fluid workplace drug testing.     

European guidelines for workplace drug testing in oral fluid

These guidelines for Legally Defensible Workplace Drug Testing have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing should use these guidelines as a template for accreditation. These guidelines are relevant to laboratory‐based testing only. These guidelines follow current best practices and are constantly under review.     

Oral fluid for workplace drug testing: laboratory implementation

As oral fluid increases in popularity for workplace testing, due to its easy and observed collection, the ability to adapt existing laboratory instrumentation without further capital investment will allow more facilities to test oral fluid. The European Workplace Drug Testing Society (EWDTS) guidelines for oral fluid testing outline the maximum cut-off concentrations acceptable under the workplace drug testing programme. The recommended cut-off values may be subject to change as advances in technology or other considerations warrant identification of these substances at different concentrations; however, the instrumentation currently exists for routine screening using immunoassay and confirmation by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography with tandem mass spectral detection (LC-MS/MS) so laboratories can easily implement oral fluid analysis in their current systems. Immunoassays for the detection of the drug classes at recommended levels have been developed using various collection devices and different formats: liquid reagent chemistries and enzyme-linked immunosorbent assay (ELISA) platforms. Immunoassays provide faster turnaround than mass spectral methods particularly when the number of specimens increases. Since the guidelines state that positive immunoassay results should not be reported without confirmation, fully validated methods using LC-MS/MS and/or GC-MS for all drugs are also widely available. All proposed concentrations are easily achievable using MS instruments currently in testing laboratories; however, the likelihood of a low number of positive specimens in workplace populations allows the test facility to screen specimens in a cost-effective manner using immunoassay, while ensuring scientific credibility and defensibility by confirming the positive results with a second test.     

Urine specimen validity test for drug abuse testing in workplace and court settings

In recent decades, urine drug testing in the workplace has become common in many countries in the world. There have been several studies concerning the use of the urine specimen validity test (SVT) for drug abuse testing administered in the workplace. However, very little data exists concerning the urine SVT on drug abuse tests from court specimens, including dilute, substituted, adulterated, and invalid tests. We investigated 21,696 submitted urine drug test samples for SVT from workplace and court settings in southern Taiwan over 5 years. All immunoassay screen-positive urine specimen drug tests were confirmed by gas chromatography/mass spectrometry. We found that the mean 5-year prevalence of tampering (dilute, substituted, or invalid tests) in urine specimens from the workplace and court settings were 1.09% and 3.81%, respectively. The mean 5-year percentage of dilute, substituted, and invalid urine specimens from the workplace were 89.2%, 6.8%, and 4.1%, respectively. The mean 5-year percentage of dilute, substituted, and invalid urine specimens from the court were 94.8%, 1.4%, and 3.8%, respectively. No adulterated cases were found among the workplace or court samples. The most common drug identified from the workplace specimens was amphetamine, followed by opiates. The most common drug identified from the court specimens was ketamine, followed by amphetamine. We suggest that all urine specimens taken for drug testing from both the workplace and court settings need to be tested for validity.     

Oral fluid and hair in workplace drug testing programs: new technology for immunoassays

Workplace drug testing programs have embraced both oral fluid and hair as testing matrices. Saliva is popular due to its easy, rapid collection; its non-invasiveness compared to urine or blood; the convenience of collecting a specimen anywhere, anytime; and the difficulty of adulteration. The main advantage of saliva, however, remains its suitability for post-accident or 'for-cause' testing since the presence of a parent drug can assist in the determination of an individual being 'under the influence' of a drug. Hair, on the other hand, is useful for workplace programs, since its ability to provide historical information on drug intake ensures it is an excellent specimen for pre-employment testing. Both technologies have enjoyed collection and laboratory improvements for immunoassay screening over the last few years, and these are discussed in this perspective.