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41 CHAPTER SEVEN SUMMARY AND RESEARCH RECOMMENDATIONS Currently, the U.S.DOT regulates the largest drug- and alco- In general, drug positivity rates for the general U.S. work- hol-testing program in the world. In general, the drug-testing force, the federally mandated, safety-sensitive workforce, program is aimed at deterring use of illegal drugs, and the and the DOT-only workforce have been declining over time. alcohol-testing program is aimed at preventing prohibited From 2008 to 2010, the drug positivity rate for the DOT-only use of a legal substance while the employee is at work or workforce declined from 1.64% to 1.49%. In 2008, the alco- within a short period of time before reporting for work. Drug hol positivity rate for the DOT-only workforce was 0.002%. and alcohol testing may be conducted under six conditions: pre-employment, postaccident, at random, under reasonable Across modes, pre-employment, random, and reasonable suspicion (and, for railroads, for cause), on return-to duty cause tests resulted in the highest number of positive tests. after a positive test, and follow-up. In all modes, the type of tests with the highest positivity rate was reasonable cause/suspicion. Marijuana was the most Since the inception of the program, a game of cat and commonly detected drug. mouse has unfolded, with a cottage industry selling products aimed at defeating the drug tests. The three most common An attempt was made to contact companies in the DOT- methods of defeating the drug test are dilution, adultera- regulated community to identify the current best practices tion, and substitution. Many new products work when first used to deter illegal drug and alcohol use among employees. introduced, but as they are identified and detected their Only a few of the companies contacted agreed to provide use wanes, and they are replaced with newer formulations, information. These tended to be medium- and large-sized repeating the cycle. companies, and it is unlikely that their responses are rep- resentative of the entire industry, because small companies Specimen validity testing (SVT) is a set of laboratory tend to not have as extensive alcohol and drug testing pro- analyses and procedures aimed at detecting whether a speci- cedures. Nonetheless, the information they provided was men is diluted, adulterated, or substituted. The usefulness useful for the purposes of this project. They identified the of SVT depends on the ability to identify and detect the following strategies as being currently in use or in the pro- tampering. SVT appears to be effective in reducing tam- cess of being deployed. pering, with the overall percentage of specimens identified as tampered being relatively low and declining over time. Zero-tolerance policies require that employees with Some vulnerabilities, however, especially the adherence to positive alcohol or drug tests are immediately removed specimen collection procedures at the collection sites, may from the safety-sensitive position and are not immedi- continue to weaken the program. ately given a second chance to return to that position. Pre-employment alcohol screening, which is not The DOT drug-testing program requires laboratories to mandated by DOT, can be an effective and inexpensive test for five types of drugs: marijuana, cocaine, amphet- way to identify applicants who most likely have alcohol amines, opiates, and phencyclidine. The cutoff concentra- addiction and cannot abstain from alcohol. tions of the different analytes for the initial test and the Pre-employment background check periods range confirmatory test have been updated recently to harmonize up to 5 years instead of the mandated 2 or 3 years. the DOT requirement with those of the U.S. DHHS. Analysis of alternative specimens, especially hair, for pre-employment tests. Because hair analysis has To comply with DOT requirements, each DOT agency a larger detection window than urine analysis, it results must specify aspects of its drug- and alcohol-testing pro- in higher positivity rates for amphetamine/metham- gram not directly covered in the Code of Federal Regula- phetamine, cocaine, and marijuana, the most com- tions (49 CFR Part 40). We summarized how each agency monly detected drugs in both types of analyses. defines the employees in safety-sensitive work who need to Higher company-set random testing rates increase be tested, the minimum annual percentage rates for random the deterrent value of the drug and alcohol program drug testing, and record retention periods. and make it unlikely that the company will not comply with the DOT-mandated random test rates.

