Detecting

and

Assessing

Alcohol

and

Other

Drug

Use

The

response

of

many

employers

to

the

perceived

problem

of

alcohol

and

other

drug

use

has

been

to

establish

drugtesting

programs

either

voluntarily

or

in

compliance

with

federal

regulations

Drugtesting

programs

typically

have

two

main

purposes

to

determine

drug

use

among

a

firms

employees

or

prospective

employees

and

to

deter

such

use

for

reasons

of

safety

productivity

and

health

Given

the

preponderance

of

drugtesting

programs

among

the

drug

intervention

programs

of

US

corporations

a

substantial

portion

of

this

chapter

is

devoted

to

describing

what

these

programs

entail

committee

members

thought

it

was

critical

to

provide

the

reader

with

Chapter

Both

direct

and

indirect

methods

are

used

to

detect

alcohol

and

other

drug

use

among

the

work

force

Biochemical

analysis

and

selfreports

are

the

two

most

commonly

used

direct

methods

for

assessing

substance

use

Each

has

limitations

Biochemical

methods

primarily

urinalysis

usually

detect

only

recent

use

and

generally

can

not

measure

patterns

or

frequency

of

use

Although

hair

analysis

can

potentially

trace

longerterm

patterns

of

use

data

on

the

measurement

properties

of

this

analytical

technique

are

still

limited

Selfreport

methods

can

measure

patterns

and

frequency

of

alcohol

and

other

drug

use

but

are

limited

by

validity

problems

primarily

involving

the

To

avoid

the

limitations

of

the

direct

methods

the

use

of

indirect

methods

for

assessing

drug

use

and

identifying

drug

users

has

been

rapidly

growing

Indirect

approaches

typically

involve

measuring

or

observing

behaviors

or

responses

that

are

frequently

associated

with

alcohol

and

other

drug

use

and

inferring

use

from

what

is

observed

They

too

have

significant

limitations

but

they

can

complement

the

information

gleaned

from

biochemical

analysis

and

selfreports

This

chapter

first

provides

a

brief

historical

perspective

on

the

evolution

of

what

is

currently

the

most

common

biochemical

method

for

detecting

applicant

and

employee

alcohol

and

other

drug

use

in

corporate

America

It

then

reviews

the

main

procedural

components

of

forensic

drugtesting

programs

That

is

followed

by

a

description

of

the

most

widely

used

indirect

methods

for

assessing

alcohol

and

other

drug

use

personal

profiles

and

behavioral

indicators

The

chapter

ends

with

the

committees

conclusions

and

recommendations

Go

to

Evolution

Of

Biochemical

Drug

Testing

The

analysis

of

urine

specimens

and

other

body

fluids

to

determine

if

particular

individuals

have

used

various

drugs

is

not

new

Drug

testing

in

forensic

toxicology

and

some

clinical

hospital

laboratories

predates

President

Reagans

executive

order

of

September

by

at

least

years

Finkle

Hawks

and

Chiang

The

results

of

urine

testing

and

their

use

as

evidence

in

legal

contexts

has

been

tacitly

accepted

in

the

United

States

for

many

years

Largescale

drug

testing

was

originally

stimulated

by

the

Department

of

Defenses

DoD

need

to

monitor

its

armed

forces

during

the

Vietnam

War

era

and

by

the

Federal

Register

and

were

required

to

be

drug

free

and

monitored

to

confirm

that

they

were

not

taking

additional

drugs

In

late

the

testing

industry

further

expanded

as

the

Navy

following

a

series

of

incidents

that

highlighted

the

pervasive

use

of

marijuana

among

their

personnel

announced

a

policy

of

zero

tolerance

for

illicit

drugs

Cangianelli

Over

a

period

of

years

they

designed

and

implemented

a

testing

program

that

required

contracted

laboratories

to

analyze

more

than

million

urine

specimens

each

year

in

order

to

monitor

and

control

illegal

drug

use

in

the

Navy

By

the

time

the

naval

The

technical

logistical

and

laboratory

operations

requirements

to

support

these

massive

testing

programs

were

wholly

inadequate

in

the

beginning

They

rested

primarily

on

cumbersome

inefficient

and

nonspecific

techniques

such

as

thin

layer

chromatography

TLC

and

gas

chromatography

GC

Many

of

the

laboratories

doing

drug

testing

had

little

notion

of

what

constituted

legally

adequate

work

and

experienced

forensic

analytical

toxicologists

were

few

Performance

testing

surveys

revealed

serious

inaccuracies

in

some

laboratory

results

These

survey

reports

still

haunt

toxicologists

and

are

quoted

repeatedly

by

antagonists

to

todays

employee

drugtesting

programs

although

the

data

are

now

obsolete

Hanson

et

al

McBay

Against

this

long

background

and

the

example

provided

by

the

DoD

President

Reagan

issued

an

executive

order

in

directing

federal

agencies

to

achieve

a

drugfree

federal

workplace

an

action

that

was

catalyzed

by

the

report

of

the

Presidents

Commission

on

Organized

Crime

In

July

Congress

expanded

on

the

executive

order

by

enacting

a

law

that

required

urine

testing

for

federal

employees

including

employees

of

federal

contractors

and

also

required

that

technical

and

scientific

guidelines

and

standards

of

practice

be

met

by

all

laboratories

testing

urine

specimens

covered

by

the

law

Scientists

from

NIDA

and

forensic

toxicologists

worked

Federal

Register

Just

months

later

a

National

Laboratory

Certification

Program

was

implemented

by

NIDA

which

required

strict

adherence

to

the

guidelines

and

certification

standards

Today

there

are

almost

laboratories

certified

by

HHS

as

competent

to

conduct

forensic

urine

drug

testing

for

at

a

minimum

marijuana

cocaine

opiates

amphetamines

and

phencyclidine

and

their

metabolites

The

HHSNIDA

guidelines

have

since

been

revised

and

updated

Federal

Register

In

the

Nuclear

Regulatory

Commission

NRC

established

its

own

regulations

and

following

the

Omnibus

Transportation

Act

of

the

Department

of

Transportation

DOT

issued

regulations

that

included

testing

for

alcohol

and

permitted

individual

urine

specimens

to

be

split

into

two

before

submission

to

the

laboratory

The

DOT

issued

proposed

rule

making

for

their

program

in

January

Federal

Register

Professional

organizations

have

shown

an

interest

in

certifying

laboratories

in

which

their

members

are

employed

Most

notably

the

College

of

American

Pathologists

which

has

a

long

history

of

monitoring

improving

educating

and

regulating

clinical

laboratories

has

established

a

program

to

which

many

laboratories

subscribe

Their

guidelines

compare

well

with

those

of

NIDA

and

differ

only

in

detail

College

of

American

Pathologists

Similarly

some

states

have

enacted

statutes

and

regulations

specifically

to

control

laboratories

doing

employee

drug

testing

These

regulations

vary

greatly

Although

the

laboratory

aspects

of

federal

testing

programs

have

become

a

model

and

proposed

new

federal

legislation

may

In

a

period

of

about

years

urine

testing

has

moved

from

identifying

a

few

individuals

with

major

criminal

or

health

problems

to

generalized

programs

that

touch

the

lives

of

millions

of

citizens

It

has

given

rise

to

a

distinct

and

lucrative

industry

with

activities

ranging

from

specimen

collection

to

medical

treatment

that

was

unimagined

just

years

ago

Tens

of

millions

of

urine

specimens

are

analyzed

every

year

in

laboratories

that

vary

from

NIDAcertified

operations

to

uncertified

testing

at

workplaces

in

amateur

and

professional

sports

in

doctors

offices

and

in

jails

One

idea

that

motivates

such

widespread

testing

is

identify

catch

and

punish

philosophy

and

the

less

punitive

identify

treat

and

rehabilitate

approach

These

orientations

often

conflict

and

can

seriously

confound

forensic

toxicologists

and

medical

review

officers

who

are

responsible

for

interpreting

drug

test

results

At

the

end

of

NIDAs

Division

of

Applied

Research

sponsored

a

consensus

conference

to

assess

technical

scientific

and

procedural

issues

of

employee

drug

testing

after

about

months

of

operations

following

the

Presidents

executive

order

A

report

was

published

early

in

Finkle

et

al

that

expressed

the

views

and

recommendations

of

the

conference

participants

that

included

politicians

government

officials

representatives

of

business

industry

and

labor

as

well

as

laboratory

scientists

and

physicians

Their

recommendations

for

improvements

in

the

guidelines

for

testing

as

well

as

concerns

related

to

laboratory

certification

and

other

important

aspects

have

not

been

implemented

Federal

Register

This

type

of

inaction

is

particularly

unfortunate

and

has

recently

been

paralleled

with

another

important

report

Rollins

which

evaluated

the

efficacy

of

onsite

testing

still

not

released

by

NIDA

Go

to

Biochemical

Methods

For

Detecting

Drug

Use

Forensic

urine

drug

testing

begins

with

specimen

collection

from

the

donor

proceeds

to

laboratory

analysis

and

then

in

properly

run

programs

culminates

in

the

interpretation

of

reported

results

by

a

medical

review

officer

These

three

components

of

the

test

are

interdependent

and

essential

to

the

integrity

of

the

process

and

the

validity

of

the

laboratory

results

The

laboratory

however

is

the

only

actor

in

this

sequence

that

is

subject

to

certification

and

regulation

under

the

federal

guidelines

Since

actions

based

on

drug

tests

may

often

be

contested

legally

the

testing

process

