Engs, Ruth C.[Ed.], Controversies in the Addition's Field. Robert L. DuPont, MD. "Chapter 12: Mandatory Random Testing Needs To Be Undertaken At The Worksite"

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Chapter 12
Mandatory Random Testing Needs To Be Undertaken At The Worksite

Robert L. DuPont, MD

Introduction

In the late 1980s the workplace took center stage in the national drug abuse prevention effort with the focus being the drug test. No other aspect of the War on Drugs involved such a broad segment of the nation as the drug test at work. Urine tests for abused drugs had previously been limited to forensic, drug abuse treatment, and criminal justice settings (DuPont and Saylor, 1989). The drug test at work became the most controversial aspect of drug abuse prevention efforts.

Drug testing technology and practice evolved rapidly throughout the 1980s at the pinnacle of modem biotechnology, becoming effective, inexpensive, and reliable as a means of detecting recent use of specific drugs, including drugs that cause impairment in the workplace (Schottenfeld, 1989). The application of this technology in the workplace was justified by the rapid rise in the percentage of workers who used illicit drugs. In 1988, forn example, the National Institute on Drug Abuse (NIDA) estimated that 12% of full-time employed Americans between the ages of 20 and 40 used an illicit drug in the previous month (National Institute on Drug Abuse, 1989). Among high school seniors entering the workforce, the levels of drug use were even higher, in 1988, l8% reported current use of marijuana and 3% use of cocaine. High school drop outs had even higher rates of illicit drug use (University of Michigan, 1989).

Drug use had many serious costs in the workplace, including the estimated $ l,OOO paid by each worker each year because of the effects of drug and alcohol abuse, whether or not that worker used drugs or alcohol. Included in this estimate are the costs of lost productivity, accidents, and health cost of drug-and alcohol- abusing workers. This involuntary Chemical Dependence Tax has grave impacts on the nation's productivity and competitiveness (DuPont, 1989a). Cutting that tax by preventing drug problems is the goal of drug testing in the workplace with benefits in increased wages, improved health, lowered product costs, and improved product quality.

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When the drug test came to the workplace there were intense controversies over any form of testing. For example, there were charges that the tests were inherently unreliable and that they identified as drug users people who were merely in the vicinity of someone using marijuana. It was also claimed by critics of testing at work that common over-the-counter and health food supplements would be misinterpreted as drug positive results (Hawks and Chaing, 1986). The publication of guidelines for workplace drug testing by the US. Department of Health and Human Services (1988), federal requirements for drug testing within the federal workforce and among many federally regulated workplaces, and a series of court cases all occurring between 1987 and 1989, shifted the controversy about drug testing away from the question of the reliability or legality of testing.

By 1990 most opponents of testing conceded that when done properly, drug tests were able to accurately and reliably identify recent drug use. The new battleground in workplace drug testing focused on two critical, unresolved areas. The first was whether testing was warranted for workers where there was no "safety or security" risk in their work. In the view of the critics of testing, drug tests at work might be justified for transportation or nuclear power workers, but not for most workers whose jobs were not safety-sensitive. The second battleground in the early l990s about drug testing at work was whether testing should be required for workers on a "random" basis, that is, without individualized suspicion that the particular employee was impaired by drugs at the time the drug test was requested. This paper addresses the second of these two points, arguing that random, unindicated, drug testing at work is desirable.

About the Author

The reader of a chapter on so controversial and personal a subject as random drug testing in the workplace deserves to know something about the author. I am a medical doctor, a psychiatrist, who has worked for over two decades in drug abuse prevention and treatment.

The only drug users who have recovered from their addiction, in my experience, have recovered because someone else cared enough about them to insist that they become drug free. Surely the process of recovery requires that the former drug users ultimately adopt drug-free values and goals themselves, but the beginning of recovery is almost always the insistence of one or more people in the drug users' lives to end their drug use.

With reference to the specific topic of this chapter, I have seen hundreds of drug abusers who have recovered control of their lives because their employers put their employment on the line in what is called

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"job jeopardy." Bluntly, that means, "You work here, you don't use drugs; you use drugs, you don't work here." This new and, for most people, still unfamiliar approach has become known as Tough Love. It happens in the workplace just the way it does in families (DuPont, 1984). Even more personally, I have been drug tested at work for two decades. All staff members of the two organizations I work with are randomly tested for drugs. I am a "survivor" of random drug tests at work, and so are all the people with whom I work.

My views about drugs in the workplace, including my support for random drug tests at work, have been published in a variety of professional and general books, journals, and newspapers (DuPont, 1984, 1989a, 1989b, 1989c, 1989d, 1989e).

"Random" Drug Testing Defined

A drug test in the workplace today means a urine sample collected in a private, but secure, medical environment similar to routine urine collection at a doctor's office. The sample is tested to be sure it comes from the tested employee and has not been adulterated. Direct observation of the urine collection is not required in the workplace unless there is reason to believe the employee will falsify the drug test. The drug test is analyzed by a two-step process in a high-technology clinical laboratory. This drug test process includes careful collection, chain-of-custody, medical review, and retention of all positive samples for one year after collection. This total system, which is now standard in workplace drug testing, permits retest if an employee claims to have been falsely identified as a drug user. Using this system there are no false positives (US. Department of Health and Human Services, 1988; DuPont, 1989a, 1989b).

