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Workforce Drug Positivity Rate Still Peaking

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Workforce use of illicit drugs across the board—including cocaine, marijuana and methamphetamine—remains at its highest rate in a decade, a new study by Quest Diagnostics found.

Overall positivity in urine drug testing among the combined U.S. workforce in 2017 continued to hold at 4.2%, which is still 0.7% higher than the positivity rate from 2012, which represented a 30-year low. The findings were made from analysis of more than 10 million workforce drug test results.

“It’s unfortunate that we mark 30 years of the Drug-Free Workplace Act with clear evidence that drugs continue to invade the country’s workplaces. Not only have declines appeared to have bottomed out, but also in some drug classes and areas of the country drug positivity rates are increasing,” Barry Sample, senior director of science and technology at Quest Diagnostics, said in a statement.

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“These changing patterns and geographical variations may challenge the ability of employers to anticipate the ‘drug of choice’ for their workforce or where to best focus their drug prevention efforts to ensure a safe and healthy work environment.”

The new data indicates shifting patterns of drug use, with cocaine and amphetamines positivity surging in some areas of the country and marijuana positivity rising sharply in states with newer recreational use statutes.

Opioids
The one bit of good news is that prescription opiate positivity rates declined dramatically on a national basis. Quest reported that the positivity rate for opiates in the general U.S. workforce in urine drug testing declined 17% between 2016 and 2017 (0.47% versus 0.39%). More notably, oxycodones (oxycodone and/or oxymorphone) positivity declined 12% between 2016 and 2017 (0.69% vs. 0.61%), hydrocodone positivity declined 17% (0.81% vs. 0.67%); and hydromorphone positivity declined 22% (0.59% vs. 0.46%). Opiates other than codeine were at their lowest positivity rate in more than a decade.

This data is supported by the Centers for Disease Control and Prevention (CDC), which shows that the overall national opioid prescribing rate in 2017 fell to the lowest it had been in more than 10 years, although rates vary by state and are high in some areas of the country.

The topic was explored during an educational session at RIMS 2018, where it was noted that the decrease in opioid use may be attributed to corporate initiatives like prescription drug monitoring policies (PDMP), which can limit employees’ ability to refill scripts, in addition to states that had comprehensive reforms.

“This shows that the more queries there are, the bigger the drop in opioid prescribing,” said John Ruser, president and CEO of the Workers Compensation Research Institute (WCRI), last month in San Antonio. He said WCRI used Kentucky as an example of a successful PDMP. Kentucky’s HB1 law mandated the use of the PDMP and between 2011 and 2013, WCRI information indicated a 10% decline in prescriptions in the state, whereas prescription levels were flat in others that did not have similar reforms.

Methamphetamine
Methamphetamine positivity, however, is increasing. An analysis of trends in the general U.S. workforce based on the four U.S. Census regions identified large increases of methamphetamine positivity rates. Between 2013 and 2017, methamphetamine positivity increased: 167% in the East North Central division of the Midwest (Illinois, Indiana, Michigan, Ohio, Wisconsin); 160% in the East South Central division of the South (Alabama, Kentucky, Mississippi, Tennessee); 150% in the Middle Atlantic division of the Northeast (New Jersey, New York, Pennsylvania); and 140% in the South Atlantic division of the South (Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia). The percentage increase in these four divisions ranged between 9% and 25% between 2016 and 2017.

Marijuana
Overall, marijuana positivity continued its five-year upward climb for both the general U.S. workforce and the federally-mandated, safety-sensitive workforce. Marijuana positivity increased 4% in the general U.S. workforce (2.5% in 2016 versus 2.6% in 2017) and nearly 8% in the safety-sensitive workforce (0.78% versus 0.84%).

Increases in positivity rates for marijuana were most striking in states that have enacted recreational use statues since 2016. Those states include: Nevada (43%), Massachusetts (14%) and California (11%). These three states also saw significant increases in marijuana positivity in federally-mandated, safety-sensitive workers: Nevada (39%), California (20%), and Massachusetts (11%). Federally-mandated, safety-sensitive workers include pilots, rail, bus and truck drivers, and workers in nuclear power plants, for whom routine drug testing is required by the Department of Transportation.

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“These increases are similar to the increases we observed after recreational marijuana use statues were passed in Washington and Colorado,” Sample said. “While it is too early to tell if this is a trend, our data suggest that the recreational use of marijuana is spilling into the workforce, including among individuals most responsible for keeping our communities safe.”