must

have

sufficient

integrity

to

establish

the

validity

of

Specimen

Collection

When

a

specimen

is

collected

for

clinical

purposes

there

is

no

suspicion

that

the

donor

altered

the

specimen

or

attempted

to

subvert

the

analysis

It

is

generally

part

of

a

medical

evaluation

the

donor

has

health

incentives

to

cooperate

and

there

is

no

legal

attention

to

the

test

results

The

same

is

not

true

for

employee

testing

which

may

involve

use

of

illegal

drugs

and

possible

loss

of

employment

Thus

special

procedures

must

be

used

to

ensure

that

a

specimen

reaching

the

laboratory

can

be

clearly

identified

as

coming

from

a

particular

donors

urinary

bladder

at

a

particular

time

and

These

procedures

have

been

described

by

Caplan

and

Dubey

They

begin

with

specimen

collection

under

either

direct

or

indirect

observation

Direct

observation

means

that

the

collector

observes

the

urination

and

can

attest

to

the

fact

that

the

specimen

came

directly

from

the

donor

into

the

collection

container

This

is

not

a

common

practice

in

typical

employeetesting

programs

In

the

indirect

collection

process

the

actual

voiding

of

urine

is

not

witnessed

but

safeguards

are

taken

to

ensure

specimen

integrity

Common

measures

include

ensuring

no

access

to

water

taps

placing

a

bluing

agent

in

the

toilet

bowl

and

measuring

of

the

A

minor

industry

has

developed

to

provide

specimen

collection

services

Managing

urine

collection

systems

is

not

a

trivial

task

Simply

keeping

track

of

specimens

poses

difficulties

when

as

is

frequently

the

case

collection

sites

send

samples

to

several

different

laboratories

and

serve

several

different

employers

While

there

is

some

uniformity

in

the

federal

system

in

the

private

sector

employers

use

different

chainofcustody

forms

collection

kits

seals

and

courier

services

Neither

the

companies

who

provide

collection

services

urine

collectors

nor

the

sites

at

which

they

work

are

in

any

way

regulated

It

is

generally

the

responsibility

of

employers

and

laboratories

to

Tactics

often

used

in

attempts

to

confound

urine

analyses

include

dilution

of

the

urine

substitution

of

drugfree

urine

and

the

addition

of

substances

that

may

render

the

urine

unsuitable

for

analysis

Typical

adulterants

are

salt

bleach

detergents

vinegar

bicarbonate

hand

soap

vitamin

C

ammonia

peroxide

and

phosphate

Warner

Pearson

et

al

Recording

specimen

temperature

at

the

time

of

collection

is

a

useful

check

against

possible

urine

substitution

or

dilution

with

cold

water

Specific

gravity

and

concentration

of

creatinine

a

component

of

urine

may

also

indicate

dilution

but

recent

studies

strongly

suggest

they

are

of

limited

value

for

this

Temperature

specific

gravity

and

pH

are

easily

measured

When

the

urine

collection

procedure

is

indirect

not

observed

then

determination

of

creatinine

at

the

laboratory

may

be

a

useful

determinant

that

the

submitted

specimen

is

actually

human

urine

of

these

tests

is

specific

for

adulteration

or

particular

diseases

however

and

the

general

health

status

of

the

donor

may

also

affect

the

values

At

present

the

specimen

submitted

to

the

laboratory

for

analysis

is

invariably

urine

Although

more

difficult

to

analyze

blood

or

plasma

can

be

more

informative

and

useful

for

forensic

and

clinical

interpretations

however

the

routine

use

of

venopuncture

to

obtain

blood

specimens

is

not

likely

to

be

acceptable

by

either

donors

or

the

law

In

special

circumstances

such

as

testing

for

druginduced

impairment

following

a

vehicular

or

industrial

accident

blood

testing

is

commonly

seen

as

appropriate

and

often

occurs

Deep

lung

air

exhaled

into

a

breathtesting

device

to

assess

blood

alcohol

concentration

is

now

the

specimen

of

choice

in

drinkingdriving

In

contrast

the

use

of

head

hair

as

a

specimen

to

determine

illegal

drug

use

is

under

intensive

study

Since

Baumgartner

Baumgartner

used

an

immunoassay

technique

to

detect

the

most

commonly

used

illicit

drugs

and

their

metabolites

in

hair

the

analytical

toxicology

of

hair

has

been

the

subject

of

symposia

position

papers

and

extensive

research

in

both

the

United

States

and

Europe

Sunshine

Moeller

Hair

can

be

and

is

analyzed

in

specific

forensic

cases

but

has

not

yet

found

favor

in

employee

drugtesting

programs

Although

the

question

of

whether

hair

analysis

reliably

and

accurately

detects

drug

Technical

issues

relating

to

analytical

accuracy

precision

sensitivity

and

specificity

are

as

yet

unresolved

and

the

threshold

concentrations

that

are

needed

to

define

potentially

falsepositive

or

falsenegative

results

for

either

screening

or

confirmation

procedures

have

not

been

established

One

important

point

to

note

is

that

no

reference

material

is

available

with

which

to

standardize

analytical

methods

In

addition

the

quantities

of

drugs

and

metabolites

incorporated

into

hair

especially

cannabinoids

may

be

below

the

detection

limits

of

routine

confirmatory

GCMS

procedures

Issues

relating

to

the

external

contamination

of

hair

washing

or

other

aspects

of

sample

preparation

and

minimum

sample

sizes

for

Among

the

matters

we

should

know

more

about

are

the

relationship

between

the

dose

of

the

drug

and

the

concentration

of

the

drug

or

its

metabolites

in

hair

over

time

the

minimum

dose

required

to

produce

a

positive

analytical

result

the

time

interval

between

drug

use

and

the

appearance

or

detection

of

the

drug

in

the

hair

shaft

and

the

implications

of

individual

variation

by

race

age

sex

and

hair

characteristics

There

is

however

research

under

way

on

all

of

these

topics

and

much

has

been

published

in

the

last

years

suggesting

that

answers

to

questions

that

must

be

Laboratory

Methods

As

already

stated

NIDA

requires

urine

analysis

for

only

five

drug

classes

marijuana

cannabinoids

cocaine

benzoylecgonine

opiates

morphine

and

codeine

amphetamine

and

methamphetamine

and

phencyclidine

A

complete

analysis

for

these

substances

analytes

is

a

multistep

procedure

that

is

carried

out

serially

from

specimen

receipt

and

verification

to

authenticated

final

report

Two

of

the

three

steps

are

analytical

methods

The

initial

or

screening

test

is

designed

to

efficiently

identify

those

urine

specimens

that

are

negativethat

is

no

drugs

or

metabolites

are

detected

at

concentrations

above

established

cutoff

values

Those

specimens

that

test

positive

initially

are

subject

to

a

confirmatory

test

which

Although

there

are

many

immunoassay

techniques

the

demands

of

high

volume

often

thousands

of

specimens

each

day

efficiency

quality

control

and

laboratory

management

limit

the

techniques

in

practice

to

enzyme

immunoassay

EMIT

fluorescence

polarization

immunoassay

FPIA

and

radio

immunoassay

RIA

For

reasons

of

cost

efficiency

and

adaptability

to

automated

chemistry

analyzers

most

NIDAcertified

laboratories

use

EMIT

as

the

initial

screening

method

The

only

largescale

forensic

drugtesting

laboratories

using

RIA

are

those

supporting

DoD

programs

FPIA

is

an

excellent

method

but

largely

because

of

cost

it

has

found

favor

principally

as

a

secondstage

screening

method

for

specimens

that

test

positive

for

These

screening

tests

are

necessarily

designed

to

be

highly

sensitive

to

the

analytes

but

not

specific

in

their

response

which

means

that

at

the

screening

stage

some

falsepositive

results

can

be

expected

Thus

positive

screening

results

alone

do

not

necessarily

imply

the

presence

of

a

testedfor

drug

or

its

metabolite

and

positive

screening

results

can

not

support

a

final

report

nor

can

different

immunoassays

be

used

as

screening

and

confirmation

in

tandem

The

confirmation

test

must

be

based

on

a

different

chemical

principle

This

approach

to

forensic

analytical

toxicology

accords

with

the

recommended

guidelines

and

standards

of

the

bestinformed

professional

Despite

what

careful

science

demands

there

are

unregulated

drugtesting

programs

that

do

not

employ

confirmation

testing

including

testing

within

the

penal

system

for

compliance

with

parole

conditions

and

probation

and

for

prisoner

evaluation

testing

for

compliance

in

methadone

maintenance

programs

and

some

workplace

programs

that

use

onsite

laboratories

Relying

on

screening

test

results

is

an

unacceptable

practice

that

is

particularly

serious

in

contexts

in

which

personal

liberty

is

at

stake

The

FDA

requires

manufacturers

of

immunoassay

test

kits

to

include

a

statement

in

the

kit

The

assay

provides

only

a

preliminary

test

result

A

specific

alternative

method

must

be

used

When

used

by

an

appropriately

trained

and

skilled

laboratory

technician

GCMS

is

the

best

method

for

confirming

positive

screening

tests

results

Hoyt

et

al

Foltz

et

al

Although

the

types

of

GCMS

instruments

and

techniques

for

GCMS

analysis

vary

the

techniques

in

use

can

provide

very

sensitive

specific

identification

either

by

analyzing

a

full

mass

spectrum

or

more

usually

by

monitoring

at

least

three

selected

ions

and

quantitation

using

deuterated

internal

standards

of

the

drug

or

metabolite

sought

In

most

GCMS

assays

the

analyses

are

derivatized

to

provide

for

