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Drug and alcohol testing FAQs

Health First Occupational Medicine

How and what can you test for?

The agencies that regulate your company, as well as your company's drug-free policy, determine which drugs you test for. The five basic drugs of abuse (NIDA-5 panel) are marijuana, cocaine, amphetamines, opiates, and phencyclidine. Tests also commonly screen for barbiturates, benzodiazepines, methaqualone, methadone, and propoxyphene.

A variety of methods are used to test for these drugs and alcohol, including:

  • Urine screens — A donor provides a urine sample, which goes through a series of chemical tests at a certified laboratory. The results tell whether or not leftover traces of drugs are in the body. A urine test does not tell if a donor is under the influence of drugs at the time of the test, but it does reveal if alcohol or drugs were used sometime in the recent past.
  • Blood screens — A blood test measures the actual amount of alcohol or other drugs in the blood at the time of the test. Although a blood test can detect drugs, it is mostly used to test for alcohol.
  • Breath screening — An evidential breath test (EBT) is the most common test for finding out how much alcohol is in the blood. Breath Alcohol Technicians (BATs) perform EBTs using a device approved by the National Highway Safety Administration.
  • Saliva and hair screening — Researchers are studying the testing of hair and saliva to detect alcohol and other drug use. Early results suggest that testing saliva may be a valid testing method. It has not yet been determined how accurate and reliable hair testing is. It is also important to remember that the testing laboratory for federal and state compliance must be certified by the Department of Health and Human Services (DHHS). Currently, none of the laboratories performing hair testing are DHHS certified.

In what situations would employers ask employees to take a drug test?

  • Pre-employment — To decrease the chance that a current drug user will be hired, some employers test job applicants when offering employment. The job offer depends on a negative drug test result.
  • Reasonable suspicion and for cause — When an employee shows obvious signs of not being fit for duty (for cause), or has a documented pattern of unsafe work behavior (reasonable suspicion), an employee may be asked to take a drug test. It is recommended a supervisor escort the employee for testing.
  • Random — To discourage drug use among all employees, an employer may ask employees to take drug tests at random and unpredictable times, using random sampling techniques (random pool). Federal testing programs require random testing.
  • Post-accident tests — An employer may test employees who are involved in an accident or unsafe practice incident to find out if alcohol and/or other drug use was a factor.
  • Post-treatment tests — When an employee has been receiving inpatient or outpatient treatment for substance abuse, an employer may arrange for random testing of that employee to ensure sobriety. This form of testing only applies when the employer knows that the employee is involved in a treatment program. It may not be necessary for the employee to inform the employer he or she is seeking treatment.

Why set up a drug testing program?
  • Federal or state regulations — Some workplaces must comply with a federal or state agency's drug testing requirements. For example, the Department of Transportation, Department of Defense, Department of Energy, and Nuclear Regulatory Commission are federal agencies that require contractors working for them to set up drug testing programs. Employers choosing to comply with the State of Florida Drug-Free Workplace Act must comply with specific state regulations, and are entitled to a discount on their workers' compensation insurance premiums.
  • Safety concerns — Use of alcohol or other drugs on the job can cause accidents, safety problems, and other costly mistakes. As a result, many employers choose to protect their staff and workplace by starting a drug testing program for employees in positions deemed "safety sensitive."
  • High costs of alcohol and other drug abuse — Research has shown that alcohol and illicit drug use at work adversely affects employees and increases costs to the employer. Workplace drug abuse often results in lower productivity, higher workers' compensation claims, more time away from work, and higher medical costs. It also has been linked to crime on the job and can affect employee mood and well-being.


Are drug tests accurate?

If drug tests follow the guidelines of the Department of Health and Human Services (DHHS), they are very accurate. These guidelines require that certain procedures be followed:

  • Chain of custody: A chain-of-custody form is used to document the handling and storage of a urine specimen from the time it is collected until the time it is released to the testing laboratory. It links donors to their urine sample. It is written proof of all specimen activity between collection site and laboratory.
  • Initial screen: The first test done on a urine sample is called an "initial screen" (by radioimmunoassay, or RIA). Should the initial screen be positive, DHHS guidelines require a second test to confirm the results.
  • Confirmation test: A second test by gas chromatography/mass spectrometry (GC/MS) is highly accurate and will rule out any false positives (mistakes) from the initial screen. For a test result to be reported as positive, both test results must agree.
  • Medical review officer: A medical review officer (MRO) is a licensed physician who has special training in the area of substance abuse. If the drug test is positive, the MRO reviews the results to make sure the chain-of-custody procedures were followed, and contacts the donor to make note of any medical reasons that may have affected the result. It is only at this point that the MRO may report the positive test result to the employer. Medications can sometimes cause a positive test result. If this is the case, and the medication was prescribed by a physician, the test is reported as negative.

The DHHS requires that these and other guidelines be met for a drug testing laboratory to be certified. If you are interested in learning more about the testing procedures, you can order a free copy of the Mandatory Guidelines for Federal Workplace Drug Testing Programs from the National Clearinghouse for Alcohol and Drug Information (1-800-729-6686).

What can employees expect when they go for a drug test?

When reporting to the test site, donors will be asked for a photo identification (ID). Acceptable forms of ID include a driver's license, passport, military ID, official ID from the company the test is for, and a state ID. If an employee doesn't have an ID, a representative from the company will be asked to identify the donor. After the donor provides a urine sample, the bottle should not leave his or her sight until it is sealed with special "evidence" tape. Donors will sign the label on the container, the chain-of-custody form, and record book stating that the sample collected was theirs. The specimen is then shipped to a DHHS-certified laboratory for testing. If the seal is broken, or if the donor does not sign the container, the laboratory will not test the sample.

Will donors have privacy when giving the sample?

In most cases, a "monitored collection" is performed. A monitored collection means the collector will be able to hear, but not observe, the donor providing a sample. In monitored collections, the collector doesn't have to be same sex as the donor. However, there are situations when a collector may need to see the donor give their sample — a "witnessed collection." For example, if there is reason to believe that an employee has tried to tamper with the sample, another specimen may be collected with someone of the same sex watching to ensure honesty. In some cases, donors may be asked to give a sample with someone watching to ensure honesty as part of a follow-up or return-to-work drug test, and the collector will always be of the same sex.

Who should know the results of the drug test?

Confidentiality is very important. The drug test results will be kept private, and only those who need to know will receive the drug test results. This might be the supervisor, manager, union representative, or someone in the medical or personnel department. Often, employees are asked to sign a release form that states who will receive the test results. A drug test is reported as positive or negative; if the results are positive, the amount of the drug(s) found is usually not reported. Confidentiality should also mean that drug test results will not be part of an employee's personnel file.

Will a donor test positive for drugs if he or she is around someone who is using drugs, or if they eat foods with poppy seeds?

The Addictions Research Center did a series of studies showing that the chances are very small that a donor could test positive for marijuana at DHHS cutoff levels after being in a room with marijuana smoke. At most, "trace" levels of the drug might be found, and this would mean a negative test result if using DHHS guidelines. Early results of studies on exposure to cocaine and methamphetamine smoke also suggest that the chances of testing positive under DHHS guidelines are small.

Because poppy seeds contain small amounts of opium, eating food with poppy seeds can cause donors to test positive for opiates. MROs are aware of this, and are trained to report the test as positive only if there is also physical evidence of drug abuse.

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