Workforce Drug Positivity Rate Highest Since 2004

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Workforce use of illicit drugs across the board—including cocaine, marijuana and methamphetamine—has climbed to the highest rate in 12 years, a study by Quest Diagnostics found.

Overall positivity in urine drug testing among the combined U.S. workforce in 2016 was 4.2%, a 5% relative increase over last year’s rate of 4%—the highest annual positivity rate since 2004 (4.5%), according to an analysis of more than 10 million workforce drug test results.

“This year’s findings are remarkable because they show increased rates of drug positivity for the most common illicit drugs across virtually all drug test specimen types and in all testing populations,” Barry Sample, senior director of science and technology at Quest Diagnostics Employer Solutions, said in a statement. “Our analysis suggests that employers committed to creating a safe, drug-free work environment should be alert to the potential for drug use among their workforce.”

The positivity rate in urine testing for cocaine increased for the fourth consecutive year in the general U.S. workforce and for the second consecutive year in the federally-mandated, safety-sensitive workforce. Cocaine positivity increased 12% in 2016, reaching a seven-year high of 0.28%, compared to 0.25% in 2015 in the general U.S. workforce, and 7% among federally-mandated, safety-sensitive workers to 0.28% from 0.26% in 2015.

Marijuana positivity continued to climb in both the federally-mandated, safety-sensitive and general U.S. workforces. In oral fluid testing, which detects recent drug use, marijuana positivity increased nearly 75%, from 5.1% in 2013 to 8.9% in 2016 in the general U.S. workforce. Marijuana positivity also increased in both urine testing (2.4% in 2015 versus 2.5% in 2016) and hair testing (7.0% in 2015 versus 7.3% in 2016) in the same population. Among the federally-mandated, safety-sensitive workforce, which only uses urine testing, marijuana positivity increased nearly 10% (0.71% in 2015 versus 0.78% in 2016), the largest year-over-year increase in five years.

In Colorado and Washington, the first states in which recreational marijuana use was legalized, the overall urine positivity rate for marijuana outpaced the national average in 2016 for the first time since the statutes took effect. The national positivity rate for marijuana in the general U.S. workforce in urine testing increased 4% (2.4% in 2015 compared to 2.5% in 2016).

Positivity for amphetamines (which includes amphetamine and methamphetamine) continued a year-over-year upward trend, increasing more than 8% in urine testing in both the general U.

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S. and federally-mandated, safety-sensitive workforces compared to 2015. According to Quest, this rise over the past decade has been driven primarily by amphetamine use, including certain prescription drugs such as Adderall.

After four straight years of increases, in 2016, urine testing positivity for heroin held steady in the general U.S. workforce and declined slightly among federally-mandated, safety-sensitive workers.

Positivity for prescription opiates—including hydrocodone, hydromorphone and oxycodones—declined in urine testing among the general U.S. workforce. Oxycodones have seen four consecutive years of declines, dropping 28% from 0.

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96% in 2012 to 0.69% in 2016. Hydrocodone and hydromorphone both showed double-digit declines in both 2015 and 2016 (0.92% in 2015 to 0.81% in 2016) and (0.67% in 2015 to 0.59% in 2016), respectively.

This decline may be due to the fact that state and federal authorities have made efforts in the past few years to place tighter controls on opiate prescribing in order to address the opioid crisis.

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Positive Workforce Drug Tests Reach 10-Year High

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drug-testing
An analysis of 11 million workforce drug tests reveals a 10-year high in positive test results, with an increase of 4%, according to the Quest Diagnostics Drug Testing Index (DTI). Post-accident positivity increased 6.

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2% in 2015, compared to 2014, and has jumped 30% since 2011.

The report found that amphetamine positivity increased 44% and marijuana positivity increased 26% since 2011; and that nearly half (45%) of individuals in the general U.S. workforce with a positive drug test for any substance in 2015 showed evidence of marijuana use.

Heroin positivity in that period increased 146%. The oxycodone positivity rate has declined annually since 2011, confirming previous research showing that opioid prescriptions have declined in 49 states since 2012, Quest said.