improved

chromatographic

characteristics

and

greater

sensitivity

This

twostage

analytical

procedure

can

achieve

reliable

results

within

defined

limits

of

sensitivity

and

precise

quantitation

at

concentrations

significantly

less

than

the

HHSNIDA

established

cutoff

threshold

values

Not

all

programs

use

the

NIDA

cutoff

concentrations

even

government

agencies

differ

see

Table

The

Nuclear

Regulatory

Commission

allows

licensees

to

use

cutoffs

more

stringent

than

NIDA

requirements

and

they

often

do

so

DoD

has

cutoffs

for

drugs

not

in

the

NIDA

panel

such

as

barbiturates

and

LSD

The

variation

in

privatesector

programs

is

even

greater

There

is

nothing

intrinsically

wrong

with

going

beyond

what

NIDA

requires

but

there

should

be

a

rationale

for

such

choices

that

are

supported

by

laboratory

quality

assurance

data

and

external

blind

performance

testing

that

demonstrates

laboratory

capability

at

and

below

the

cutoffs

chosen

TABLE

Example

of

Administrative

Threshold

cutoff

Concentrations

nanogramsmilliliter

January

Although

the

twostage

method

approved

by

NIDA

appears

well

suited

to

its

task

there

is

a

cost

associated

with

rigidly

setting

the

analytical

methods

to

be

used

in

drug

testing

Innovation

may

be

stifled

and

the

drug

testing

industry

may

fail

to

take

advantage

of

new

advancements

in

analytical

chemistry

or

indeed

of

existing

methods

that

might

find

limited

application

in

some

workplace

programs

For

example

thin

layer

chromatography

TLC

and

high

performance

liquid

chromatography

HPLC

may

not

enjoy

all

the

attributes

of

sensitivity

and

specificity

and

efficiency

required

by

very

large

programs

and

highvolume

laboratories

but

these

techniques

have

No

matter

which

analytical

methods

are

used

their

reliability

depends

on

laboratory

quality

control

and

assurance

and

demonstrated

proficiency

in

the

processes

employed

In

governmentregulated

programs

the

NIDAcertified

laboratory

is

the

only

component

of

the

urinetesting

process

that

is

tightly

controlled

and

regulated

with

regard

to

quality

Quality

control

requirements

include

review

of

documentation

from

specimen

receipt

to

final

report

and

of

the

complete

data

package

for

every

urine

specimen

analyzed

In

addition

analyses

must

take

place

in

secure

laboratories

with

limited

access

to

specimens

by

necessary

personnel

and

the

integrity

of

the

specimens

must

be

documented

by

internal

chainofcustody

Collection

site

information

external

chain

of

custody

temperature

identification

Courier

receipt

Internal

chain

of

custody

form

note

abnormal

circumstances

Specimen

identification

confirmation

Integrity

check

pH

SG

etc

Accessioning

chain

of

custody

Screening

data

controls

calibrators

quality

control

and

certifying

scientist

signatures

Accessioning

chain

of

custody

for

confirmations

GCMS

data

controls

calibrators

quality

control

and

certifying

scientist

signatures

Positive

identification

validation

report

signatures

numbers

cut

offs

Specimen

longterm

storage

Every

NIDAapproved

laboratory

must

have

a

quality

assurance

program

Quality

assurance

programs

involve

documented

procedures

that

the

laboratory

follows

to

minimize

human

and

technical

error

and

to

ensure

the

reliability

of

the

analysis

and

final

report

by

controlling

the

way

specimens

are

extracted

and

handled

and

the

way

analytical

instruments

are

checked

for

correct

function

A

typical

flow

of

specimens

in

which

checks

and

control

points

are

incorporated

is

shown

in

Figure

Crouch

and

Jennison

Quality

assurance

programs

should

at

a

minimum

include

auditing

specimen

collection

and

protocols

quality

control

of

laboratory

assays

participation

in

open

and

external

blind

proficiency

testing

programs

and

continuous

training

of

laboratory

staff

The

most

complex

of

these

components

is

the

control

of

laboratory

assays

Quality

assurance

and

control

is

described

in

detail

in

the

NIDA

Standards

for

Certification

of

Laboratories

it

must

include

the

analysis

of

instrument

calibrators

open

specimen

controls

blind

specimen

controls

and

establishment

of

specificity

and

sensitivity

limits

for

all

assays

For

confirming

quantitative

data

statistical

linearity

and

precision

must

be

defined

FIGURE

Typical

flow

of

NIDA

HHS

samples

at

the

laboratory

SOURCE

Crouch

and

Jennison

Limits

of

detection

and

quantitation

should

be

known

for

each

analyte

and

may

be

determined

by

one

of

the

following

procedures

a

mean

value

of

the

blank

plus

three

standard

deviations

b

extension

of

the

calibration

curve

to

zero

c

a

designated

signaltonoise

ratio

d

a

limit

of

at

least

percent

of

the

administrative

cutoff

value

For

studies

involving

quantitation

of

an

analyte

the

following

should

also

be

known

a

linearity

over

the

appropriate

concentration

range

which

should

include

a

blank

and

concentrations

less

than

the

cutoff

value

b

precision

at

designated

concentrations

over

the

linear

range

c

if

available

deuterated

internal

standards

should

be

used

for

GCMS

assays

If

not

then

analogs

of

the

analyte

are

preferred

and

d

each

assay

batch

should

include

matrixmatched

controls

both

blanks

and

positives

For

qualitative

identification

controls

should

also

be

matched

with

the

biological

specimenurine

and

include

a

negative

At

least

one

positive

and

one

negative

should

be

included

with

each

set

of

specimens

for

analysis

NIDAcertified

laboratories

are

challenged

with

proficiency

specimens

every

months

and

are

also

inspected

on

site

by

three

NIDA

inspectors

every

months

At

the

inspection

the

laboratory

director

and

certifying

scientists

must

be

able

to

demonstrate

that

their

urinetesting

methods

follow

the

HHSNIDA

guidelines

and

NIDA

Standard

Operating

Procedures

This

is

an

exacting

costly

and

often

stressful

aspect

of

the

NIDA

Certification

Program

but

it

is

absolutely

essential

to

the

integrity

and

credibility

of

certified

forensic

laboratories

There

are

however

growing

complaints

that

NIDA

inspections

are

becoming

too

expensive

detailed

intrusive

punitive

and

bureaucratic

NIDA

should

review

with

their

OnSite

Testing

Facilities

Although

millions

of

tests

are

performed

annually

in

NIDAcertified

urine

drugtesting

laboratories

there

are

perhaps

hundreds

of

other

facilities

usually

small

and

often

on

site

at

industrial

plants

or

near

a

major

work

force

that

do

urine

testing

for

drugs

but

do

not

generally

meet

the

exacting

standards

required

by

governmentregulated

HHSNIDA

laboratories

The

reliability

and

performance

of

onsite

testing

was

discussed

briefly

at

the

NIDA

Employee

Drug

Testing

Consensus

Conference

Finkle

et

al

The

delegates

at

that

conference

recommended

that

facilities

performing

screening

tests

only

should

be

subject

to

basic

forensic

standards

for

specimen

collection

chainofcustody

documentation

and

NIDAcertified

laboratories

are

exempt

from

the

Amendments

published

February

to

the

Clinical

Laboratory

Improvement

Act

CLIA

but

facilities

conducting

onsite

drug

screening

are

not

exempt

Federal

Register

Companies

with

onsite

laboratories

conducting

drug

screening

will

have

to

obtain

CLIA

laboratory

certificationan

exacting

process

that

will

include

inspections

at

least

every

years

by

officials

from

the

Health

Care

Financing

Administration

HCFA

They

will

also

be

required

to

have

a

quality

assurance

program

and

to

analyze

quality

control

samples

through

their

methods

and

instruments

each

day

The

staff

at

the

facility

or

laboratory

will

also

have

to

meet

certain

standards

particularly

the

designated

laboratory

director

Implementation

of

standards

for

onsite

drug

testing

is

a

high

priority

and

attention

should

be

given

to

establishing

some

consistency

across

Adding

to

the

List

of

Drugs

to

be

Tested

As

we

have

noted

laboratories

that

run

NIDAcertified

programs

test

urine

for

one

or

more

of

a

panel

of

five

drugs

Privatesector

programs

and

laboratories

that

engage

in

drug

testing

and

are

not

certified

by

NIDA

are

free

to

test

for

whatever

panel

of

drugs

they

are

able

to

identify

and

may

choose

cutoff

concentrations

at

any

level

By

far

the

most

common

of

the

drugs

that

can

affect

work

performance

is

ethanol

alcoholic

beverages

Other

legal

drugs

that

may

be

used

or

abused

and

that

can

harm

work

performance

can

be

bought

over

the

counter

in

drug

stores

or

Alcohol

testing

using

NHTSAapproved

breath

testing

devices

will

soon

be

included

in

drugtesting

programs

conducted

under

the

auspices

of

the

Department

of

Transportation

The

result

will

indicate

blood

alcohol

concentration

Urine

testing

to

identify

alcohol

use

also

presents

no

particular

difficulties

for

most

laboratories

Urine

test

results

do

not

however

show

whether

there

is

alcoholinduced

impairment

whether

alcohol

has

been

used

in

the

workplace

or

whether

there

is

alcohol

in

the

blood

while

at

work

Establishing

impairment

due

to

alcohol

is

important

because

the

Americans

With

Disabilities

Act

ADA

does

not

protect

current

users

of

illicit

drugs

but

it

does

Federal

Register

which

is

substantially

lower

than

the

or

percent

level

for

drivers

as

defined

by

most

states

The

example

of

