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Workplace drug testing: How is it changing?

Within 2 years, the Health and Human Services Mandatory Guidelines will make sweeping changes in nearly all aspects of regulated workplace drug testing. The new guidelines change the types of specimens used, the types of laboratories that can process them, and the type of information that can be determined. For laboratories, this may offer new opportunities to increase the bottom line.

"Right now in order to get a drug test, you go to a collection site to get the specimen collected and send the urine specimen to a laboratory. You have to wait for your result." said Yale Caplan, PhD, Director of National Scientific Services in Baltimore, MD.

This has been the standard procedure since 1988, but the revision in HHS guidelines will allow laboratories to test at the point of collection. Types of testing currently available range from hand-held kits to automated systems. "With point-of-collection testing, the negative test results will be available essentially immediately," said Caplan. "Nonnegative tests, which are less than 5% of the total number of tests, will still have to go to the laboratory for confirmation" and perhaps through a medical review officer to ascertain whether drug usage was medically justified.

According to Caplan, point-of-collection testing addresses the need of employers for staffing in the current era of low unemployment. He noted, "Typically, an individual who is seeking employment doesn't go one place. If you are going out to look for a job, you go to K-Mart, Wal-Mart, and five other similar places. If they all do drug testing, the first person who tests negative may get hired."

Caplan also noted, "Personally, I believe this is an opportunity for moderate-sized, good quality labs, to have lots of outreach programs." He expects some laboratories to set up screening labs to do point-of-collection testing. He thinks others will continue to confirm nonnegative tests. However, unlike the current lab regulations that are in effect, laboratories do not have to do both. Thus, the new regulations allow labs to pursue the 95% negative test market rather than maintain the specialized equipment required for confirmation of a nonnegative test.

The second important change will allow the testing of specimens other than urine. Proposed additional specimens include oral fluids, sweat, and hair. Caplan noted that the use of oral fluids avoids some of the problems associated with use of urine specimens. Oral fluids can be collected immediately and under direct observation. He stated that privacy issues cause urine collection to be monitored, but the actual collection is not observed. For this reason, there are always concerns about contamination, adulteration, or substitution.

Specimens other than urine better address additional concerns as well. For example, if an employer is seeking to hire employees who have not been exposed to drugs for at least several months before they are hired into the workplace, then human hair could be a very good specimen. Caplan commented, "Urine may be a very good specimen for random testing" because the specimen is not necessarily related to drugs that are currently affecting the body. "Following a work accident, however, oral fluids may be the best specimen because they are going to provide us with a closer association to drugs in an individual at the time of an accident"

When implemented, the guidelines will apply to the 20% of the workplaces that mandate regulated testing, such as the Department of Transportation, civilians in the nuclear regulatory area, etc. The other 80% of the drug testing in the workplace is not regulated, so effectively "anything goes." However, Robert L. Stephenson, Director of Division of Workplace Programs, Center for Substance Abuse Prevention, Substance Abuse in Mental Health Services Administration, in Rockville, MD, predicts the guidelines ultimately will be used as standards even for unregulated testing.

Stephenson commented, "My guess is, usually when you build a better mousetrap, that kind of adage...what you do is you create a model that works. You case law examples that are well defined. You have good and ongoing quality assurance. Others in the industry will find a reason to follow. That's been the experience of the last 10 years."

At press time, the third draft of the Mandatory Guidelines can be viewed online at Within the next 6 months they are likely to be officially published in The Federal Register. After that, the law requires that there be a public comment period and a review of the comments. Next will be a publication of a final rule, and then some time will elapse before the guidelines are actually implemented. Caplan remarked, "It's sort of on target to be completed by the end of next year."
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Title Annotation:Health and Human Services Mandatory Guidelines
Author:Hitchens, Kathy
Publication:Medical Laboratory Observer
Article Type:Brief Article
Geographic Code:1USA
Date:Feb 1, 2001
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