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42 Longer preduty alcohol abstinence periods are meant to with general knowledge related to drug impairment. It is decrease the likelihood of the employee being under the a 16-h training course. The development of such training influence of alcohol prior to the beginning the work shift. would require time and effort and would have to be tailored Stricter consequences for blood alcohol contents to the specific needs of the regulated community, with input (BACs) between 0.020 and 0.039 are consistent with likely required from DOT, TAP, industry representatives, what is currently known about the effects of alcohol on and labor unions. human performance, even at low BACs, and are meant to signal a company's low tolerance for violations of In this synthesis, the distinction was made between preduty abstinence periods. detection of drug use and detection of impairment. The Stricter postaccident testing reduces the time elapsed current DOT drug-testing program is aimed at detec- between an accident and the subsequent required alco- tion of illegal drug use. However, it may be beneficial hol and drug testing. If the employee involved in the to expand the purpose of testing to include detection of accident was under the illegal influence of alcohol or impairment by all drugs that are known to negatively drugs, this increases the probability of a positive test. affect human performance and that are empirically Stricter follow-up testing procedures increase the fre- linked to reductions in transportation safety. quency of tests following a positive test, the duration of the testing period, or both. The shift in emphasis is fraught with difficulties. First, Access to a national database would ensure that drivers drugs that are current and emerging threats to transportation who test positive and/or refuse a DOT test are in com- safety have to be identified. Studies must be conducted in pliance with the substance abuse professional require- the laboratory and in the field to identify drugs that clearly ments before returning to a safety-sensitive function reduce transportation safety. Those studies, especially field by making their results available to prospective motor studies, such as casecontrol studies, require large sampling carriers when performing background checks. Such a populations, are methodologically complex, and are expen- database is expected to be implemented by FMCSA the sive. However, the identification of such drugs hinges on end of 2012. integration of knowledge from previous research and invest- Driving record notations are retained for drivers who ment in future projects. test positive in a drug or alcohol test for a pre-deter- mined period, usually 2 to 3 years. Second, the analytical cutoffs of testing must be estab- lished. Impairment-based regulations for drugs that have Based on the results of the synthesis, the following research legal use require criteria above which the levels of risks recommendations were made: outweigh the benefits. For any medicinal drug, the criterion must separate normal use of the drug (i.e., within the pre- Given the high positivity rate for reasonable-cause scribed dose) and the illegal or improper use of that same tests with relatively limited supervisor training, it may drug. Establishment of that criterion must be based on the be useful to investigate whether additional supervi- empirical evidence of the doseeffect relationships in a sor training would result in higher detection rates for majority of the user population. reasonable-cause tests. To that end, it may be pos- sible to develop a training program that would allow Third, the approach requires the integrated dissemination a deeper and wider understanding of the observable of information in different groups outside of DOT. Physi- signs and symptoms of illegal alcohol (BAC > 0.040) cians and pharmacists must make informed decisions on and drug use. Such training could be based on the prescribing and dispensing medications that are impairing Advanced Roadside Impaired Driving Performance to patients in safety-sensitive positions; medications must be (ARIDE) program developed by the National Highway properly labeled as impairing, using an easy-to-understand, Traffic Safety Administration with input from the graded-level warning system; and employees must learn to International Association of Chiefs of Police Technical identify their own signs and symptoms of impairing drugs. Advisory Panel (TAP) and the Virginia Association of These difficulties notwithstanding, the shift in empha- Chiefs of Police. sis from detection of illegal drug use to detection of drug impairment is likely to have beneficial effects on transporta- ARIDE was created to address the gap in training tion safety. between the Standardized Field Sobriety Testing (SFST) and the Drug Evaluation and Classification (DEC) program. The As previously discussed, some researchers assert that SFST program trains officers to identify and assess drivers the inherent drawbacks of hair testing preclude it for suspected of being under the influence of alcohol, and the use in the workplace, where accuracy and fairness in DEC program provides more advanced training to evaluate employment decisions are paramount, whereas other suspected drug impairment. ARIDE is intended to bridge researchers assert that the main analytical problems the gap between these two programs by providing officers have been adequately resolved and it is important that

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43 hair be preferentially chosen for pre-employment and prospective data. One potentially useful set of studies would random tests. Some companies in the regulated com- compare drug positivity rates for different matrices between munity, however, have been routinely using hair for groups of men and women with different shades of hair pig- the purpose of pre-employment tests. Thus, a situa- mentation and racial background. For each drug of interest, tion has arisen in which market forces within a portion the participants would be casual drug users who would agree of the regulated community have selected hair as the to abstain for a period of time of sufficient duration for them matrix of choice for pre-employment tests but DOT to be verifiably clear of drugs prior to participation in the regulations allow urine only for purposes of workplace study and who would agree to abstain for a minimum of 90 drug testing. days following participation in the study. During the study, participants would be administered different doses of a sin- The controversy on hair testing may be resolved on the gle drug under controlled conditions. The doses would vary basis of empirical data. To that end, an appropriate number from zero (placebo) to the average street dose for that drug. of studies would need to be conducted to examine the unre- Blood, urine, hair, sweat, and saliva analyses would then solved issues. It would be particularly important that the be conducted at regular intervals for a minimum of 90 days issue of external contamination be examined using state-of- from the administration of the drug. Such studies would the-art analytical procedures, including wash criteria. have to be carefully designed and executed, paying particu- lar attention to the welfare of the participants, the quality Because retrospective data are potentially unsuitable for of collection procedures and analyses, and the overarching drug studies, the issue of race bias may be examined with ethical and legal issues involved in such research.