alcohol

about

which

there

is

more

scientific

knowledge

than

any

other

legal

drug

illustrates

some

of

the

technical

difficulties

and

procedural

complexities

consequent

to

adding

other

groups

of

drugs

to

testing

panels

Additional

difficulties

arise

in

testing

for

legal

prescription

and

nonprescription

drugs

since

this

poses

ethical

issues

of

confidentiality

employer

and

employee

rights

and

the

involvement

of

physicians

who

treat

employees

as

patients

Undaunted

many

employers

have

added

drug

classes

that

contain

dozens

of

individual

drugs

and

metabolites

to

their

requests

for

laboratory

analysis

Testing

for

some

of

these

drugs

and

their

metabolites

poses

difficult

analytical

The

NIDA

consensus

conference

which

considered

the

proliferation

of

tested

drugs

recommended

that

testing

should

not

extend

to

additional

drugs

unless

the

criteria

regarding

analytical

methods

and

procedures

in

the

present

NIDA

guidelines

with

respect

to

an

initial

screening

test

and

an

independent

confirmatory

test

could

be

met

This

means

that

for

each

candidate

drug

screening

and

confirmation

cutoff

concentrations

must

be

determined

and

these

cutoffs

should

be

applied

nationally

Also

proficiency

testing

and

open

and

blind

quality

control

programs

should

be

in

place

for

each

additional

drug

before

any

testing

of

employee

urine

samples

is

undertaken

and

the

laboratory

Since

the

addition

of

other

drugs

to

the

present

opens

a

Pandoras

box

of

procedural

and

technical

issues

it

seems

prudent

to

prohibit

their

inclusion

unless

there

is

evidence

that

their

misuse

has

serious

detrimental

consequences

in

the

workplace

With

the

exception

of

alcohol

evidence

of

significant

detriments

associated

with

drugs

does

not

exist

at

the

present

time

Some

employers

may

expand

their

definition

of

a

drugfree

workplace

but

they

do

so

at

the

risk

of

inadequate

technical

and

forensic

support

Accuracy

and

Interpretation

Given

that

the

current

NIDAspecified

cutoff

concentrations

are

generous

and

sensitivity

and

specificity

requirements

are

high

when

a

urine

specimen

is

analyzed

for

the

five

illicit

drugs

and

their

metabolites

in

strict

accordance

with

NIDA

guidelines

including

a

report

to

the

medical

review

officer

the

likelihood

that

an

individual

employee

will

be

falsely

accused

of

illicit

drug

use

in

this

situation

is

remote

Almost

all

known

problems

with

falsepositive

reports

in

the

past

years

have

been

caused

by

procedural

documentation

and

administrative

errors

or

have

been

recorded

by

unregulated

uncertified

laboratories

D

Bush

personal

communication

This

is

a

Unexpected

technical

difficulties

do

occur

but

they

can

be

detected

by

the

quality

control

and

assurance

procedures

in

place

in

the

NIDAcertified

laboratories

For

example

it

was

learned

that

massive

concentrations

of

ephedrine

or

pseudoephedrine

especially

in

the

presence

of

low

concentrations

of

methamphetamine

could

lead

to

false

identification

and

quantitation

of

methamphetamine

but

as

soon

as

this

became

apparent

procedural

changes

were

made

and

technical

improvements

implemented

through

the

NIDA

laboratory

network

National

Institute

on

Drug

Abuse

This

type

of

experience

is

nonetheless

sobering

and

argues

for

the

intelligent

and

continuous

examination

of

quality

assurance

data

NIDA

and

Despite

their

accuracy

and

precision

analytical

results

seldom

allow

clear

answers

to

the

questions

that

most

concern

medical

review

officers

employers

and

lawyers

These

questions

include

a

was

the

individual

impaired

at

the

time

the

specimen

was

taken

b

when

was

the

drug

taken

c

route

of

consumption

d

what

was

the

dose

of

the

drug

taken

and

e

is

the

individual

a

chronic

abuser

of

the

drug

The

establishment

of

causeandeffect

relationships

and

retrospective

calculations

of

drug

does

and

time

of

consumption

generally

can

not

be

made

from

single

urine

drug

and

metabolite

concentrations

alone

Most

of

the

metabolites

A

positive

analytical

result

indicates

only

exposure

to

the

identified

drug

In

unusual

or

extreme

circumstances

it

is

possible

that

the

exposure

did

not

result

from

an

individuals

conscious

or

intentional

action

This

does

not

render

positive

test

results

false

but

it

does

highlight

the

importance

of

accurate

interpretation

Two

of

the

most

commonly

claimed

sources

of

unintentional

exposure

are

the

passive

inhalation

of

cannabinoids

from

marijuana

smoke

and

the

unintentional

consumption

of

morphine

and

codeine

from

poppy

seeds

Research

has

shown

however

that

the

passive

inhalation

of

marijuana

smoke

is

very

unlikely

to

result

in

a

positive

urine

analysis

Poppy

seeds

which

are

commonly

used

on

bagels

and

other

baked

foods

often

do

contain

sufficient

amounts

of

morphine

to

cause

detectable

concentrations

of

morphine

codeine

or

both

in

urine

Published

data

on

urine

concentrations

of

these

opiates

following

measured

doses

of

poppy

seeds

Elsohly

and

Elsohly

Selavka

permit

cautious

interpretations

when

this

reason

is

offered

for

the

positive

urine

results

Moreover

if

the

heroin

metabolite

is

identified

despite

alleged

poppy

seed

consumption

then

the

sole

cause

of

the

positive

test

is

heroin

use

Unfortunately

because

of

urinary

excretion

time

and

the

inability

of

some

laboratories

to

The

possible

confounding

of

ephedrine

and

methamphetamine

has

already

been

noted

It

should

be

recognized

however

that

the

concentrations

of

ephedrine

and

pseudoephedrine

or

of

the

decongestant

drug

phenylpropanolamine

that

must

exist

for

positive

tests

means

that

these

drugs

have

been

consumed

in

far

greater

amounts

than

anything

required

for

reasonable

medical

therapy

The

widely

used

Vicks

inhaler

is

also

sometimes

alleged

to

be

the

cause

of

methamphetamine

amphetamine

or

both

being

found

in

urine

specimens

Although

there

is

no

evidence

that

appropriate

use

of

a

Vicks

inhaler

will

produce

concentrations

of

methamphetamine

in

urine

greater

than

the

cutoff

values

These

are

just

some

of

the

reasons

that

individuals

whose

urine

has

tested

positive

for

an

illegal

drug

give

to

deny

responsibility

for

the

exposure

or

consumption

Undoubtedly

new

explanations

will

be

argued

in

the

future

When

they

are

one

can

expect

that

past

practice

will

continue

and

that

each

contested

or

alleged

false

positive

will

be

investigated

by

NIDA

and

the

matter

evaluated

following

scientific

evaluation

by

the

Drug

Testing

Advisory

Board

Other

test

program

errors

are

false

negatives

which

means

that

individuals

who

have

recently

used

a

tested

drug

are

not

identified

There

seems

to

be

no

limit

to

the

imaginative

methods

used

by

some

drug

users

to

avoid

detection

these

include

substitution

of

drugfree

human

urine

deliberate

adulteration

of

the

urine

specimen

as

discussed

earlier

consumption

of

a

drug

designed

to

mask

the

illicit

drug

and

deliberate

hydration

and

diuresis

using

drugs

copious

amounts

of

water

or

commercial

products

that

claim

to

hasten

the

excretion

of

a

drug

or

to

dilute

the

urine

to

a

point

at

which

the

drug

When

the

NIDA

guidelines

are

not

followed

poor

quality

assurance

procedures

at

either

the

laboratory

or

the

collection

site

can

lead

to

errors

as

can

the

failure

to

use

appropriate

confirmation

tests

to

verify

positive

initial

screening

results

In

these

circumstances

false

positive

results

are

a

genuine

threat

to

those

who

are

tested

A

recent

US

General

Accounting

Office

report

has

made

recommendations

to

simplify

NIDA

requirements

in

the

interest

of

cost

savings

Their

suggestions

may

have

merit

but

should

not

be

implemented

without

very

careful

evaluation

of

the

possible

consequences

to

program

quality

and

safeguards

for

the

employeedonors

Go

to

Indirect

Methods

Of

Assessing

Alcohol

And

Other

Drug

Use

In

an

attempt

to

avoid

some

of

the

technical

measurement

limitations

of

the

direct

methods

as

well

as

the

controversial

legal

issues

surrounding

drug

testing

specifically

see

Appendix

A

for

a

detailed

treatment

of

the

legal

climate

of

drug

testing

the

development

of

indirect

methods

for

assessing

alcohol

and

other

drug

use

has

been

rapidly

growing

Indirect

approaches

typically

involve

measuring

or

observing

behaviors

or

responses

that

are

frequently

associated

with

alcohol

and

other

drug

use

and

inferring

such

use

from

what

is

observed

One

approach

constructs

profiles

of

personal

characteristics

or

behaviors

including

biographical

and

attitude

data

on

which

alcohol

and

other

drug

users

and

nonusers

tend

to

differ

Another

approach

identifies

behaviors

that

are

associated

with

alcohol

and

other

drug

intoxication

or

impairment

and

monitors

those

behaviors

Personal

Profiles

As

stated

above

one

approach

to

assess

alcohol

and

other

drug

use

indirectly

is

to

develop

profiles

of

personal

characteristics

that

differentiate

between

users

and

nonusers

These

characteristics

typically

involve

demographic

and

other

personal

background

factors

attitudes

and

behaviors

associated

with

alcohol

and

other

drug

use

and

evidence

of

impairment

from

use

or

intoxication

Integrity

Tests

Several

