Substance misuse can compromise the integrity and stability of the workplace. The construction industry carries outsized risks when workers are impaired, putting themselves and others in danger of accident and injury. Barry Sample, Ph.D., senior director of science and technology, Quest Diagnostics, shares construction-industry drug positivity insights from the latest Quest Diagnostics Drug Testing Index, trends in workforce drug testing and the impact of recreational and medical marijuana laws.

CE This Week: What is the Drug Testing Index?

Barry Sample: The Quest Diagnostics Drug Testing Index is a series of reports that provide insights into trends in workforce drug use based on positivity rates of de-identified laboratory tests performed by Quest Diagnostics for a range of illicit, legal and prescription drugs. It examines test results from multiple categories of workers as well as 17 industry segments, including the construction industry.

CETW: What Are the Overall Findings From the Most Recent Report?

BS: The 2021 Drug Testing Index results showed overall positivity rate in the combined U.S. workforce based on more than seven million urine drug tests collected between January and December 2020 was down only slightly in 2020 (4.4%) compared to 2019 (4.5%, a 16-year high). Positivity for most drug categories other than marijuana declined or remained flat in the combined U.S. workforce over the past five years.

Marijuana positivity surged ahead in 2020 in the U.S. general workforce and across specimen types (urine, oral fluid and hair). In the U.S. general workforce, marijuana positivity increased 16.1% in urine testing (3.1% in 2019 versus 3.6% in 2020), 35.2% in oral fluid testing (9.1% in 2019 versus 12.3% in 2020) and 22.5% in hair testing (7.1% in 2019 versus 8.7% in 2020). Amphetamines (which includes methamphetamine) persisted at 1.1% positive each year.

CETW: What Does the Data Show in the Construction Industry?

BS: The Drug Testing Index data for the construction industry was mixed. The overall positivity rate in the construction industry based on all drugs decreased from 4.2% in 2019 to 4.1% in 2020. However, positivity for marijuana increased from 2.2% in 2019 to 2.5% in 2020. The construction industry also had the highest workforce drug positivity for cocaine (0.32%) and methamphetamine in 2020 (0.21%) among the 17 major U.S. industries. Comparatively high positivity for cocaine and methamphetamine in the construction industry has been persistent for several years.

CETW: Given New Laws in Many States That Make Recreational and Medical Marijuana Legal, is the News About Marijuana Positivity Alarming?

BS: The construction industry is known to have hazard risks that impact safety. According to the Occupational Safety and Health Administration, construction accounted for about 20% (1,061) of worker fatalities in private industry in calendar year 2019 – about one in five worker deaths for the year. Drug misuse in the workplace, including marijuana, puts construction industry employers at greater risk for increased accidents and absenteeism, lower productivity and higher insurance costs. At the same time societal attitudes toward marijuana appear to be relaxing. Multiple surveys show a large percentage of U.S. adults favor marijuana legalization for medical and/or recreational use. Altogether, 35 states, including recently Virginia and New York, have passed comprehensive marijuana laws. Seventeen states, plus D.C. and two U.S. territories (Northern Mariana Islands and Guam), have recreational marijuana laws. These known hazards and emerging trend lines in marijuana legalization should be concerning for construction industry employers.

CETW: Is Marijuana a Workforce Safety Risk?

BS: Relaxed attitudes toward marijuana in the general population and state-by-state legalization has reduced the stigma surrounding marijuana. As a result, fewer people may see it as a risk. However, according to a study reported by the National Institute on Drug Abuse, employees who tested positive for marijuana had 55% more industrial accidents, 85% more injuries and 75% greater absenteeism compared to those who tested negative. Also impacting the bottom line are decreased productivity, increased worker compensation and unemployment compensation claims and high turnover.

CETW: How Can an Employer Determine if Drugs Were a Factor in an Accident?

BS: If an employee has been involved in a workplace accident, post-accident drug testing can be performed. Testing is used to determine whether drugs may have been a factor in the incident. Although the result of a post-accident drug test may determine drug use, a positive result in and of itself cannot prove that drug use caused an accident. In the U.S. general workforce, in 2012, marijuana pre-employment positivity was 1.9% and post-accident positivity was 2.4% (a 26.3% difference). In 2020, pre-employment marijuana positivity was 3.7% and post-accident 6.4% (a 73% difference). Increasing post-accident drug testing positives show a disturbing pattern with recent changes in marijuana use.

