Drug Testing and Workplace Accidents
Paul Rountree, M.D.
Over the past twenty years the use of workplace drug tests have become commonplace. Both Hanson1 and Zwerling2 have presented excellent overviews of the history of drug and alcohol testing for industry in this country. At present approximately 35 million drug tests are performed each year at a direct cost exceeding one billion dollars. 3 This money is distributed among numerous parties within an enormous drug testing industry, and recipients include laboratories, third party administrators, medical review officers (MROs), substance abuse professionals (SAPs), specimen collectors, and others. Indirect costs of this effort are rarely contemplated and involve decreased productivity as a result of time lost for testing. Tests are typically performed before employment, after accidents, for suspicious behaviors, in a random fashion, or for follow-up of individuals with a history of drug use. It is estimated that companies with drug-testing requirements employ half of the American workforce. The vast majority of employees believe that these tests deter drug use. Most also believe that drug tests reduce accidents and product defects.4 There has always been a close relationship between safety concerns and workplace drug screening programs. Over the years several spectacular accidents have been associated with drugs. Proof of drug use was noted, for example, after the 1981 crash of an EA-6B Prowler on the USS Nimitz, the 1987 wreck of a Conrail/Amtrak train in Maryland, and the 1989 environmental disaster resulting from the Exxon Valdez incident. These episodes have highlighted concerns about job performance by impaired workers. Intuitively it would seem that drug use is associated with workplace accidents, and many drug-testing advocates have offered estimates of very high injury and fatality rates among involved employees,5, 6, 7 but most scientific authorities agree that there is little data regarding such a relationship.2,8, 9,10,,11 Few studies have been published about drugs and their association with on-the-job injuries because of several barriers. Accident rates of drug users are rarely compared with matched groups of non-users. Unlike a blood alcohol test, correlations between a positive urine test, a drug’s pharmacologic effect, and related levels of impairment are generally unknown. Studies about vehicular accidents note that 40-80% of drivers who have positive drug tests also are intoxicated with alcohol, 12 but many times employees involved in accidents on the job are not tested for alcohol or other legal drug use. In addition, several investigators have noted that drug and alcohol use is significantly lowered among work injury patients compared to non-work related injury victims. 13,14 Reports about drug use and accidents rarely determine causality or include consideration about variables such as time of day, weather conditions, or other circumstances that may be involved.
Personality traits obviously influence behavior. Sensation seeking activities have been associated with a number of risky jobs, sports, sexual activity, drug and alcohol use, reckless driving, and driving under the influence.15 Drug use may simply be a marker of a risk-taking behavior. One study of post-office workers, for example, noted a significantly increased relative risk of accident and injury among cigarette smokers, when compared to the non-smokers.16
Published Studies about the Relationship between Accidents and Drug Tests In Harris County, Texas, Lewis and Cooper reported on 196 fatal work-related injuries occurring between 1984-85. Of this group alcohol was detected in 13.3% of cases examined, and drugs capable of altering physiologic function in 7% of cases examined. Only one individual, however, was noted to have a positive illicit drug test.17 In 1989 Taggart described a dramatic decline in “personal injuries” associated with fewer positive tests in a railroad industry...
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