National Academies Press: OpenBook

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

Chapter: CHAPTER THREE Transportation Workplace Drug- and Alcohol-Testing Program

« Previous: CHAPTER TWO Background
Page 7
Suggested Citation:"CHAPTER THREE Transportation Workplace Drug- and Alcohol-Testing Program." 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.
×
Page 7
Page 8
Suggested Citation:"CHAPTER THREE Transportation Workplace Drug- and Alcohol-Testing Program." 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.
×
Page 8
Page 9
Suggested Citation:"CHAPTER THREE Transportation Workplace Drug- and Alcohol-Testing Program." 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.
×
Page 9
Page 10
Suggested Citation:"CHAPTER THREE Transportation Workplace Drug- and Alcohol-Testing Program." 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.
×
Page 10
Page 11
Suggested Citation:"CHAPTER THREE Transportation Workplace Drug- and Alcohol-Testing Program." 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.
×
Page 11
Page 12
Suggested Citation:"CHAPTER THREE Transportation Workplace Drug- and Alcohol-Testing Program." 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.
×
Page 12
Page 13
Suggested Citation:"CHAPTER THREE Transportation Workplace Drug- and Alcohol-Testing Program." 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.
×
Page 13
Page 14
Suggested Citation:"CHAPTER THREE Transportation Workplace Drug- and Alcohol-Testing Program." 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.
×
Page 14

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

5 CHAPTER THREE TRANSPORTATION WORKPLACE DRUG- AND ALCOHOL-TESTING PROGRAM Under 49 CFR Part 40, there is an important distinction between drug testing and alcohol testing. The drug-testing program is aimed at deterring use of illegal drugs, regard- less of the pattern and frequency of use in relationship to the job. The alcohol-testing program, in contrast, is a fitness-for- duty program aimed at preventing prohibited use of a legal substance while the employee is at work. REASONS FOR TESTING Pre-employment Drug and alcohol testing must be conducted before an employee’s first-time performance in a safety-sensitive posi- tion, either because of a transfer from a non–safety-sensitive position or because of a new job offer. The employee must pass the tests before safety-sensitive work can begin. Not all administrations require pre-employment alcohol testing. Postaccident The definition of “accident” varies by mode, but it is gener- ally interpreted as a series of connected events that result in death, injury, or damage to property. All administrations require that specimens for alcohol postaccident tests be col- lected within 8 h of the occurrence of the accident, and that specimens for drugs postaccident tests be collected within 32 h of the occurrence of the accident. Random Drug and alcohol testing must be conducted at random and without prior notification at predetermined rates, determined by the individual administrations on the basis of the random positive rates for the previous year. In general, the minimum annual percentage rate for random drug testing is 50% of covered employees; the random alcohol testing rate is 10%. These rates, however, are subject to review by the adminis- trators of each DOT agency. The administrator’s decision to increase or decrease the minimum annual percentage rate for random drug and alcohol testing is based, respectively, on the reported positive drug and alcohol violation rates for the entire industry. For drugs, when the minimum annual percentage rate for random drug testing is 50%, the administrator may lower this rate to 25% of all covered employees if the administrator determines that the data for the two preceding consecutive calendar years indicate that the reported positive rate is less than 1.0%. When the minimum annual percentage rate for random drug testing is 25%, and the data for the calendar year indicate that the reported positive rate is equal to or greater than 1.0%, the administrator will increase the min- imum annual percentage rate for random drug or random alcohol testing to 50% of all covered employees. For alcohol, when the minimum annual percentage rate for random alcohol testing is 25% or more, the adminis- trator may lower this rate to 10% of all covered employ- ees if the administrator determines that the data for two consecutive calendar years indicate that the violation rate is less than 0.5%. When the minimum annual percentage rate for random alcohol testing is 50%, the administrator may lower this rate to 25% of all covered employees if the administrator determines that the data for two consecu- tive calendar years indicate that the violation rate is less than 1.0% but equal to or greater than 0.5%. When the minimum annual percentage rate for random alcohol test- ing is 10%, and the data for that calendar year indicate that the violation rate is equal to or greater than 0.5%, but less than 1.0%, the administrator will increase the minimum annual percentage rate for random alcohol test- ing to 25% of all covered employees. When the minimum annual percentage rate for random alcohol testing is 25% or less, and the data for that calendar year indicate that the violation rate is equal to or greater than 1.0%, the administrator will increase the minimum annual percent- age rate for random alcohol testing to 50% of all covered employees. Note that not all DOT agencies are required to apply random alcohol testing regulations to the work- forces they regulate. Reasonable Suspicion Drug and alcohol testing must be conducted when a properly trained supervisor observes specific clues in an employee’s behavior and appearance that are associated with drug or alcohol abuse.