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“The DTI statistics for the last five years underscore the threat to employers—and employees—from drug abusers in our workplace. The numbers on hair testing—the methodology with the longest look-back and therefore a more telling measurement of regular use—show a 34% positive-rate increase for illegal drug use by the general workforce in the last five years,” Mark de Bernardo, executive director of the Institute for a Drug-Free Workplace, said in a statement. “However, all the numbers for various testing methodologies confirm this disturbing trend and should provide a wake-up call to employers to do more to combat workplace substance abuse and to do it more effectively.”

Barry Sample, senior director of science and technology at Quest Diagnostics, noted:

  • The percentage of employees in the combined U.S. workforce testing positive for drugs has steadily increased over the last three years to a 10-year high of 4.0%.
  • According to analysis of urine drug test results, the rate of amphetamine, marijuana, and heroin detection has increased annually for the past five years.
  • Positivity rates for post-accident urine drug testing are rising in both the general U.S. and federally-mandated, safety-sensitive workforces; rates have increased 30% and 22%, respectively, since 2011.
  • Almost half (45%) of individuals in the general U.S. workforce with a positive drug test for any substance in 2015 showed evidence of marijuana.
  • Heroin positivity, indicated by the presence of the 6-AM marker, increased 146 percent between 2011 and 2015 in the general U.S. workforce.
  • The overall positivity rate for oral fluid testing increased 47% over the last three years in the general U.S. workforce—equating to almost one in 11 job applicants who are unable to pass an oral fluid drug screen.
  • Overall positivity in the general U.S. workforce was highest in hair drug tests, at 10.3% in 2015, a 7% increase over the previous year.

Marijuana’s Cost to Employers

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With the adoption of more state laws to legalize marijuana, employers will face challenges to protect their employees from injury and to comply with federal requirements to maintain a drug-free workplace.

Employers also face potentially costly litigation as case law surrounding legal marijuana develops, according to the Quest Diagnostics whitepaper “What Will ‘Legal’ Marijuana Cost Employers?”

Marijuana-workplace

Quest reports that medical marijuana legalization brought forth a new phenomenon: the production of marijuana-infused foods and gadgets, which presents a special problem for employers. Today, nearly half of marijuana users in states where it is legal consume marijuana by eating it rather than smoking it. In addition, vape pens, which are like e-cigarettes but contain capsules of concentrated marijuana oils, leave no marijuana smell and are impossible to tell apart from e-cigarettes. These two modes of consumption will make it more difficult, if not impossible, for employers to tell when employees are using marijuana on the job.

As marijuana use increases, so will workplace injuries, accidents, mistakes, and employee illnesses, escalating the costs of companies’ liability, workers’ compensation and health insurance.

Questions companies should ask include:

  • Will employers have to accommodate marijuana use in their workplaces? A closely watched case. Before the Colorado Supreme Court will establish, at least in Colorado, whether employees can use marijuana off the clock even if they may be impaired the next day.
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  • Must employers pay for employees’ medical marijuana if they are injured on the job? By allowing a court of appeals decision to stand, the New Mexico Supreme Court finds that the answer is yes.
  • Will the use of legal cannabinoids like delta 8 THC be allowed in the workplace?
  • What does increased adolescent marijuana use portend for the future workforce? Research shows that compared to nonusers, teens who smoke marijuana on weekends over a two-year period are six times more likely to drop out of high school, three times less likely to enter college, and four times less likely to earn a college degree?
  • How can employers meet federal requirements to maintain a drug-free workplace if states require proof of impairment rather than the presence of marijuana in the body when no level of impairment has been scientifically established and no noninvasive test to denote impairment has been developed?
  • If courts hold that drug testing is no longer a valid indicator of impairment, how can employers whose businesses involve driving or other safety-sensitive positions protect their workers and the public from injuries and deaths cause by stoned drivers?
  • What if courts hold that failing a pre-employment drug test is no longer a valid reason to deny employment to applicants?

There are, however, steps employers can take to protect themselves:

1) Stay up-to-date with the changing legal landscape and adjust workplace policies accordingly.

2) Remember that marijuana is still illegal under federal law.

3) Join other employers to monitor state legislation and take action with legislators to ensure workplace protections are included in any marijuana laws.

4) Educate your workforce about the dangers marijuana poses to children, families and the workplace.

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5) Challenge the notion that marijuana is medicine, or risk paying for it in your health insurance program. No marijuana medicines being sold in states that legalized them have been approved by FDA as pure, safe, or effective.

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Doctors cannot prescribe them and pharmacies cannot sell them.