Employer Considerations for Drug Testing, Part 2: Drug Testing Methods
The second part of Employer Considerations for Drug Testing (Link to Part One here) has to do with the methods you would use to enforce your drug testing policy. A quick online search shows a wide array of options from the type of specimen to collect to who will collect and how the testing is to be conducted. This blog entry is to provide you with a quick guide to help you make informed decisions about each step of the process. (Please note that the methods discussed here mostly pertain to non-regulated (NDOT) drug testing.)
A typical drug test involves the three steps below.
Collection – Testing – Results
A donor provides the sample (see specimen type considerations) for the drug test. The samples are subject to an initial screen and non-negatives (above cut-off levels/ presumptive positives) are confirmed by gas chromatography/mass spectrometry (“GC/MS”).
In the event a sample has non-negative results after the confirmation screen, a Medical Review Officer will make attempts to interview the donor regarding results and gather further information (e.g. Can donor provide prescription information as evidence of prior or existing drug intake, etc). The MRO will then release the results to the employer based on their findings.
Method Considerations for Drug Testing
- Specimen Type
Drug use is often traced using one of the following specimen types: urine, saliva (oral), hair, blood or sweat. Each specimen type comes with differing thresholds and detection periods; therefore, employers need to weigh the advantages of one specimen type over another based on their business needs. Urine drug testing has long been regarded as the “standard” for drug testing; while saliva (oral) and hair testing are increasingly coming to the forefront due to their less invasive nature. Some employers prefer oral swab testing as it can detect certain drug use within hours while some employers prefer the wide detection period offered by hair testing to check for patterns of drug use. Blood is usually the method of last resort as it is highly invasive and a very expensive method of testing.
- Lab-Based or Instant Drug Testing
One of the major decisions an employer has to make when implementing their drug testing policy is to decide whether they will conduct lab-based drug testing or instant (sometime called on-site) testing. Lab-based testing is done when the collected specimen in sent to a testing facility for both initial and confirmation testing. Many employers choose this method as they do not have the internal know-how to properly collect and test specimens and they simply prefer to fully outsource the function of drug testing. This lab-based testing of urine samples closely resembles DOT requirements and has become the best practice for non-regulated drug testing.
While lab-based testing is a tried and true method for drug testing, instant /on-site tests are becoming increasingly popular due to their low cost and quick results. There is wide availability of instant testing devices that allow employers to collect the specimens on their own and read the results on the testing strips built into the testing cups or dipped into the sample, much like how pregnancy tests work. While this option provides the employer with a quick and low-cost solution for screening, instant tests are only meant to perform the initial screen. Any non-negatives must be sent to a testing laboratory for confirmation. Employers also must consider the human error involved with their own staff performing the tests and manually reading the results from the testing strips. Also note that instant tests are not available for all specimen types mentioned above.
- Testing Panel
You will need to decide the drugs you will test your employees for. Your drug panel should be determined based on your business needs; and if there are any federal or state requirements that dictate the panel. Many labs and instant device manufacturers create standard testing panels that include the SAMHSA 5, 7 and 9 panels; labs can also customize testing panels for you. Many employers choose the SAMHSA 5 that includes the commonly abused street drugs; however you may opt to expand your testing panel if you are in an area that has a high number of prescription medication abuse, or if you are in the healthcare industry where employees may have access to strong medication without prescription. Do note that not all instant tests can accommodate any combination of testing panels and therefore your panel may be limited by your preferred specimen type.
- Medical Review Officers
A best practice recommendation for all employers who conduct drug testing is to enlist the services of a Medical Review Officer (MRO) in the event of a non-negative drug screen result. MROs are licensed physicians who determine if a legitimate explanation exists for any non-negative drug tests. Having MROs review lab results ensures the drug test was properly performed before an adverse result is released to the employer. It also protects the employee from disclosing medical information not be related to the drug test result yet may adversely affect a hiring decision.
Using a Third Party Administrator
Drug testing is a highly fragmented process that can involve different providers to assist with supplies, collections, testing and MRO review. All these players can make tracking a result difficult; and even more complicated when they start invoicing you for their services. As an employer, you have the option of choosing a Third Party Administrator (TPA), such as PreCheck, to consolidate all of these services into one simple solution for you. When choosing your TPA, check to see how many collection sites they have in their network, which laboratories they work with, their options for ordering and receiving results and of course their cost structure.
While there’s a lot more information to consider when it comes to your workplace drug testing program and how you want it to operate, the items above will get you to a good starting point. Seek legal counsel when implementing a drug testing program for the first time to ensure all your bases are covered.