efforts

at

developing

indirect

measures

of

alcohol

and

other

drug

use

based

on

attitude

and

personality

profiles

are

outgrowths

of

paperandpencil

integrity

tests

for

employee

selection

Sackett

et

al

These

include

the

London

House

Personnel

Selection

Inventory

the

Reid

Report

and

the

Stanton

Survey

One

systematic

approach

is

the

London

House

Drug

Abuse

Scale

DAS

Martin

and

Godsey

The

DAS

was

developed

from

a

theoretical

model

based

in

part

on

Zuckermans

theory

of

sensation

seeking

Zuckerman

which

is

described

as

involving

four

interrelated

characteristics

thrill

and

adventure

seeking

experience

seeking

disinhibition

and

boredom

susceptibility

High

In

addition

to

sensation

seeking

which

is

viewed

as

a

relatively

stable

personality

characteristic

and

thus

one

that

refers

to

general

tendencies

rather

than

specific

behaviors

the

DAS

also

seeks

to

measure

more

specific

psychodynamic

mechanisms

that

are

posited

to

influence

attitudes

toward

drug

use

Specifically

drug

users

are

thought

to

be

more

likely

than

nonusers

to

rationalize

drug

use

behavior

to

project

drug

use

behaviors

onto

others

to

show

more

tolerance

for

drug

use

behaviors

and

to

be

less

likely

to

favor

punitive

approaches

to

drug

use

behavior

Martin

and

Godsey

The

DAS

scale

includes

items

most

of

which

are

derived

from

the

psychodynamic

mechanisms

Measures

of

internal

consistency

range

from

to

The

rationale

for

using

DAS

scale

scores

as

a

selection

device

is

that

job

applicants

will

be

naturally

reluctant

to

disclose

heavy

drinking

or

illicit

drug

use

but

that

they

can

be

identified

by

attitudes

that

are

relatively

robust

to

incentives

to

distort

A

metaanalysis

of

validation

studies

with

the

DAS

Martin

and

Godsey

examined

studies

in

which

it

was

the

predictor

Criteria

included

drug

and

alcohol

use

selfreport

or

urinalysis

job

performance

and

theft

Four

potential

moderators

were

examined

type

of

subjectstudents

applicants

or

employees

method

of

collecting

the

criterionselfreport

or

nonselfreport

supervisor

ratings

urinalysis

suspensions

or

termination

job

relevance

of

the

criterionbehavior

at

work

or

behavior

away

from

work

and

subject

matter

of

the

criteriondrug

or

alcohol

use

theft

or

job

performance

Results

of

the

metaanalysis

showed

an

overall

validity

coefficient

of

Martin

and

Godsey

Studies

based

on

selfreports

had

higher

validities

r

than

those

based

on

other

types

of

criteria

r

For

selfreport

studies

applicant

and

employee

samples

yielded

higher

validity

coefficients

than

did

student

samples

Studies

using

jobrelated

criteria

had

higher

validity

coefficients

than

those

using

other

criteria

Finally

there

were

no

differences

regarding

the

prediction

of

different

criterion

behaviors

such

as

drug

or

alcohol

use

and

theft

The

validity

of

integrity

tests

for

predicting

drug

and

alcohol

use

was

also

examined

in

a

metaanalytic

study

by

Viswesvaran

et

al

From

a

data

base

of

integrity

test

validity

studies

several

relationships

were

examined

They

first

estimated

the

combined

validity

of

all

integrity

test

items

for

predicting

the

criterion

of

illicit

drug

and

alcohol

use

A

total

of

studies

with

a

combined

sample

size

of

contributed

to

the

analysis

The

mean

validity

was

estimated

to

be

In

another

analysis

these

investigators

examined

the

validities

of

the

individual

drug

scales

of

the

same

integrity

tests

There

has

been

a

substantial

increase

in

the

use

of

paperandpencil

integrity

tests

which

has

stimulated

debate

about

a

number

of

aspects

of

integrity

testing

In

particular

there

has

been

significant

concern

about

the

possibility

that

these

tests

may

yield

unacceptably

large

falsepositive

rates

ie

they

may

mistakenly

label

large

numbers

of

individuals

as

dishonest

American

Psychological

Association

Task

Force

Ekman

and

OSullivan

Manhardt

Martin

and

Terris

Murphy

The

same

concern

applies

to

these

instruments

drug

scales

that

is

a

substantial

number

of

individuals

can

be

mistakenly

labeled

drug

users

Although

there

is

now

growing

evidence

that

integrity

tests

demonstrate

acceptable

levels

of

validity

for

predicting

both

job

performance

and

various

forms

of

problem

behavior

including

drug

use

see

Ones

et

al

in

press

Viswesvaran

et

al

these

tests

may

still

yield

an

unacceptable

number

of

false

positives

This

is

in

part

due

to

the

relatively

low

base

rate

for

drug

use

in

the

populations

of

interest

Murphy

has

shown

that

the

proportion

of

false

positives

will

be

high

when

the

base

rate

is

low

even

when

a

highly

accurate

test

is

used

Thus

the

concern

over

false

For

purposes

of

illustration

Figure

shows

the

proportion

of

false

positives

expected

for

various

population

base

rates

and

various

test

accuracy

levels

The

three

lines

in

the

figure

depict

the

expected

false

positive

rates

for

tests

differing

in

sensitivity

and

specificity

The

sensitivity

of

the

test

is

the

likelihood

that

it

will

identify

an

individual

as

a

drug

user

when

he

or

she

is

a

true

drug

user

The

specificity

of

the

test

is

the

likelihood

that

it

will

identify

an

individual

as

a

nondrug

user

when

he

or

she

is

a

true

nondrug

user

The

three

lines

represent

tests

with

a

sensitivities

and

specificities

FIGURE

Proportion

of

false

positives

by

base

rate

and

test

accuracy

Based

on

the

numbers

in

Figure

consider

an

organization

with

employees

of

which

percent

are

drug

users

Using

a

test

with

percent

sensitivity

and

specificity

would

result

in

correctly

identifying

of

the

drug

users

and

of

the

nonusers

However

employees

would

be

falsely

classified

as

drug

users

meaning

that

percent

of

the

identified

users

would

in

fact

have

not

used

drugs

If

a

test

with

a

sensitivity

and

specificity

of

was

used

with

a

base

rate

of

percent

percent

of

identified

drug

users

would

be

false

positives

The

important

point

is

that

for

a

given

level

of

test

accuracy

the

value

of

a

test

will

vary

as

a

function

of

the

base

rate

prevalence

of

drug

use

in

Other

Personal

Profile

Measures

Another

indirect

approach

based

on

attitude

theory

is

that

of

Lehman

and

his

colleagues

Holcom

et

al

Lehman

et

al

Rosenbaum

et

al

In

this

approach

attitude

prototype

theory

Lord

et

al

is

used

to

develop

a

series

of

vignettes

in

which

employees

are

described

as

using

alcohol

or

illicit

drugs

at

or

away

from

work

Attitude

prototype

theory

predicts

how

general

attitudes

about

social

categories

for

example

illicit

drug

users

are

applied

to

specific

category

members

General

attitudes

are

more

likely

to

guide

behavior

toward

typical

rather

than

atypical

category

members

Novices

or

observers

who

Although

systems

based

on

attitude

prototypes

are

still

in

the

developmental

stage

several

pilot

studies

have

been

completed

that

show

differences

between

experienced

and

novice

observers

with

experience

defined

on

the

basis

of

the

observers

own

drug

use

experience

or

the

number

of

drug

users

the

observer

knows

Lehman

et

al

In

one

study

with

college

students

Holcom

et

al

asked

respondents

to

classify

different

alcohol

and

other

drug

user

types

into

categories

to

develop

profiles

of

different

alcohol

and

other

drug

user

categories

by

rating

each

category

on

a

list

of

positive

and

negative

adjectives

and

to

express

their

level

of

tolerance

for

different

situations

involving

alcohol

and

other

drug

use

at

work

Results

indicated

that

overall

college

students

classified

alcohol

and

other

druguser

categories

according

to

the

perceived

harmfulness

of

the

drug

with

tobacco

use

and

light

drinking

at

one

end

of

the

scale

heavy

drinking

and

marijuana

Consistent

with

social

categorization

theory

experienced

observers

showed

more

differentiation

of

alcohol

and

other

drug

user

classes

on

the

profiling

task

than

did

novices

Novices

profiles

of

user

classes

were

essentially

parallel

differing

in

level

of

negativity

but

not

in

pattern

ie

shape

of

negativity

rating

across

user

classes

The

profiles

of

experienced

observers

were

more

distinct

showing

differences

in

negativity

as

well

as

profile

pattern

For

example

experienced

observers

tended

to

use

difference

levels

of

negativity

Novices

tended

to

use

the

same

adjectives

to

describe

all

alcohol

and

other

drug

user

classes

but

rated

them

with

different

levels

of

In

a

second

study

of

college

students

Rosenbaum

et

al

presented

a

series

of

vignettes

describing

employee

alcohol

and

other

drug

use

in

a

variety

of

situations

that

varied

as

to

the

type

of

drug

used

tobacco

light

drinking

heavy

drinking

marijuana

cocaine

where

drug

use

took

place

at

or

away

from

work

whether

the

user

was

in

a

safetysensitive

position

and

whether

the

user

was

described

as

having

a

close

working

relationship

with

the

observer

Respondents

rated

each

situation

with

respect

to

their

attitudes

acceptability

and

normality

of

the

behavior

sympathy

for

the

user

and

behavioral

intentions

toward

A

subset

of

vignettes

from

the

Rosenbaum

et

al

study

was

then

presented

to

municipal

employees

from

a

large

city

in

the

southwestern

United

States

