By Mark Pew, Senior VP, Preferred Medical
This week I want to share two articles, both on the topic of employer drug testing policies. The first article is about the trends in employee drug test results. The second article is about drug testing policies of companies and how times are changing from zero-tolerance to “look the other way.”
Positive Drug Test Rate Among Workers is Way Up, Quest Says
According to Quest Diagnostics’ latest Drug Test Index, the rate of workers testing positive for drugs is at its highest in 15 years. However, the use of illicit opioids and heroin has dropped significantly—nearly 21 percent for opioids and 6 percent for heroin between 2017 and 2018. While the use of opioids and heroin have dropped in drug tests, marijuana positivity levels are up 5 percent from 2017 to 2018. This should not be a huge surprise as many states have legalized medicinal and recreational marijuana use. There are many takeaways from the results, most of which are open to your interpretation.
ICYMI on Friday, this article by Nancy Grover quotes me on the implications of drug testing results just published by Quest Diagnostics. There are the obvious takeaways and then the not-so-obvious (which are the ones I focused on). Here are my observations:
- The decline in positive results for prescription opioids makes sense given the decline in prescriptions that started in 2012 (per the CDC, “Prescribing Practices”) and began to be documented by Work Comp in 2014. So the trend of declining positives will likely continue.
- It was likewise not a surprise that positive tests for heroin also declined. However, there is a hole in the statistics because they did not mention test results for the fentanyl and it’s analogues that largely replaced heroin and prescription opioids as the primary killer by 2016 (what is known as the “third wave” of the opioid epidemic). So this analysis is incomplete.
- It was not a surprise that positive marijuana tests increased since medical and recreational use has been NORMLized (in case that pun is too subtle, NORML = National Organization for the Reform of Marijuana Laws) across the country. However, to reiterate what I’ve been saying/writing since 2014, presence does not necessarily mean impairment when it comes to marijuana.
The implications of these trends in drug test results mean that individual companies are making individual decisions. Some are required to have zero tolerance policies because they receive federal funding and/or have employees with commercial drivers licenses. Others have made a corporate cultural decision to disallow presence of any type. Others have decided to have different rules for different jobs. And others have decided to either forego testing completely or just remove some drugs (like THC) from the panel. In other words, how employers are managing drug testing mirrors how our country is handling marijuana – piecemeal and local. Did you know there are “dry” cities and counties in Colorado and California that don’t consider the state’s recreational legalization applicable? In one word—it’s complicated.
In the age of legal marijuana, many employers drop ‘zero tolerance’ drug tests
The Quest Diagnostics report showed an increase in positive tests for marijuana. Only 1.6 percent of tests in California tested positive for marijuana in 2010 but that had increased in 2018 to 2.5 percent. While this number has risen, it is also safe to say that there could be many more unaccounted for since people who use marijuana generally do not apply for jobs that perform pre-employment drug tests. Overall, this data suggests that marijuana use continues to move into the workplace.
This article reiterates what I’ve been saying to audiences around the country since 2014 about #marijuana and the workplace. The concept of zero-tolerance drug policies are increasingly a subjective (and pragmatic) decision by individual employers. I incorporate multiple stories from employers I’ve spoken with (CA, CO, NM, IL, NC, GA, NY, etc.) that (1) confirm a zero-tolerance policy (2) do drug tests but remove THC from the panel (3) don’t do drug tests at all. This article from LA Times is a great overview of each angle and the reasons behind them. If you want more info about the Quest Diagnostics study see the “Positive Drug Test Rate Among Workers is Way Up, Quest Says” story above. The job of a business owner, H/R manager, supervisor and Medical Review Officer continues to get more difficult by the day. The primary question – How do you balance a safe workplace and full employment? For some, that means a compromise on potential impairment. More good back-n-forth comments on this article:
- J. Stephen Monahan: “We should instead have policies focusing on impaired performance regardless of cause. That doesn’t mean fire the person, but it does mean remove them from the work environment where the person poses a danger to himself and co-workers, and the bottom line. It means observation supervision and coaching which all to often are under valued.”
- And my response: “Spot on! It comes down to whether they can do the job they were hired to do. If they can’t, regardless of the impairing chemical, then they need help (to either proactively confront their need for impairment or find a different job). All of that is management – true management – of not just the task but the person performing the task. The “observation, supervision, coaching” that you mention is indeed a key component to that and often overlooked / under-utilized.”
To read everything on my mind this past week, please visit me on LinkedIn.
Disclaimer: The views and opinions expressed above are those of Mark Pew, and do not necessarily reflect the views of Preferred Medical.
About Mark Pew
Mark Pew, Senior Vice President of Product Development and Marketing for Preferred Medical, is a passionate educator and agitator. Known as the RxProfessor, Mark is focused on the intersection of chronic pain and appropriate treatment, particularly as it relates to the clinical and financial implications of prescription painkillers, non-pharma treatment modalities and the evolution of medical marijuana. He is a strong champion for the workers’ compensation industry to #PreventTheMess and #CleanUpTheMess, movements he created to drive attention to the importance of individualized appropriate treatment for injured workers. Mark is a vocal advocate of the BioPsychoSocialSpiritual treatment model.
Mark serves on the IAIABC’s Medical Issues Committee and SIIA’s Workers’ Compensation Committee. In addition, he serves as technical advisor to regulators and legislators in 20+ jurisdictions on subjects such as drug formularies, treatment guidelines, Opioid Task Force initiatives, encouraging support of non-pharma treatment options and the medicinal use of cannabis. Mark received the WorkCompCentral Magna Comp Laude award in 2016 and the IAIABC’s Samuel Gompers Award in 2017.