This system does not detect use of medicines, except for those that are on occasion abused by drug users. Thus, the workplace drug testing system does not identify use of birth control pills, heart medicines, or antidepressants. Workplace drug tests only detect use of "controlled substances," or drugs that are either purely illegal (such as marijuana and PCP), or drugs that can be used either medically or nonmedically (such as painkillers, antianxiety medicines, and sleeping pills). Medical use is separated from nonmedical use of these substances by a medical review officer, a trained physician who sees the drug tests before they are reported to the employer. Only urine drug tests taken at work that show recent use of potentially impaired drugs, for which there is no medical prescription for that employee, are reported to the employer as positive. Medical use of substances, such as Valium or codeine, are reported as "negative" tests.

"Random testing" needs to be contrasted to the other two common types of drug tests in the workplace. The first is "pre-employment" testing;

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that is, urine tests for recent drug use taken at the time a person applies for a new job. The second common form of drug test at work is "for-cause" testing. These are tests of a particular person because he or she shows some particular signs of possible drug use. Examples of causes for drug tests at work include appearing to be under the influence of a drug, being repeatedly late for work, or having an accident. Other causes justifying a drug test for a particular employee are a past history of treatment for drug abuse, and abnormal behavior at work (e.g., fighting or falling asleep). Neither pre-employment nor for-cause testing is now either particularly uncommon or controversial in the American workplace.

In contrast to pre-employment and for-cause testing, random testing remains controversial in nonmilitary workplaces in the United States. Random testing for drugs means that a particular worker is chosen at random to be tested at a particular time. Usually this selection is done by computer with a small percentage of workers being selected to be tested each day with only a few hours of notice. With random drug testing, every worker is subject to being drug tested every day the worker is at work regardless of how the worker is performing on that day.

The Uses of Random Drug Testing in the Workplace

If all drug users were obviously impaired at work, random testing would not be needed because supervisors could be trained to detect drug caused impairment. They could, having identified a potentially impaired worker, request a for-cause drug test. Unfortunately, there is clear evidence that most illicit drug users do not appear to be impaired at work, even when drugs are having a profound effect on their performance. After 20 years working with drug abusers, I always insist on drug testing my patients simply because I cannot tell when they are using drugs, even when I spend 50 minutes talking with them in my office. If I cannot identify recent drug use, how can even the most highly trained supervisor?

Why should someone who has never used an illegal drug welcome a random drug test at work? Unless those non-using employees are tested, employees who do use illicit drugs will not be tested. The non-user of illicit drugs who is drug tested at work is in the same situation as those who have no intention of ever hijacking an airplane when they walk through metal detectors at airports; if they do not submit to the slight inconvenience of going through the detector, then hijackers will not be deterred or, failing deterrence, detected.

Although most drug use does not produce easily detected symptoms, some drug use causes such flagrant symptoms of impairment that supervisor training is worth the investment. Supervisors, and co-workers, can identify the most outrageous examples of drug-caused impairment on the

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job. Even when signs of recent drug use are identified, such as irritable mood or the appearance of fatigue, these behaviors are often caused by other factors in the employees' lives. Thus, many for-cause tests for drugs will be negative. Supervisors are usually reluctant to ask for a drug test if there is any doubt that the abnormal behavior is caused by drug abuse. Employees are usually not pleased when a supervisor singles them out for a drug test. Supervisors are generally not pleased when the requested for cause drug test comes back showing no recent drug use. Thus, when a company has a for-cause drug test program they typically do few drug tests, even when high percentages of their employees are using illicit drugs. This means that for-cause testing is a weak deterrent to drug use in the workplace because it is seldom used. Drug users in the workforce typically have a high level of confidence that their drug use will not be detected because they do not feel impaired and they do not believe they will be drug tested. All too often they are wrong in believing they are not impaired, but right in believing that they will not be tested.

One good reason to do random tests is that most drug-caused impairments are not identified when companies rely on for-cause tests. Another good reason is that such tests are routine and do not require a supervisor to confront an employee with the suspicion that he or she is using drugs. The military experience using random tests since 1982 and the smaller civilian experience with random testing over the last few years have established these two central points: Random testing is fair and it is effective. Random drug testing at work achieves its primary goal of preventing drug use and drug-caused problems, without demoralizing workers or forcing large numbers of workers either to leave their jobs or to enter treatment. It does this by making the drug-free workplace a reality. Random testing at work give workers at all levels a strong, practical reason to stop using illicit drugs: If they do not stop using illicit drugs they will lose their jobs (National Institute on Drug Abuse, Of lice of Workplace Initiatives, 1989; Walsh and Gust, 1989).