Lehman

et

al

Vignettes

described

tobacco

use

at

work

light

and

heavy

alcohol

use

away

from

work

marijuana

use

at

and

away

from

work

and

cocaine

use

away

from

work

Employees

were

asked

to

react

to

each

vignette

in

terms

of

their

tolerance

for

the

behaviors

described

and

their

concerns

for

safety

in

the

situation

Employees

were

classified

according

to

their

selfreported

alcohol

and

other

drug

use

along

two

dimensions

whether

they

Results

showed

that

experienced

users

showed

substantially

higher

tolerance

for

almost

all

employee

drug

use

situations

with

larger

differences

for

the

most

extreme

behaviors

such

as

marijuana

use

at

work

or

cocaine

use

Employees

who

had

used

illicit

drugs

during

the

past

year

were

more

tolerant

of

coworker

alcohol

and

other

drug

use

than

were

alcoholonly

employees

and

were

more

tolerant

than

lifetime

but

not

current

users

Results

also

indicated

decreasing

tolerance

among

all

groups

for

more

serious

forms

of

drug

use

from

light

to

heavy

alcohol

use

to

marijuana

to

cocaine

use

However

location

of

use

at

or

away

Newcomb

used

data

from

a

survey

of

young

adults

in

the

Los

Angeles

area

to

develop

a

risk

profile

of

characteristics

that

were

associated

with

disruptive

alcohol

and

other

drug

use

A

total

of

young

adults

between

the

ages

of

and

were

interviewed

for

the

study

Of

these

half

were

currently

employed

fulltime

an

additional

percent

employed

parttime

and

percent

were

enrolled

in

school

Disruptive

alcohol

and

other

drug

use

was

defined

as

any

use

or

being

under

the

influence

of

illicit

drugs

or

alcohol

at

work

or

at

school

Newcomb

developed

two

indices

These

risk

factors

were

selected

from

variables

in

previous

analyses

of

the

data

set

that

were

related

to

disruptive

alcohol

and

other

drug

use

and

for

which

information

was

potentially

available

to

an

employer

From

the

set

of

variables

chosen

a

multiple

regression

analysis

was

run

using

disruptive

alcohol

and

other

drug

use

as

the

criterion

Variables

that

were

significant

predictors

in

the

multiple

regression

were

chosen

for

the

risk

indices

The

prevalence

and

frequency

of

disruptive

alcohol

and

other

drug

use

were

calculated

for

each

number

of

risk

factors

Results

indicated

that

respondents

with

few

risk

factors

were

very

unlikely

to

engage

in

disruptive

use

of

alcohol

or

other

drugs

those

respondents

with

many

risk

factors

were

very

likely

to

engage

in

disruptive

use

Thus

the

extremes

of

the

risk

factor

indices

were

more

predictive

of

disruptive

use

than

the

middle

of

the

index

Pointbiserial

correlations

between

disruptive

use

and

the

number

of

risk

factors

indicated

that

disruptive

use

of

any

drug

was

more

predictable

than

disruptive

use

of

any

A

profile

of

personal

and

work

characteristics

predictive

of

employee

alcohol

and

other

drug

use

was

developed

by

Lehman

et

al

In

their

analyses

based

on

selfreport

responses

from

a

sample

of

municipal

employees

recent

illicit

drug

use

and

alcohol

or

other

drug

use

at

work

were

regressed

on

sets

of

predictor

variables

representing

personal

background

and

work

domains

The

personal

background

domain

included

demographic

measures

such

as

age

gender

race

and

education

personal

background

measures

included

religious

attendance

arrest

history

psychological

functioning

and

family

and

peer

relations

The

job

domain

included

job

background

variables

such

as

tenure

on

The

results

of

the

Lehman

et

al

analyses

showed

that

employees

who

had

recently

in

the

past

year

used

illicit

drugs

were

more

likely

than

nonusers

to

be

younger

have

an

arrest

history

associate

with

peers

who

were

illicit

drug

users

work

in

a

safetysensitive

job

and

work

alone

or

in

a

small

group

Employees

who

reported

using

alcohol

or

illicit

drugs

at

work

within

the

past

year

were

on

average

younger

than

their

counterparts

and

more

likely

to

be

unmarried

have

an

arrest

history

have

low

selfesteem

and

to

associate

with

peers

who

use

alcohol

and

other

drugs

Summary

Several

limitations

of

the

use

of

profiles

to

identify

alcohol

and

other

drug

users

should

be

recognized

Perhaps

the

most

developed

use

of

profiles

involves

integrity

tests

used

as

preemployment

selection

tools

A

number

of

test

batteries

are

currently

in

use

and

the

results

of

several

metanalyses

indicate

that

they

are

predictive

of

alcohol

and

other

drug

use

as

well

as

of

other

undesirable

employee

behavior

such

as

theft

and

lower

productivity

However

use

of

drug

scales

in

selecting

employees

has

a

potential

for

high

falsepositive

rates

Although

research

has

demonstrated

significant

predictive

validities

in

the

to

range

Regardless

of

whether

or

not

the

preemployment

use

of

drug

scales

is

justified

such

profiles

should

not

be

used

to

identify

current

employees

who

may

be

users

given

the

level

of

falsepositive

classification

error

associated

with

these

instruments

Taking

disciplinary

action

against

a

current

employee

who

happens

to

score

high

on

a

drug

scale

has

more

serious

ramifications

than

using

such

a

test

to

choose

among

several

job

applicants

Moreover

current

employees

generally

are

provided

a

higher

degree

of

due

process

protection

than

are

applicants

see

Appendix

B

Obviously

more

research

needs

to

be

done

on

profile

scales

like

those

described

above

in

order

to

develop

valid

measures

However

it

is

doubtful

that

such

instruments

will

ever

reach

accuracy

levels

high

enough

to

become

useful

tools

to

personnel

administrators

given

the

falsepositive

rates

associated

with

their

use

Behavioral

Indicators

Identifying

specific

behaviors

associated

with

alcoholand

other

druginduced

impairment

is

the

basis

for

using

behavioral

indicators

to

identify

users

Such

behaviors

include

overt

physical

symptoms

of

intoxication

reddened

eyes

slurred

speech

impaired

motor

coordination

odor

of

alcohol

or

marijuana

as

well

as

other

indicators

of

impairment

such

as

decrements

in

work

performance

Drug

Evaluation

and

Classification

Program

The

most

systematic

attempt

to

identify

illicit

drug

users

by

using

observable

behaviors

and

physiological

signals

has

been

the

Drug

Evaluation

and

Classification

Program

DEC

pioneered

by

the

Los

Angeles

Police

Department

In

reaction

to

increasing

evidence

of

illicit

drug

involvement

among

fatally

injured

drivers

and

impaired

drivers

detained

by

police

a

drug

recognition

procedure

was

developed

that

could

be

performed

by

a

trained

police

officer

to

obtain

evidence

that

a

suspect

was

impaired

at

the

time

of

being

detained

by

police

it

also

was

designed

to

determine

whether

the

nature

of

the

impairment

was

consistent

with

a

particular

category

The

DEC

program

is

described

as

a

standardized

systematic

method

of

examining

a

person

suspected

of

impaired

driving

or

some

other

alcoholor

drugrelated

offense

or

both

to

determine

whether

the

suspect

is

impaired

and

if

so

whether

the

impairment

is

drugrelated

or

medically

related

and

if

drugrelated

the

broad

category

or

combination

of

drugs

likely

to

have

caused

the

impairment

National

Highway

and

Transportation

Safety

Administration

It

is

stressed

that

the

process

is

not

a

field

procedure

but

takes

place

in

a

carefully

controlled

environment

does

not

determine

exactly

what

illicit

drugs

have

been

used

but

seeks

to

narrow

the

presence

of

drugs

to

certain

broad

categories

and

is

not

a

substitute

for

a

chemical

test

which

is

required

to

secure

evidence

to

corroborate

the

suspicion

generated

by

the

DEC

However

because

the

DEC

can

narrow

the

probability

of

drug

use

to

a

limited

set

of

drug

categories

it

can

suggest

more

specific

chemical

tests

than

would

otherwise

be

possible

The

DEC

program

involves

a

standardized

and

systematic

examination

of

a

suspects

appearance

behavior

performance

on

psychophysical

tests

eyes

and

vital

signs

The

examination

includes

a

breath

alcohol

test

an

interview

of

the

arresting

officer

preliminary

examination

of

the

suspect

examination

of

the

subjects

eyes

for

horizontal

gaze

nystagmus

vertical

nystagmus

and

lack

of

convergence

divided

attention

psychophysical

tests

examination

of

vital

signs

including

pulse

blood

pressure

and

temperature

darkroom

examination

to

check

pupil

size

and

response

examination

of

muscle

tone

and

examination

for

injection

sites

The

ability

of

the

DEC

process

to

discriminate

between

different

categories

of

drugs

is

based

on

evidence

that

different

drug

types

have

different

physiological

and

behavioral

effects

For

example

depressants

can

lead

to

horizontal

gaze

nystagmus

and

lack

of

convergence

in

eye

examinations

and

disorientation

sluggishness

and

drunk

like

behavior

Cannabis

use

in

contrast

is

associated

with

lack

of

convergence

but

not

horizontal

gaze

nystagmus

the

odor

of

marijuana

reddened

eyes

increased

appetite

and

impaired

perception

of

time

and

distance

The

utility

of

the

DEC

program

is

that

it

can

provide

probable

cause

to

justify

a

request

for

a

blood

Several

studies

have

been

completed

evaluating

the

DEC

program

Bigelow

et

al

Compton