6 Return-to-duty Drug and alcohol testing (alone or in combination) must be conducted prior to an employee’s return to a safety-sensitive position following a positive test. Follow-up Drug and alcohol testing (alone or in combination) must be conducted at unannounced bases at least six times in the first 12 months following the return to a safety-sensitive position after a positive test. DRUG TESTING Specimen Collection Subpart E of 49 CFR Part 40 is dedicated to the collection of specimens. It is a detailed set of instructions, from the preliminary steps in the collection process to the shipping of the specimen to the laboratory. A urine specimen must be collected using chain of cus- tody procedures documented with the Federal Drug Test- ing Custody and Control Form (CCF). Specimen collection must be conducted by a trained individual using a standard collection kit. The collection begins with the collector completing Step 1 of the CCF. Precautions the collector must take to prevent tampering include dyeing the toilet water and asking the employee to show the contents of his or her pockets. The collector then instructs the employee to wash and dry his or her hands. The employee is not allowed to wash his or her hands again until after delivering the specimen. Employees are not allowed access to water or to materials that can be used to adulterate or dilute a specimen. A sealed or wrapped collection container is selected with both the employee and the collector present. The employee is then directed to go to the room used for urination and provide a specimen of at least 45 ml, not flush the toilet, and return the specimen as soon as he or she has completed the void. The collector must pay careful attention to signs that the employee is attempt- ing to tamper with the specimen. To prevent substitution, the room used for urination has a toilet tank with a blue dye in it. The collector inspects the specimen to ensure that it is of sufficient volume and acceptable temperature range (32°C−38°C or 90°F−100°F). The collector also checks for signs of tampering, such as unusual color, appearance, and odor of the specimen. If the collector suspects tampering, he or she may request that the employee provide a new speci- men under direct observation. Follow-up and return-to-duty tests require direct observation. Before sending the specimen for analyses, the collec- tor divides the specimen into two bottles, the first con- taining at least 30 ml of urine, the second containing at least 15 ml of urine. The two bottles are then sealed, dated, and sent to the laboratory for analyses with a copy of the completed CCF. Initial Test and Confirmation Test On arrival at the laboratory, each urine specimen must be tested twice. The initial immunoassay test is used to eliminate negative urine specimens from further consid- eration and to identify the presumptively positive speci- mens that require confirmation or further testing. The confirmatory test uses gas chromatography/mass spec- trometry (GC/MS) or liquid chromatography interfaced to (tandem) mass spectrometry (LC/MS or LC/MS/MS) to identify and quantify the presence of a specific drug or metabolite. Common Methods Used to Defeat the Drug-Testing Program As discussed earlier, the DOT drug-testing program has measures to determine whether the specimen is urine and whether the urine presents normal characteristics or has been adulterated. At the collection site, the urine is checked for proper temperature and unusual appearance. In some cases, direct observation of the specimen collection is required. At the laboratory, specimen validity testing is con- ducted to determine whether the specimen is consistent with normal human urine. In spite of these precautions, however, products aimed at “beating the test” continue to proliferate. In August 2010, a Google search on the phrase “beat a drug test” yielded 1,500,000 results. As of May 2005, the National Laboratory Certification Program identified more than 400 products that are marketed to beat a drug test. Earlier methods of beating the tests were crude and often ineffective. Over time, however, methods improved and a cottage industry developed, especially through the Internet. In general, many new products work when first introduced, but as they are detected, identified, and ultimately tested for, their use wanes, and they are replaced with newer formula- tions, repeating the cycle. Drug users can use three general approaches to beat the urine test: dilution, adulteration, and substitution. Each is discussed in the following sections, which, unless otherwise noted, are based in large part on the following publications: Jambor (2000), Caplan (2007), Dasgupta (2007), Bush (2008), and Jaffee et al. (2008). The reader is encouraged to refer to these publications for additional material.

