In this next module, we're now going to focus our attention on substance use in the workplace and its effects and consequences. I'll also be focusing on a couple of other federal programs about which you need to know, and I do want to give thanks to all of our MRO faculty and to the staff at the Division of Workplace Programs at SAMHSA for pulling much of this data together and helping provide these materials. Earlier, I emphasized that illicit drug use is strongly influenced by age, education, geography, the type of drugs that people use, and gender. Now we're going to also look at work status, that is, whether people are unemployed, working part-time or full-time. We'll look at occupation and other factors. The reason that the data on drug use in the United States is so relevant and important is because two-thirds of current drug users are also employees. Here you see that 68% are employed, and among the others, they may be students, people who are housekeepers, caring for children full-time, people who are retired or disabled. So type of employment strongly affects the likelihood of illegal drug use. You see that 11.1% of full-time employees were using one of the five classes in the federal panel, but that rose to 14.4% among part-time workers and almost 21% among those who were unemployed. Illicit drug use and marijuana use were much higher among part-time employees than full-time employees, but notice that alcohol use was slightly higher among full-time employees. We know that illegal drug use is strongly influenced by the type of jobs that people have, and here you see that the most frequent illegal drug users are in the accommodations and food services industries, in arts and entertainment, in management of companies, in the construction industry, in real estate and rental and retail trade. The very least frequent users of illegal drugs are in public administration, in education, and in utilities and mining. Now we would naturally think, well, if the Department of Transportation led the way in creating national drug testing regulations, that must have been particularly significant in transportation, but you see in the green arrow that the current illegal drug use in the transportation industry is at 7%. Turning to heavy alcohol use, we see that things are a little different. Here the heaviest drinkers are in the construction industry, in mining, in the hospitality industry, in utilities, arts, entertainment, recreation, and in management, and those with the lowest heavy alcohol use are in healthcare, social assistance, education, public administration. Again, you see that transportation and warehousing are relatively low, almost 8% heavy alcohol users among them, and the question, of course, comes up, is that partly due to the drug and alcohol testing regulations? The reason employers are concerned about the use of drugs and alcohol in the workplace is because there are metrics that adversely affect workplace performance, safety, and efficiency. So there's higher job turnover among users of illegal drugs, higher absenteeism, higher accidents and injuries, higher use of medical care services, lower productivity, as well as theft and security issues and the need to retrain new employees. Data have been collected for several decades about these, and we will look at a little bit of that. The National Survey on Drug Use and Health reported that among illegal drug users, these people were much more likely to have had three or more employers in the last year. They were also more likely to have missed two or more days in the past month and twice as likely to have skipped one or more days in the past month. Contrasting illegal drug use with heavy alcohol use, you see the same kinds of trends, namely three or more employers in the last year missing two or more days in the past month or skipping one or more days in the past month. Because of deep concerns about the use of illegal drugs and their adverse impact on the workplace, the federal government coined the term drug-free workplace. So the drug-free workplace program is a federal term, but it's obviously been modeled and copied by independent employers throughout the country. And here's the exact language that came from President Reagan's executive order in September 1986. He said the federal government, as the largest employer in the nation, can and should show the way towards achieving drug-free workplaces through a program designed to offer drug users a helping hand. Here we looked at the five major components of a drug-free workplace program, a written policy, some form of employee assistance, training of supervisors and education of employees, and some method for detecting illegal drug use. So the question arises, how frequently are these elements of the drug-free workplace program disseminated throughout private industry? Here's the results of a survey of full-time workers about three aspects of their company program. And you'll see that the current illegal drug users are separated from non-current illicit drug users. So we see in the middle that 83% of non-drug users are aware of written policies about drug or alcohol use, 60% are aware that the company is offering an employee assistance program of some kind, and 42% report that the company is providing education or information about drug and alcohol use. Notice that the current illegal drug users are less likely to report knowledge of these programs. As far as drug testing, looking at a wide variety of employers in the United States, you see that the most common type of drug testing is that done during the hiring process, what we call the pre-employment or the pre-placement examination. So that's almost half of employers. 33% test randomly for drugs or alcohol. How has the percent of drug test positives changed over time? Well, we're fortunate to have data from Quest Diagnostics, a very large national laboratory, and you see the results for urine, oral fluid, and hair. The most dramatic results are for urine testing, where you see that between 1988, when the rate was 13% positive, it gradually dropped and leveled off at around 4.5% positive. Oral fluid testing was introduced later, but during the last five years, you see that oral fluid test positives have also gone up, and they're about twice as high as that of urine drug tests. Hair testing, which of course tests a substance with a longer window of detection, is the one with the highest rate of positives, and that's around 10%. So what drugs most frequently test positive? Well, here you see that there are rather dramatic differences in the percent of positives in the federal workforce and in the general non-federally regulated workforce. Of course, marijuana is the most frequent positive in both of them, but in the federal workforce, marijuana is at a much lower rate. Opioids are the second most highest, amphetamines are the third, and notice that a 10% positive rate occurs for cocaine. But in the general workforce, marijuana is much more prevalent. You see that now opioids are about the same as amphetamines, and cocaine is only 