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Operator Drug- and Alcohol-Testing Across Modes (2012)

Chapter: CHAPTER SEVEN Summary and Research Recommendations

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Suggested Citation:"CHAPTER SEVEN Summary and Research Recommendations." National Academies of Sciences, Engineering, and Medicine. 2012. Operator Drug- and Alcohol-Testing Across Modes. Washington, DC: The National Academies Press. doi: 10.17226/14635.
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Suggested Citation:"CHAPTER SEVEN Summary and Research Recommendations." National Academies of Sciences, Engineering, and Medicine. 2012. Operator Drug- and Alcohol-Testing Across Modes. Washington, DC: The National Academies Press. doi: 10.17226/14635.
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Page 44
Page 45
Suggested Citation:"CHAPTER SEVEN Summary and Research Recommendations." National Academies of Sciences, Engineering, and Medicine. 2012. Operator Drug- and Alcohol-Testing Across Modes. Washington, DC: The National Academies Press. doi: 10.17226/14635.
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Page 45

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

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

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

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TRB’s Commercial Truck and Bus Safety Synthesis Program (CTBSSP) Synthesis 23: Operator Drug- and Alcohol-Testing Across Modes explores practices used to deter drug and alcohol use among operators within the U.S. Department of Transportation’s (DOT’s) regulated community.

The report includes a brief history of the transportation workplace drug- and alcohol-testing program, the general approach, the reasons for testing, some of the issues that impact the validity of the tests, and an outline of the specific regulations by mode.

Some alcohol- and drug-testing statistics are presented in the report to help provide a sense of the scope of the program and of the prevalence of illegal alcohol and drug use among safety-sensitive employees.

The report also highlights alternative strategies aimed at helping to deter illegal alcohol and drug use among employees.

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