7 Dilution The dilution and cleansing products are aimed at diluting the urine in the bladder (in vivo) to such an extent that the concentrations of tested illicit drugs fall below the estab- lished cutoffs. Dilution and cleansing products are available through various Internet sites, and even large retailers sell them, usually with product descriptions that tout the prod- ucts’ purported abilities without mentioning their likely purposes. These products—sold as teas, pills, gel caps, drinks, and chewable tablets—are usually to be consumed with large amounts of water 1 to 5 h before providing a urine specimen. In addition to selling products, some Internet sites also provide advice on how to beat the test. Drug users are advised to drink as much water as possible before the test and to take high dosages of aspirin, presumably because it may reduce the sensitivity of some urine tests. Donors are advised to never give the first urine of the morning. Taking of vitamin B-2 is advised to color the urine, likely to be clear from drinking the great quantity of water. Taking diuretics is also advised, from weak diuretics such as coffee, cranberry juice, certain health food products, and over-the-counter pills for premenstrual water retention, to potent diuretics like furosemide, which are available only with a prescription in the United States but can be purchased over-the-counter in Mexico. According to some websites, the diuretics can be detected in urine, but analyses of these drugs are rarely included in drug-testing programs not aimed at athletes. There is evidence that ingestion of large quantities of water can produce false negatives. Cone et al. (1998) exam- ined the effectiveness of two herbal products (Naturally Klean Herbal Tea and golden seal root), a diuretic medication (hydrochlorothiazide), and water (1 gal, 12 oz) as a means of passing a drug test. Subjects smoked a marijuana cigarette and insufflated cocaine and were randomly assigned to one of the treatments. Twenty-two hours after taking the drugs, subjects consumed their respective treatment. The herbal products, the diuretic medication, and the 1 gal of water were served in four 1-qt drinks at 1-h intervals. By the time the subjects drank 2 qt of any fluid, they were generally produc- ing false negatives. The ingestion of large quantities of water produced dilute specimens (creatinine concentration less than 20 mg/dl and specific gravity less than 1.003). Negative marijuana results rarely returned to positive after drinking the 1-gal treatments, but cocaine results reverted to positive after the dilution effects disappeared. Adulteration Adulteration additives are chemical compounds that are added to the urine after it is provided in the collection cup (in vitro). Types of additives range from common house- hold items to special formulations purposely developed to increase the probability of false negatives. Some act by inter- fering with the immunoassay detection scheme, others by converting the target drug to compounds that do not bind to the antibodies used in the immunoassay or that produce negative results in confirmation testing (Wu et al. 1999). The first type of adulterants were common household items such as bleach, vinegar, hand soap, drain cleaner, eye drops, lemon juice, table salt, and golden seal tea. Mik- kelsen and Ash (1988) set up an experiment to determine how these common household items affected urine drug tests. Solutions of several illegal and medicinal drugs were added to urine from a healthy drug-free individual. The results indicated that with the exception of lemon juice, all adulterants produced some false negatives, depending on the type of drug and adulterant concentrations. With the excep- tion of eye drops, however, all adulterants could be detected because they shifted urine characteristics outside of normal human range. Salt produced specific gravity values greater than 1.035; drain cleaner, bleach, and vinegar shifted pH val- ues; golden seal caused a dark appearance in the urine; and hand soap produced cloudiness in the specimen. The effects of eye drops on urine drug tests were fur- ther examined by Pearson et al. (1989). Solutions of several illegal and medicinal drugs in isotonic saline were added to drug-free urine. Eye drop solution was added in various con- centrations to each specimen before analyses. Eye drop solu- tion produced false negatives only for marijuana and only in some concentrations, and it was not detectable by rou- tine urine analyses. The lowering of tetrahydrocannabinol (THC) in the specimen could be accounted for by two com- ponents, benzalkonium chloride and borate, which reduced the availability of the drug to be tested by increasing the attraction of 9-carboxy-THC to the walls of the glass tubes. Glutaraldehyde was the active ingredient in some of the first commercially available products marketed to beat the urine drug tests (UrinAid, Clear Choice). It interferes with screening immunoassays by producing final absorbance rates readings for amphetamines, cocaine metabolites, can- nabinoids, opiates, and phencyclidine that are lower than true negative urine specimens (Goldberger and Caplan 1994; Wu et al. 1994). Products with hydrochloric acid, such as Amber 13, THC Free, and an early version of Urine Luck, were marketed next. They did interfere with some immunoassays, often resulting in false negatives. However, because of their acid- ity, they could be easily detected. In late 1996, products with nitrates became common (Klear, Whizzies, Randy’s Clear). Nitrates did not appear to have a large effect on immunoassays, but they did produce false negatives for marijuana in the confirmatory (GC/MS) tests (Tsai et al. 1998; Wu et al. 1999). Nitrates can naturally