The

study

by

Bigelow

et

al

was

a

controlled

laboratory

evaluation

of

the

DEC

process

conducted

at

Johns

Hopkins

University

Using

the

established

DEC

process

it

was

possible

to

correctly

identify

percent

of

drugfree

subjects

as

unimpaired

classify

percent

of

highdose

subjects

as

impaired

and

identify

the

category

of

drugs

for

percent

of

the

highdose

subjects

Identification

of

lowdose

subjects

was

not

nearly

so

successful

A

second

study

involved

a

fieldbased

evaluation

of

the

DEC

program

Compton

In

this

study

adult

suspects

arrested

by

regular

traffic

officers

of

the

Los

Angeles

Police

Department

or

the

California

Highway

Patrol

for

driving

under

the

influence

and

who

were

suspected

of

being

under

the

influence

of

a

illicit

drug

or

combination

of

illicit

drug

and

alcohol

were

examined

by

drug

recognition

experts

DRE

who

had

been

trained

and

certified

in

the

DEC

process

If

the

DRE

concluded

that

the

suspect

was

under

the

influence

of

a

drug

other

than

alcohol

the

suspect

was

asked

to

consent

to

Results

of

the

evaluation

showed

that

for

percent

of

the

suspects

identified

by

a

DRE

as

being

under

the

influence

of

illicit

drugs

a

drug

other

than

alcohol

was

found

in

the

blood

Over

percent

of

subjects

yielded

detectable

levels

of

more

than

one

illicit

drug

In

terms

of

overall

accuracy

of

DRE

judgments

all

illicit

drugs

were

correctly

identified

in

percent

of

cases

some

but

not

all

illicit

drugs

were

correctly

identified

percent

of

the

time

and

the

DRE

failed

to

correctly

identify

any

illicit

drugs

percent

of

the

time

If

only

one

illicit

The

DEC

program

is

currently

operating

in

states

and

the

District

of

Columbia

National

Highway

Traffic

Safety

Administration

Although

it

is

the

most

systematic

attempt

to

use

indirect

methods

of

behavioral

assessment

to

infer

drug

impairment

it

has

several

limitations

that

may

prevent

its

widespread

use

in

the

workplace

The

DEC

program

seems

to

be

most

effective

when

dealing

with

highly

impaired

suspects

Both

evaluation

studies

described

above

showed

limited

success

with

low

drug

doses

In

workplace

settings

the

highly

impaired

employee

is

relatively

rare

and

is

likely

to

be

detected

by

less

strenuous

methods

such

as

by

Although

it

is

unlikely

that

the

DEC

program

can

easily

be

adapted

to

the

workplace

some

of

its

components

may

be

useful

in

limited

workplace

situations

For

example

for

workplaces

involving

safetysensitive

work

situations

EAP

personnel

could

be

trained

in

some

of

the

DEC

methods

in

order

to

make

an

assessment

of

an

employee

who

has

been

identified

as

impaired

by

firstline

supervisors

Such

techniques

could

be

used

to

break

through

employee

denial

and

might

lead

to

successful

treatment

However

in

order

for

the

techniques

to

remain

useful

they

need

to

be

continuously

practiced

by

the

practitioner

and

few

workplaces

In

summary

although

the

use

of

behavioral

indicators

to

indirectly

identify

users

of

alcohol

and

other

drugs

is

a

growing

field

Heishman

and

Henningfield

Ellis

Perez

et

al

this

line

of

research

has

serious

limitations

Indicators

based

on

behavioral

impairment

may

be

influenced

by

a

variety

of

factors

other

than

alcohol

or

other

drug

use

such

as

fatigue

stress

and

legally

obtained

medications

The

causal

argument

sometimes

made

that

measures

of

impairment

imply

drug

use

or

intoxication

is

simply

not

valid

If

however

the

goal

is

to

identify

impaired

workers

to

either

refer

them

to

treatment

or

to

prevent

them

from

performing

a

task

that

may

endanger

themselves

or

others

then

behavioral

indicators

provide

a

more

direct

means

than

drug

tests

of

identifying

employees

unable

to

perform

at

required

levels

The

underlying

motivation

for

many

drugtesting

programs

although

certainly

not

all

of

them

is

to

minimize

hazardous

behavior

and

other

performance

problems

Behavioral

indicators

may

be

a

better

means

to

this

goal

than

are

chemical

tests

However

psychomotor

tests

of

impairment

have

not

yet

developed

to

the

point

at

which

they

Occupational

Alcoholism

and

Employee

Assistance

Programs

Behavioral

indicators

of

alcohol

and

other

drug

use

are

widely

used

through

occupational

alcoholism

programs

OAPs

and

employee

assistance

programs

EAPs

Problem

employees

are

identified

by

decrements

in

job

productivity

missed

deadlines

lowerquality

work

output

increased

absenteeism

or

tardiness

and

accidents

Trice

and

Roman

Reichman

et

al

Using

performance

decrements

to

identify

alcohol

or

other

drugusing

employees

has

several

problems

One

is

that

performance

decrements

can

be

associated

with

a

wide

variety

of

employee

problems

other

than

substance

use

such

as

family

health

emotional

and

financial

problems

The

other

major

weakness

of

job

performance

as

an

indirect

indicator

Chapter

Go

to

Conclusions

And

Recommendations

This

chapter

provided

a

brief

review

of

the

critical

components

of

drugtesting

programs

ie

specimen

collection

laboratory

analysis

interpretation

of

results

and

other

indirect

methods

for

detecting

drug

use

Furthermore

it

discussed

the

technical

and

procedural

strengths

and

weaknesses

of

these

methods

Based

on

the

substantive

issues

and

the

serious

nature

of

the

potential

negative

consequences

often

associated

with

the

results

of

such

tests

the

committee

makes

the

following

conclusions

and

recommendations

Methods

approved

by

the

National

Institute

on

Drug

Abuse

NIDA

for

detecting

drugs

and

their

metabolites

in

urine

are

sensitive

and

accurate

Urine

collections

systems

are

a

critical

component

of

the

drugtesting

process

but

they

are

the

most

vulnerable

to

interference

or

tampering

Positive

results

at

concentrations

greater

than

or

equal

to

NIDAspecified

thresholds

reliably

indicate

prior

drug

use

There

is

however

room

for

further

improvement

along

the

lines

of

the

recommendations

emanating

from

the

Consensus

Report

on

Employee

Drug

Testing

and

the

OnSite

Drug

Testing

Study

Moreover

more

could

be

learned

about

laboratory

strengths

and

problems

if

Recommendation

To

obtain

accurate

test

results

all

workrelated

urine

tests

including

applicant

tests

should

be

conducted

using

procedural

safeguards

and

quality

control

standards

similar

to

those

put

forth

by

NIDA

All

laboratories

including

onsite

workplace

testing

facilities

should

be

required

to

meet

these

standards

of

practice

whether

or

not

they

are

certified

under

HHSNIDA

Guidelines

Recommendation

The

extensive

data

on

the

reliability

of

laboratory

drugtesting

results

that

have

been

accumulated

through

the

DoD

and

NIDA

blind

performance

testing

programs

should

be

analyzed

by

independent

investigators

and

the

findings

of

their

analyses

published

in

the

scientific

literature

Government

standards

have

improved

the

quality

of

laboratory

practices

however

their

inflexibility

and

the

difficulty

of

making

prompt

changes

to

established

government

regulations

may

inhibit

the

development

of

new

analytical

techniques

and

better

experimentalbased

procedures

Strict

regulation

of

drugtesting

procedures

and

the

National

Laboratory

Certification

Programs

are

nonetheless

justified

Highvolume

productionoriented

drugtesting

laboratory

operations

require

the

vigilant

forensic

quality

control

of

routine

repetitive

procedures

rather

than

innovative

experimental

science

Strict

regulation

need

not

however

mean

bureaucratic

inflexibility

that

pointlessly

increases

costs

or

retards

progress

nor

should

it

interfere

with

research

designed

to

improve

current

urine

testing

procedures

or

efforts

to

Recommendation

Within

a

regime

of

strict

quality

control

allowances

should

be

made

for

variations

in

procedures

so

long

as

they

do

not

compromise

standards

and

they

do

reflect

professional

judgments

of

laboratory

directors

and

forensic

toxicologists

about

what

is

required

to

meet

individual

program

needs

No

laboratory

should

be

penalized

for

any

practice

that

is

clearly

an

improvement

on

or

beyond

what

is

required

by

the

HHSNIDA

guidelines

When

such

innovations

are

attempted

data

on

their

performance

should

be

systematically

collected

and

shared

with

NIDA

NIDA

should

take

the

lead

in

disseminating

to

all

laboratories

information

about

such

improvements

and

At

present

urine

remains

the

bestunderstood

specimen

for

evaluation

of

drug

use

and

the

easiest

to

analyze

Thus

it

must

for

the

moment

remain

the

specimen

of

choice

in

employee

drugtesting

programs

However

other

specimens

have

potential

advantages

over

urine

in

that

they

involve

less

intrusive

collection

procedures

or

have

a

longer

detection

period

Recommendation

Researchers

should

be

encouraged

to

evaluate

the

utility

of

using

specimens

other

than

urine

such

as

head

hair

and

saliva

for

the

detection

of

drugs

and

their

metabolites

There

has

been

an

unnecessary

proliferation

of

drugs

included

in

the

urine

test

battery

Testing

for

LSD

and

sedative

drugs

for

example

is

not

always

justified

Recommendation

Additional

drugs

should

not

be

added

to

the

drugtesting

panel

without

some

justification

based

on

epidemiological

data

for

the

industry