CETW: Is Marijuana Misuse Hazardous in a Workplace Setting?

BS: According to the Centers for Disease Control and Prevention, heavy marijuana use (daily or near-daily) can do damage to memory, learning and attention, which can last a week or more after the last use. A recent study from the Insurance Institute for Highway Safety, showed injury and fatal crash rates jumped 6% and 4%, respectively, in California, Colorado, Nevada, Oregon and Washington following relaxation of marijuana laws compared with other Western states where recreational marijuana use was illegal. Insurance records showed a similar increase in collision claims after marijuana became legal. In the construction industry, in which workers frequently travel within and between worksites, the risks should be apparent. Other tasks common in the construction setting such as working on scaffolding and ladders, in excavation and trenches, heavy material handling, operating tools and equipment and moving heavy objects could also be made more hazardous under the influence of marijuana.

CETW: What is the Cost of Drug misuse to Employers?

BS: Every year there are more than four million workplace injuries ranging from falls to fatal accidents, according to the National Safety Council. Some industries, including construction, are more vulnerable to on-the-job accidents. An injury can bring difficulty for employees and employers alike. Costs can include the loss of salary, productivity, administrative burdens, time and healthcare expenses, among others. In 2018, the total cost of work injuries was estimated to be $170.8 billion. Most employers want to create a safe, productive, healthy work environment, and a drug testing policy and program can help employers reduce accidents and injuries while encouraging safety.

CETW: What Drugs are Detected with Drug Tests?

BS: Quest Diagnostics tests for the following drugs: amphetamines, barbiturates, benzodiazepines, cocaine, marijuana, MDMA (ecstasy) and its metabolite, methadone, semi-synthetic opiates, opiates, oxycodone, phencyclidine (PCP) and propoxyphene, synthetic cannabinoids (“K2/Spice”) and synthetic stimulants (“Bath Salts”). Additionally, the company offers specialized panels such as Medical Professional Panels for a broad range of prescription drugs more accessible in the healthcare industry and a steroids panel to detect performance enhancing drugs and anabolic steroid use.

CETW: What is the Most Frequently Used Method for Drug Testing?

BS: While all drug test specimen types – urine, oral fluid and hair – have their advantages, urine drug testing is by far the most common. However, random and instant testing are proactive testing methods to help secure the health and safety of a construction job site.

CETW: What Types of Specimen Collections are Common?

BS: Routine specimens submitted for workforce drug misuse testing include urine, hair and oral fluid. Urine specimen drug testing detects recent drug use (during the previous 24 to 72 hours). Urine is suitable for all testing reasons, from pre-employment to random to post-accident, and can be performed for a wide range of illicit and prescription drugs.

Hair specimen drug testing has a longer window of detection providing up to a 90-day drug use history. Hair testing requires a small sample of hair that is collected under direct supervision without any invasion of privacy. When compared with urine testing, hair testing provides nearly twice the number of positives due to its longer detection window. Oral fluid enables donors to collect their own specimens on-site and in the presence of a monitor, reducing the likelihood of tampering or a donor challenge later in the drug screening process. They are all used in combination and individually in the construction industry.

CETW: What Advice Do You Have for Construction Industry Executives?

BS: First, employers should know their workforce. Employers should take an effort to interact with employees and understand their work habits, behaviors and attitudes. Employers should also understand their work environments and surroundings. Where are there hazards? What are safety procedures? What is the chain of command?

Second, employers should know the law and their obligations under it. As states increasingly enact laws legalizing recreational and medical marijuana, there are corresponding regulations and additional laws that impact employers, employees and workforce drug testing procedures. Keeping up to date on state and federal law related to marijuana is an employer's responsibility.

Third, employers in all industries, especially construction, should have and frequently update a workforce drug and alcohol policy. Most policies make clear the employer's obligations for employee assistance, work rules and drug and alcohol testing policies.