8 occur in human urine, but at much lower levels than those resulting from adulteration (Urry et al. 1998). Pyridinium chlorochromate (PCC) was the active ingredi- ent of the next generation of adulterants (Urine Luck). Wu et al. (1999) conducted a series of studies to determine the condi- tions under which PCC interfered with the screening and con- firmation analyses of illegal drugs. PCC was added at three concentrations to urine specimens positive for methamphet- amine, cocaine, opiates, phencyclidine, and marijuana. The adulterated specimens were tested with two immunoassays and GC/MS. Results indicated that PCC affected response rates as a function of immunoassay, type of drug, and PCC concentration. In general, however, intermediate and high concentrations of PCC resulted in lower detection of opiates and marijuana with both immunoassays and GC/MS. Urine Luck was reformulated by dropping the pyridinium ion, making chromium (VI) (chromate) the active ingredi- ent. The new formulation had effects similar to the previ- ous one, a positive screen and negative confirmation result for THC. Paul and Jacobs (2002) investigated the effects of chromate and other oxidizing agents on the GC/MS test for tetrahydrocannabinol carboxylic acid (THCA). They found that, when treated with chromate, THCA was lost com- pletely in the specimen. Another chromium-based product is Ultra Kleen. In 2001, Cody and Valtier reported the effects of Stealth, an adulterant sold in two vials, one containing peroxidase and the other peroxide. The user pours the content of one vial into the collection cup, adds urine, and then adds the con- tents of the second vial. The combination of the two chemi- cals creates a strong oxidant in the urine. Stealth was found to cause immunoassay false negatives for marijuana, LSD, and morphine. The effects of several oxidants, including iodine (a halo- gen, with fluorine, chlorine, and bromine) were examined by Paul and Jacobs (2005). Iodine was found to destroy morphine and 6-acetylmorphine almost immediately. The effects were less evident on THCA. Substitution Some donors substitute their urine, which would presumably result in a positive test, with urine that is clear of drugs and that, if undetected, would result in a negative test. The drug- free urine, natural or synthetic, is sold in containers and can be frozen for up to 1 year. At the time of collection, the drug- free urine must be warmed to body temperature and trans- ferred to the collection cup. To avoid detection even under direct observation, the drug-free urine is transferred through a hose (the Urinator) or fake penis (the Whizzinator), which can be purchased to match the color of the skin of the donor. The Whizzinator received media coverage in May 2005 after a professional football player was caught with one in an airport. A month later, the player was suspended by the NFL for substance abuse. In October 2008, federal prosecutors won a 19-count indictment against the maker of the Whizzi- nator for fraud and selling drug paraphernalia. Prosecutors alleged that by manufacturing and selling the Whizzinator, the company’s president and vice president conspired to defraud the Substance Abuse and Mental Health Services Administration. In November 2008, the two individuals pleaded guilty in federal court to one count of conspiracy to defraud the government and one count of conspiracy to sell drug para- phernalia. In April 2010, one man was sentenced to 6 months in federal prison followed by 3 years of supervised release; the other was sentenced to 3 years’ probation (Burris 2010). Their company was forced to shut down and the website used to sell the product has been closed. The next generation of the Whizzinator, however, can still be purchased online. It has been marketed as paraphernalia for urolagnia. It can be noted, however, that to combat substitution under observed collection, the observer gives instructions to the donors to raise their clothing above the waist, lower clothing and underpants, and to turn around to permit the observer to determine the presence of a prosthetic or other device that could be used to interfere with the collection process. Specimen Validity Testing (SVT) In the DOT drug-testing program, measures are in place to determine whether a specimen is urine, whether the urine presents normal characteristics, or whether it has been adulterated. Normal Urine Characteristics In healthy humans, urine has specific physical characteris- tics: temperature, color, clarity, odor, and foaming proper- ties. It also has specific chemical characteristics: creatinine, specific gravity, and pH. Urine temperature is typically 90°F–100°F (32°C–38°C) within 4 min of collection. Temperatures outside this range may be an indication that a substitute sample was used. The color of urine depends on several factors. A first morning void has a deep yellow color. After hydration, the urine becomes dilute, and it is a pale yellow. Very dilute urine is almost colorless. A normal urine specimen is clear and transparent. Bac- teria, blood, sperm, crystals, or mucus can make urine look cloudy.