and

region

The

analytical

methods

used

to

identify

additional

drugs

should

meet

existing

NIDA

technical

criteria

Preemployment

drug

testing

may

have

serious

consequences

for

job

applicants

Applicants

unlike

most

employees

often

do

not

enjoy

safeguards

commensurate

with

these

consequences

A

particular

danger

of

unfairness

fairness

arises

because

screening

test

data

are

often

reported

to

companies

despite

the

known

possibility

of

a

false

positive

classification

errors

Recommendation

No

positive

drug

test

result

should

be

reported

for

a

job

applicant

until

a

positive

screening

test

has

been

confirmed

by

GCMS

technology

If

a

positive

test

result

is

reported

by

the

laboratory

the

applicant

should

be

properly

informed

and

should

have

an

opportunity

to

challenge

such

results

including

access

to

a

medical

review

officer

or

other

qualified

individual

to

assist

in

the

interpretation

of

positive

results

before

the

information

is

given

to

those

who

will

make

the

hiring

decision

Drugtesting

results

may

reveal

drugs

taken

legally

for

medical

treatment

that

do

not

seriously

affect

an

employees

job

performance

These

drugs

may

however

be

associated

with

conditions

that

the

employee

for

good

reasons

wishes

to

keep

private

Recommendation

In

the

absence

of

a

strong

detrimental

link

to

job

performance

legally

prescribed

or

overthecounter

medications

detected

by

drug

testing

should

not

be

reported

to

employers

Furthermore

such

results

should

not

be

made

part

of

any

employment

record

except

confidential

health

records

with

the

employees

permission

Alcohol

and

other

drug

use

by

work

force

members

can

not

be

reliably

inferred

from

performance

assessments

since

performance

decrements

may

have

many

antecedents

Conversely

performance

decrements

are

often

not

obvious

despite

alcohol

and

other

drug

use

More

direct

measures

of

the

likely

quality

of

worker

performance

hold

promise

for

determining

workers

fitness

to

perform

specific

jobs

at

specific

times

regardless

of

the

potential

cause

of

impairment

Efforts

to

identify

such

measures

however

are

still

in

their

infancy

Recommendation

If

an

organizations

goal

is

to

avoid

work

decrement

eg

accidents

injuries

performance

level

due

to

impairment

then

research

should

be

conducted

on

the

utility

of

performance

tests

prior

to

starting

work

as

an

alternative

to

alcohol

and

other

drug

tests

Integrity

testing

and

personality

profiles

do

not

provide

accurate

measures

of

individual

alcohol

and

other

drug

use

and

have

not

been

adequately

evaluated

as

predictors

or

proxy

measures

of

use

Using

these

tests

to

aid

in

employment

decisions

involves

a

significant

risk

of

falsely

identifying

some

individuals

as

users

and

missing

others

who

actually

use

drugs

The

accuracy

of

these

tests

is

affected

not

only

by

their

validity

but

also

by

the

characteristics

of

the

population

being

tested

Urine

tests

by

contrast

can

be

quite

accurate

in

detecting

recent

drug

use

Recommendation

If

an

organization

treats

alcohol

and

other

drug

use

as

a

hiring

criterion

it

should

rely

on

urinalysis

testing

that

conforms

with

NIDA

guidelines

to

detect

use

rather

than

on

personality

profiles

or

paperandpencil

tests

Go

to

References

American

Academy

of

Forensic

Sciences

Forensic

Toxicology

Laboratory

Guidelines

Society

of

Forensic

Toxicologists

Grosse

Point

Mich

American

Psychological

Association

Task

Force

Questionnaires

Used

in

the

Prediction

of

Trustworthiness

in

Preemployment

Selection

Decisions

An

APA

Task

Force

Report

Washington

DC

American

Psychological

Association

Baumgartner

WA

Employee

Screening

by

Hair

Analysis

The

Answer

to

Urinalysis

Problems

Los

Angeles

IANUS

Foundation

Hair

analysis

for

drugs

of

abuse

Journal

of

Forensic

Science

Bigelow

GE

WE

Bickel

JD

Roache

IA

Liebson

and

P

Nowowieski

Identifying

Types

of

Drug

Intoxication

Laboratory

Evaluation

of

a

SubjectExamination

Procedure

National

Highway

and

Transportation

Safety

Administration

Washington

DC

US

Department

of

Transportation

Boone

JD

Reliability

of

urine

drug

testing

Journal

of

the

American

Medical

Association

Cangianelli

LA

The

effects

of

a

drug

testing

program

in

the

Navy

In

LS

Harris

editor

ed

Problems

of

Drug

Dependence

Proceedings

of

the

Annual

Scientific

Meeting

The

Committee

on

Problems

of

Drug

Dependence

Inc

NIDA

Research

Monograph

Rockville

Md

National

Institute

on

Drug

Abuse

PubMed

Caplan

YH

and

IS

Dubey

Workplace

drug

testing

Clincial

Chemistry

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Issues

Fronteirs

in

TDM

and

Clinical

Toxicology

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of

American

Pathologists

Forensic

Urine

Drug

Testing

Inspection

Check

List

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of

American

Pathologists

Northfield

Ill

Compton

RP

Field

Evaluation

of

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Los

Angeles

Police

Department

Drug

Detection

Program

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Highway

and

Transportation

Safety

Administration

Washington

DC

US

Department

of

Transportation

Cone

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and

JR

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highs

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drug

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drug

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drug

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alcohol

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rules

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laboratory

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assays

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examinations

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Mandatory

guidelines

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federal

workplace

drug

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M

Forum

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Employee

Drug

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ADM

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Health

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AF

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editor

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Drug

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drug

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results

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workplace

Chemical

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June

Hawks

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CN

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practical

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Drug

Users

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presented

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the

annual

meeting

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Society

of

IndustrialOrganizational

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Hoyt

DW

RE

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testing

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defensible

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the

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hair

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NIDA

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ML

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J Athl Train v332 AprJun 1998 PMC1320407 J Athl Train 1998 AprJun 332 171176 PMCID PMC1320407 Sexual Harassment A Concern for the Athletic Trainer Benito J Velasquez DA ATC LAT Author information Copyright and License information This article has been cited by other articles in PMC Abstract Objective Sexual harassment is a vital social issue that affects the business community educational institutions and personnel in the US military Addressing sexual harassment in the athletic training clinical setting is an important issue for the athletic training professional Athletic trainers need to understand the complex definitions of sexual harassment and how to identify and handle claims of sexual harassment in order to prevent sexual harassment from occurring and to prevent civil lawsuits of alleged sexual harassment Background Professional journals legal textbooks policy handbooks unpublished findings from the NATA Women in Athletic Training Committee report and current news media sources were used to gain a greater understanding of this social problem Description To make the athletic trainer aware of this important social issue and to offer suggestions for the athletic training staff to aid in preventing problems of sexual harassment Clinical Advantages This article provides definitions and examples of sexual harassment discussion of policy development and suggestions for ways to eliminate sexual harassment in the athletic training environment Full text Full text is available as a scanned copy of the original print version Get a printable copy PDF file of the complete article 10M or click on a page image below to browse page by page 171 172 173 174 175 176 Articles from Journal of Athletic Training are provided here courtesy of National Athletic Trainers Association

O O O O O O O O O O O O O O O O B I O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O B I O O O B I O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O B I O O O O B I O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O B I O O O O O O O O O O O O O O O B I O O O O O O O O O B I O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

sexual harassment
athletic trainer
social issue