Throughout this chapter I have focused on employees in safety and security positions, emphasizing that they are the most appropriate employees to be subjected to random drug testing. The same arguments that apply to these employees apply to all others: Random testing is the best, fairest, and most cost-effective way to prevent illicit drug use. Focusing on only those industries with safety-related jobs discriminates against all other employees. All workers stand to gain equally from random drug testing. The reason for beginning with safety and security roles is not because they are more important or because the employees in their other jobs are not equally benefited by random testing, it simply reflects the controversies over the use of random testing in the workplace today.

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It is my strong belief that any employee subject to drug testing is helped by that testing. That randomly tested employee is not harmed by testing, whether or not that employee is in a safety-related job, and whether or not that employee uses illicit drugs. Anyone concerned for employee welfare should be arguing for random drug tests in the workplace today. Despite this belief, however, I recognize that many people are unfamiliar with random drug tests. These sometimes fearful people may even believe that such tests are a threat to them. Much of the media and many apologists for illicit drug use as well as many opponents of testing actively fuel these fears. Out of consideration for these fears, and the political and legal conflicts they support, I am respectful of the necessity of time passing before random drug testing is universally applied in the American workplace.

Random drug testing, still unfamiliar in the civilian workplace, is not for everyone. There are important contractual and financial issues in many workplace settings when it comes to random testing. There is an important educational requirement before beginning random testing to be sure everyone in the company understands the system and how it works. Particular concern needs to be shown to non-using employees who inappropriately but understandably may fear identification of their use of legitimate medicines. Concems about the reliability of the entire drug testing system need to be dealt with fully.

Societal Implications of Random Drug Tests at Work

After two decades of dealing with the drug abuse epidemic, it is becoming increasingly clear that the drug abuse epidemic will end only when the demand for drugs dries up. The recent calls for drug legalization again point out the terrible incentive provided for illicit drug traffickers by the huge demand of the 14.5 million Americans who now use illicit drugs on a regular basis. Seventy percent of these current American users of illicit drugs are employed (DuPont, 1989c; DuPont and Goldfarb, 1990). If this nation is to achieve the goal of drug abuse prevention and dry up the demand for drugs, the first and best place to act is in the workplace. We can give a clear signal to Americans of all ages,races, and social classes: Using illicit drugs is incompatible with work. Random drug testing in the workplace is the best way to make this point.

REFERENCES

DuPont, R.L. (1984 ). Getting Tough on Gateway Drugs: A Guide for the Family. American Psychiatric Press: Washington, DC.

DuPont, R.L. (1989a). Drugs in the American workplace: Conflict and

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opportunity. Part I: Epidemiology of drugs at work. Social Pharmacology, 3 133-146.

DuPont, R.L. (1989b). Drugs in the American workplace: Conflict and opportunity. Part II: Controversies in workplace drug use prevention. Social Pharmacology, 3 147-164.

DuPont, R.L. (1989c). Never trust anyone under 40: What employers should know about drugs in the workplace. Policy Review, Spring 1989, 52-57

DuPont, R.L. (1989d). Workplace urine tests will cut drug use. Newsday, March 14, 1989.

DuPont, R.L. (1989e). A doctor's case for random drug tests. The Washington Times, March 27,1989.

DuPont, R.L. and Goldfarb, R.L. (1990). Drug legalization: Asking for trouble. The Washington Post, January 26, 1990.

DuPont, R.L. and Saylor, K.E. (1989). Urine Testing in Drug Treatment: Harnessing Technology to Promote Recovery. Institute for Behavior & Health, Inc.: Rockville, MD. (unpublished).

Hawks, R.L. and Chaing, C.N. (1986). Urine Testing for Drugs of Abuse. Research Monograph #73. National Institute on DrugAbuse: Rockville, MD.

National Institute on Drug Abuse (1989). Highlights of the 1988 National Household Survey on Drug Abuse. NIDA Capsules, August 1989.

National Institute on Drug Abuse, Office of Workplace Initiatives. (1989). Drugs in the Workplace: Research and Evaluation Data. DHHS publication number (ADM)89-1612, NIDA Research Monograph 91. National Institute on Drug Abuse: Rockville, MD.

Schottenfeld, R.S. (1989). Drug and alcohol testing in the workplace— objectives, pitfalls, and guidelines. Am J Drug Alcohol Abuse, 15 413527.

University of Michigan. (1989). Teen drug use continues decline, according to U-M survey. Cocaine down for second straight year; crack begins decline in 1988. University of Michigan, News and Information Services, Institute for Social Research: Ann Arbor. February 24,1989. (News release jointly with the Alcohol, Drug Abuse and Mental Health Administration and the National Institute on Drug Abuse.)

US. department of Health and Human Services. (1988). Mandatory guidelines for federal workplace drug testing programs. Federal Register, April 11, 1988.

Walsh, AM. and Gust, S.W. (Eds). (1989) Workplace DrugAbuse Policy. DHHS publication number (ADM)89-1610. National Institute on Drug Abuse, Office of Workplace Initiatives: Rockville, MD.

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