9 A specimen is substituted when • The creatinine concentration is less than 2 mg/dl and the specific gravity is less than or equal to 1.0010 on both the initial and confirmatory tests on two separate aliquots, or • The creatinine concentration is less than 2 mg/dl and the specific gravity is greater than or equal to 1.0200 on both the initial and tests on two separate aliquots. A specimen is adulterated when • The pH is less than 3 or equal to or greater than 11; • The nitrite concentration is equal to or greater than 500 mcg/ml (two different tests required); • The chromium (VI) concentration is equal to or greater than 50 mcg/ml (two different tests required); • The presence of halogen (e.g., bleach, iodine, fluoride) is detected and confirmed, with a specific halogen con- centration equal to or greater than the limit of quanti- tation (LOQ) of the confirmatory test on the second aliquot (two tests required); • The presence of glutaraldehyde is detected and con- firmed, with the glutaraldehyde concentration equal to or greater than the LOQ of the confirmatory test on the second aliquot (two tests required); • The presence of pyridine (pyridinium chlorochromate) is detected and confirmed, with a concentration equal to or greater than the limit of detection (LOD) of the con- firmatory test of the second aliquot (two tests required); • The presence of a surfactant is detected and confirmed, with a concentration equal to or greater than 100 mcg/ ml dodecylbenzene sulfonate-equivalent cutoff con- centration on the second aliquot (two tests required); or • The presence of any other nonspecified adulterant is verified using an initial test on the first aliquot and a different confirmatory test on the second aliquot. A specimen is invalid when • Creatinine concentration and specific gravity are inconsistent with normal human urine; • pH is equal to or greater than 3 and less than 4.5; • pH is equal to or greater than 9 and less than 11; • The nitrite concentration is equal to or greater than 200 mcg/ml but less than 500 mcg/dl; • There is general oxidant activity that cannot be accounted for by identifying a specific agent; or • A urine specimen does not meet the criteria for dilute, substitute, or adulterated but clearly is not normal. Detection of Tampering An important distinction must be made at this point between detection of tampering and prevalence of tampering. Detec- tion of tampering is obtained through SVT. If SVT were Typically, dilute urine has little to no odor. The smell of urine can be affected by the consumption of foods and bev- erages such as asparagus, curry, alcohol, coffee, turkey, and onion. Abnormal urine odors can be caused by urinary tract disorders, diabetes, and E. coli bacteria infection. Urine foaming can be a sign of protein in the specimen. Normal urine foaming does not have the rainbow appear- ance that is typical of soap adulteration. Creatinine is a waste product formed by the break- down of creatine, a nitrogenous organic acid that helps to supply energy to muscle. Creatinine is filtered out of the blood by the kidneys and then is passed out of the body in urine. Normal creatinine concentrations are greater than 20 mg/dl. Specific gravity assesses the amount of substances in the urine. The higher the specific gravity, the more solid material is in the urine. Normal values are between 1.0020 and 1.0200 (Caplan 2007), depending on fluid intake and hydration. pH is a measure of urine acidity or alkalinity. A urine pH of 4 is strongly acidic, 7 is neutral, and 9 is strongly alkaline. Types of Validity Tests Laboratories must conduct the following validity testing of the specimen: • Determine the creatinine concentration on each pri- mary specimen. Determine its specific gravity if the creatinine concentration is less than 20 mg/dl. • Determine the pH of each primary specimen. • Perform one or more validity tests for oxidizing adul- terants on each primary specimen. • Perform additional validity tests on the primary speci- men when the following conditions are observed: – Abnormal physical characteristics, – Reactions or responses characteristic of an adulter- ant obtained during initial or confirmatory drug tests (e.g., nonrecovery of internal standards, unusual response), or – Possible unidentified interfering substance or adulterant. • If it is determined that specimen is invalid, send to a second laboratory for additional analyses. Validity Tests Criteria A specimen is dilute when • The creatinine concentration is greater than or equal to 2 mg/dl but less than 20 mg/dl, and • The specific gravity is greater than 1.0010 but less than 1.0030 on a single aliquot.