5%. As I said earlier, the positive rates depend heavily upon the industry. Here you see a comparison of more than 2.4 million federal tests versus that of more than 6.5 million general tests in the non-federal workforce. And obviously, federal testing has a much, much lower positive rate. The rate ranges from 1.5% to just under 3%, whereas in the non-federal general tests, the range has been averaging 4.5% to most recently just over 5%. Let's shift gears and look at some data from the Department of Justice. Although these are old data, there's no indication that they have changed significantly. The point is that more than half of all federal prisoners who are in prison are drug offenders, so they were either buying or selling drugs. That means that the huge growth industry of building prisons has been, in large part, due to drug offenses. This data on local police arrest is also quite revealing. When an individual is arrested, the police usually do not want to take them to the jail and try to calm them down and calm often domestic situations. But if an individual continues to be disruptive or represent a threat, they're taken to jail and there usually a drug test is performed. So here you see that a surprisingly high percentage of those arrested have positive drug tests and the drugs most often associated with this disruptive behavior are amphetamines and THC. It's important for you to know a little about the clinical laboratory improvement amendments, and I bet you may have a test question on this subject. So CLIA covers clinical testing for drugs and alcohol in treatment and rehabilitation settings. But notice that forensic criminal justice testing, that is police work and workplace drug testing, are not covered for either drugs or alcohol. But if someone has seen an SAP and they enter into a treatment program, then their drug testing will be covered under CLIA, both for drugs and alcohol, except if there's breath testing. Similarly, the over-the-counter test kits, which parents sometimes buy to test their teenage children for the presence of drugs, those kits are covered by CLIA, both for drugs and again for alcohol, unless it was a breath alcohol testing method. The Americans with Disabilities Act was a major advance to rehabilitation acts, which was intended to enfranchise people with disabilities to be able to not only meet in public places, but also to work. So it prohibits discrimination against people with disabilities. And this act was strengthened in 2008. So what is a disabled individual? Well, there are three ways that one can be considered disabled. The first and direct route is if they have a physical or mental impairment that substantially limits one or more major life activities. The second is if they have a history or a record of impairment. So someone, for example, who was a drug addict and who has recovered has a history of having had a disability. And finally, if an employer or someone treats an individual as if they are currently using drugs and currently have an impairment, then the fact that they were treated as such means that they're automatically covered under disability protections. So how does the Americans with Disabilities Act pertain to substance abuse and drug and alcohol testing? Well, alcoholism can be a protected disability, particularly a history of alcoholism. Similarly, a history of drug addiction can be a protected disability. And if somebody is currently under treatment for substance abuse, that can also be a protected disability. But you noticed I was hedging my bets by saying can be. Congress made it very clear that they did not want an individual who is currently using unauthorized drugs to be considered a person with a disability. So they specifically excluded that. They said that anyone who tests positive for any of the controlled substances, that any scheduled drug that is not medically authorized is automatically excluded from ADA protection. So if you're an alcoholic and you're currently using alcohol, that's not a controlled substance. So your protection does not go away. But if you're a drug addict and you have a current positive drug test, all of your drug test protections disappear. Furthermore, ADA does not interfere with an employer being able to take appropriate actions for abuse or impairment. So they can have, for example, a no drink policy, no alcohol on board, or a no drug policy. And as long as they apply that equally to everyone, that is not restricted. Because the purpose of the ADA was to allow people with disabilities to be able to enter the workforce, they specifically banned pre-employment medical examinations. One had to be offered a conditional offer of employment, and only then could they have their medical evaluation. So alcohol is considered a medical test, and it cannot be done before a job offer has been made. On the other hand, drug tests were specifically designated by Congress as not being part of a medical examination. So that means that employers can do a drug test before they make a job offer. Let's change subjects again and talk about state medical marijuana laws. It's important for all of us to recognize that federal law supersedes state laws. And this is very definitely true with regard to the Drug-Free Workplace Program. So very specific guidance has been issued by officials in the Department of Health and Human Services that prohibits the use of Schedule I drugs. And that, of course, includes currently marijuana from being considered medically appropriate. So here are the words. The use of any federal controlled substance act Schedule I drug, whether for non-medical or ostensible medical purposes, violates federal law and the Drug-Free Workplace Program. It's also inconsistent with the performance of safety-sensitive, health-sensitive, and security-sensitive positions, and with other testing circumstances. So as an MRO, we will be guided by federal law in interpreting marijuana results for federally-regulated tests. But on non-federally-regulated tests, then it's a very different situation. So here's the very specific language that applies to us as MROs. We shall not accept a prescription or the verbal or written recommendation of a physician for a Schedule I drug as a legitimate medical explanation. So this applies to all federal agencies. That is about 1.8 million employees, and it covers all 50 states. The issue also arose several years ago about so-called health food bars, sometimes called seedy sweeties, that contained enough hemp oil with THC in it to actually test positive for marijuana. The question was, was that an acceptable medical explanation? More recently, of course, the whole issue of cannabidiol or CBD has arisen. So again, very clear federal guidance came forth, in this case from the DOT. And they say, again, the MRO shall not accept the ingestion of a foodstuff allegedly containing THC or the ingestion of hemp oil allegedly containing THC as a legitimate medical explanation for the presence of delta-9-THC acid in a donor specimen.

substance use

workplace

effects

consequences

drug testing