10 TABLE 1 ANNUAL NONNEGATIVE RATES (%) BY VALIDITY TESTING CATEGORY Specimen Validity Test Category 2005 2006 2007 2008 2009 Acid-Base 0.01 0.00 0.01 0.020 0.03 Invalid 0.12 0.12 0.11 0.11 0.09 Oxidizing Adulterants 0.00 0.00 0.00 0.00 0.00 Substitution 0.05 0.05 0.05 0.05 0.06 TABLE 2 SPECIMENS BY TAMPERED OR REJECTED STATUS FOR U.S.DOT SAFETY-SENSITIVE WORKFORCE Test Category 2008 (July–December) 2009 (Full Year) 2010 (January–June) Total Results 2,850,106 5,163,165 2,662,335 Tampered 5,106 8,421 3,948 Percentage Tampered 0.18 0.16 0.15 Rejected 4,636 7,106 3,484 Percentage Rejected 0.16 0.13 0.13 Vulnerabilities of DOT Drug Testing A 2007 GAO report described an undercover operation that revealed significant vulnerabilities in the DOT’s drug-testing program. GAO investigators created two fictitious trucking companies and produced bogus commercial drivers’ licenses using software and hardware available on the market to the general public. The undercover investigators reported to urine collection sites pretending to have been selected by their 100% effective in detecting tampering, then the prevalence of tampering would equal the rate of detection. In reality, of course, SVT is not 100% effective in detecting tamper- ing, and the true measure of prevalence of tampering is unknown. It can be noted that as part of a report on motor carrier safety by the U.S. Government Accountability Office (GAO 2008), eight undercover investigators provided spec- imens that were adulterated or substituted, and none was detected with SVT. The relationship between the detection of tampered specimens and the prevalence of tampered specimens can be viewed in two competing ways. The first is that drug test takers are becoming more sophisticated and more successful in their methods of beating the test. The second view is that SVT has become increasingly effective in detecting tam- pered specimens. In this report, this view of the relationship was adopted. Thus, when a reduction in detection is referred to, it also implies a reduction in prevalence. Table 1 reports the annual nonnegative rates by validity testing category for the federally mandated, safety-sensitive workforce from one large-scale laboratory (Quest Diagnos- tics, September 2010). Table 2 reports the annual tampered or rejected specimens for the DOT safety-sensitive work- force (Swart, personal communication, Nov. 22, 2010). Figure 1 shows the adulterated, substituted, and invalid specimens as a percentage of tampered specimens (Swart, personal communication, Nov. 22, 2010). Note that the per- centage of invalid specimens has declined over the past 3 years, whereas the percentage of substituted and adulterated specimens has increased. FIGURE 1 Substituted, adulterated, and invalid specimens as a percentage of all tampered specimens for the U.S.DOT safety-sensitive workforce.

11 combat adulteration and substitution, it would be useful to conduct similar undercover investigations on a regular basis to determine whether failure rates are decreasing over time. Table 3 reports the failure rates for the DOT protocols included in the investigation. Classes of Drugs Laboratories must test for the following five drugs or classes of drugs in a DOT drug test. DOT specimens cannot be tested for any other drugs. • Marijuana metabolites, • Cocaine metabolites, • Amphetamines, • Opiate metabolites, and • Phencyclidine (PCP). Cutoff Concentrations In 2010, to harmonize DOT drug-testing requirements with those of DHHS, DOT amended certain provisions of its drug- testing procedures. In general, among other changes, DOT procedures now require initial testing for methylenedioxymeth- amphetamine (MDMA); confirmatory testing for MDMA, methylenedioxyamphetamine (MDA), and methylenedioxyeth- ylamphetamine (MDEA); initial testing for 6-acetylmorphine; lower initial test and confirmatory test cutoff concentrations for amphetamines; and lower initial test and confirmatory test cutoff concentrations for cocaine. Table 4 reports the current cutoff concentrations for initial and confirmation tests. companies for drug testing. Twenty-four sites were selected throughout the United States. At each collection site the inves- tigators tested 16 specific DOT protocols. Eight of the 24 urine specimens were either adulterated or substituted. The results indicated that 22 of the 24 sites showed varying degrees of failure to comply with DOT protocols. In addition, none of the eight adulterated or substituted specimens were detected. Interestingly, the GAO did not count these instances as violations of protocol because the collectors were not required to validate the identity of the employees, but only to ensure that employees presented identification (GAO 2007). TABLE 3 FAILURE RATES FOR SELECTED DOT PROTOCOLS TESTED BY GAO Selected DOT Urine Specimen Collection Protocol Percentage of the 24 Collection Sites That Failed Secure the facility from all substances that could be used to adulterate or dilute the specimen 75 Secure all sources of water in the restroom 67 Ask the employee to empty his/her pockets and dis- play items to ensure that no items are present that could be used to adulterate the specimen 42 Check the temperature of the specimen 19 Place a bluing agent in the toilet or secure it with tape 17 Although the GAO investigation is now 3 years old, and new procedures have been implemented since then to TABLE 4 CURRENT CUTOFF CONCENTRATIONS FOR INITIAL AND CONFIRMATION TESTS Initial Test Analyte Initial Test Cutoff Concentration (ng/ml) Confirmatory Test Analyte Confirmatory Test Cutoff Concentration (ng/ml) Marijuana Metabolites 50 THCAa 15 Cocaine 150 Benzoylecgonine 100 Opiate Metabolites Codeine/Morphineb 6-Acetylmorphine 2,000 10 Codeine Morphine 6-Acethylmorphine 2,000 2,000 10 Phencyclidine 25 Phencyclidine 25 Amphetaminesc Amphetamine/Methamphetamined MDMAf 500 500 Amphetamine Methamphetaminee MDMA MDAg MDEAh 250 250 250 250 250 a Delta-9-tetrahydrocannabinol-9-carboxylic acid. b Morphine is the target metabolite for codeine/morphine testing. c Either a single initial test kit or multiple initial test kits may be used, provided the single test kit detects each target analyte independently at the specified cutoff. d Methamphetamine is the target analyte for amphetamine/methamphetamine testing. e To be reported positive for methamphetamine, a specimen must also contain amphetamine at a concentration equal to or greater than 100 ng/ml. f Methylenedioxymethamphetamine. g Methylenedioxyamphetamine. h Methylenedioxyethylamphetamine.

12 Reporting of Results All drug test results fall into one of three categories: 1. Negative results a. Negative b. Negative-dilute, with numerical values for creatinine and specific gravity 2. Nonnegative results a. Positive, with drug metabolites noted b. Positive-dilute, with drug metabolites noted, with numerical values for creatinine and specific gravity c. Adulterated, with adulterants noted d. Substituted, with confirmatory values for creatinine and specific gravity e. Invalid 3. Rejected for testing Medical Review Officer Laboratories send the drug test results to the medical review officer (MRO), a licensed physician. The MRO is the gate- keeper of the drug-testing program, responsible for verify- ing the laboratory test results and determining whether there may be a legitimate medical reason for a positive drug test or whether the employee has committed a rule violation. The MRO can evaluate explanations for certain drug results and, under certain circumstances, has the authority to downgrade a result from positive to negative. MROs must meet stringent qualifications and must submit to requalification examina- tions every 5 years. MROs must keep negative and cancelled results for 1 year and nonnegative results for 5 years. ALCOHOL TESTING Although alcohol is a legal drug, there is no legitimate medi- cal explanation for alcohol in one’s system. Thus, MROs have no role in alcohol testing. Alcohol tests can be administered for the same reasons as drug tests: pre-employment, random, reasonable suspicion, postaccident, return-to-duty, and follow-up. Random alco- hol testing is not required under some DOT administrations. As for the drug tests, a dual-test procedure is used to determine whether an employee has prohibited alcohol concentrations in the system. The initial test can use either saliva or breath. If the initial test is positive, only breath can be used in the confirmation test to assess the level of alcohol in the system. An alcohol concentration of 0.040 and above is a positive test, and a violation of DOT regulations. An alcohol concentration between 0.020 and 0.039 is prohibited conduct, and the employee is removed from safety-sensitive work while in that alcohol concentration range. CONSEQUENCES OF A DRUG OR ALCOHOL VIOLATION An employee must be immediately removed from perform- ing safety-sensitive functions if any of the following condi- tions occur: • A verified positive drug test result. • An alcohol test result of 0.040 or higher. (An employee must also be immediately removed from safety-sensi- tive duties with a blood alcohol content (BAC) of 0.020 or higher, although a regulatory violation occurs only at the 0.040 level.) • Refusal to take the test, including verified adulterated or substituted drug test results. • Violation of DOT agency drug and alcohol regulation. • Employees with a drug or alcohol violation are not eli- gible to return to safety-sensitive work unless they suc- cessfully complete the return-to-duty requirements. SUBSTANCE ABUSE PROFESSIONAL The substance abuse professional (SAP) evaluates employ- ees who have violated DOT drug and alcohol regulations and makes recommendations concerning education, treat- ment, follow-up testing, and aftercare. The SAP must have one of the following credentials: licensed physician, licensed or certified social worker, licensed or certified psychologist, licensed or certified employee assistance professional, state licensed or certified marriage and family therapist, or certi- fied drug and alcohol counselor. The SAP must be knowl- edgeable about and have clinical experience in the diagnosis and treatment of alcohol- and controlled substances-related disorders, must be knowledgeable about the SAP function as it relates to employer interests in safety-sensitive duties, and must be knowledgeable and keep current on 49 CFR Part 40 and the various agency regulations. RECORDS The testing laboratory is required to maintain all records per- taining to each employee urine specimen for a minimum of 2 years. The MRO must keep negative and cancelled results for 1 year and positive results and refusals for 5 years. The SAP is required to maintain copies of the reports to employ- ers for 5 years. The look-back period that an employer must check on the drug- and alcohol-testing record of employees it is intending to use to perform safety-sensitive duties is 2 years (with exceptions for motor carriers and aviation).

Next: CHAPTER FOUR Specific Regulations by Mode »
Operator Drug- and Alcohol-Testing Across Modes Get This Book
×
 Operator Drug- and Alcohol-Testing Across Modes
Buy Paperback | $45.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

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.

READ FREE ONLINE

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!