Drug Testing During COVID-19: Essential and Smart

During a national crisis, substance abuse increases. That’s why keeping up your company’s drug testing is crucial, especially right now.

• By Bill Current
• Jun 01, 2020

During a national crisis, substance abuse increases. And at a time when substance abuse is already on the rise, Americans now find themselves in the throes of a worldwide pandemic that is causing many people to experience stress, anxiety and fear.

Substance Abuse in Times of National Crises

After the terrorist attacks of September 11, 2001, studies found that substance abuse generally increased, especially in New York, as many people sought ways to deal with the symptoms of depression and post-traumatic stress disorder (PTSD).

A post-9/11 survey of New Yorkers showed that the “number of respondents who smoked cigarettes increased 9.7 percent, those who consumed alcohol increased 24.6 percent, and those who smoked marijuana increased 3.2 percent.”¹

The report also found that the increase in substance use persisted several months after 9/11: “… 30 percent of Manhattan residents said they drank more alcohol, smoked more cigarettes, and used more marijuana in the first month after 9/11, and that number only dropped slightly to 27 percent six months later.” v

Many studies have conclusively found that PTSD can initiate drug abuse and drug dependence and can cause recovering drug abusers to relapse as they attempt to “self-medicate” their way through the trauma they are experiencing.²

There is evidence that the PTSD-related substance abuse trend has already started with the COVID-19 pandemic. According to a Nielsen report cited by the Associated Press, “U.S. sales of alcoholic beverages rose 55 percent in the week ending March 21. Spirits like tequila, gin and pre-mixed cocktails led the way, with sales jumping 75 percent compared to the same period last year. Wine sales were up 66 percent while beer sales rose 42 percent. And online sales far outpaced in-store sales.”³

According to a survey conducted by Alcohol.org, many employees who find themselves working from home, perhaps for the first time, are doing more than just punching the clock. The survey found that 67 percent of Hawaiians working from home admitted to drinking alcohol while on the clock. Tied for second on the list was Virginia and New Hampshire at 50 percent each. Only eight percent of workers from Arkansas said they had a drink while on the job at home.⁴

Because some states have declared marijuana “essential” medicine during the pandemic, sales of legal marijuana are, in some cases, outpacing booze. Cannabis e-commerce platform Jane Technologies reported in March that average store revenue is up between 52 and 130 percent compared with sales in January 2020. New on-line buyers have increased 142 percent.⁵

Prior to the COVID-19 pandemic, drug abuse in the United States was already on the rise. This well-documented increase in drug abuse coincides with the widespread legalization of marijuana throughout the country. According to the federal government, past-year use of illicit substances among Americans 12 and older rose from 17.8 percent in 2017 to 19.4 percent in 2018. This increase is what statisticians would refer to as “statistically significant.” From that group, an estimated 43.5 million or 15.9 percent of Americans admitted to using marijuana in the past month, higher than the percentages from 2002 to 2017.⁶

The COVID-19 pandemic qualifies as a national crisis which, if history tells us anything, will lead to an increase in drug abuse at a time when marijuana abuse was already increasing at a dramatic pace. This phenomenon—the COVID-19 pandemic combined with the already rising levels of marijuana use—would appear to be the proverbial “perfect storm.” But not so fast. Unfortunately, there is a third element to the storm that threatens to make the situation even more dangerous.

Essential Industries and Substance Abuse

As many Americans hunker down and some businesses shutter, at least temporarily, some industries and occupations have been designated as “essential” to our survival. Consider the following list of essential jobs according to the federal government.⁷

• Health care and public health workers 
• Law enforcement, public safety, and first responders 
• Food and agriculture workers 
• Energy employees 
• Water and wastewater 
• Transportation and logistics 
• Public works 
• Communications and information technology 
• Other community-based government operations and essential functions 
• Critical manufacturing 
• Hazardous materials 
• Financial services 
• Chemical workers 
• Defense industrial base 

From this list we find some of the industries that historically have higher rates of substance abuse and workplace accidents. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), these are the industries with the highest rates of past-month illicit drug abuse.⁸

• Accommodations and food service: 19.1 percent
• Arts, entertainment, and recreation: 13.7 percent
• Management: 12.1 percent
• Information: 11.7 percent
• Construction: 11.6 percent

The same report indicated that these industries have the highest rates of alcohol misuse:

• Mining: 17.5 percent
• Construction: 16.5 percent
• Accommodations and food service industry: 11.8 percent
• Art, entertainment, and recreational fields: 11.5 percent
• Utilities industry: 10.3 percent

Additionally, according to one major drug testing laboratory, “Retail Trade is one of six sectors that saw year-over-year double-digit increases in positivity between 2015 and 2018. Five of these experienced an overall four-year increase in general U.S. workforce positivity more than double that of the national increase (6.2 percent) over the same time period.”⁹

• Transportation & Warehousing (34.5 percent)
• Other Services (except Public Administration) (33.3 percent)
• Wholesale Trade (20.0 percent)
• Retail Trade (14.9 percent)
• Construction (13.2 percent)
• Administrative Support, Waste Management and Remediation Services (12.2 percent)

Finally, a 2018 report from the National Safety Council found that these are the industries with the largest number of workplace accidents, from highest to lowest:

1. Service (including firefighters and police)

2. Transportation/shipping

3. Manufacturing/production

4. Installation/maintenance/repair

5. Construction

There is clearly some overlap between the list of essential occupations and industries and the lists of industries with higher levels of substance abuse, increased positive drug test results and workplace accidents. Now we have a perfect storm in the making and employers must be vigilant.

Drug Testing Methods During the Pandemic

As the saying goes, unusual times call for unusual measures and we are living in unusual times, even traumatic times. Drug abuse levels are likely to increase at a time when they were already on the rise. Some of the industries and occupations deemed essential to our survival historically have higher rates of substance abuse and workplace accidents.

Now is not the time to stop or curtail drug testing. In fact, it is possible that drug testing has never been more important. In addition to the increasing rate of substance abuse and its predictable impact on safety and workplace accidents, consider these other important factors:

• The federal government continues to require drug testing of employers in certain safety-sensitive industries such as transportation, though special guidelines have been issued to address challenges employers and providers may be experiencing while trying to comply with some of federal requirements during the COVID-19 pandemic.
• State drug testing laws that mandate drug testing and/or regulate the how, when and who of drug testing have not been suspended, and compliance is still required when testing can be conducted (check applicable state laws to ensure compliance).
• Traditional drug testing methods, such as lab-based urine testing, still work, but alternative testing methods may help employers overcome the obstacles to testing that some companies are currently experiencing.

DOT Drug Testing. So far, the federal government continues to require drug testing. For instance, the U.S. Department of Transportation (DOT) issued the following statement:

“As a DOT-regulated employer, you must comply with applicable DOT training and testing requirements. However, DOT recognizes that compliance may not be possible in certain areas due to the unavailability of program resources, such as collection sites, Breath Alcohol Technicians (BAT), Medical Review Officers (MRO) and Substance Abuse Professionals (SAP). You should make a reasonable effort to locate the necessary resources.¹⁰

DOT continues: “As a best practice at this time, employers should consider mobile collection services for required testing if the fixed-site collection facilities are not available.” Additionally, employers who find it impossible to comply with any portion of the regulations must document the reasons why and always defer to the regulations themselves.

For service providers, DOT emphasized: “As a collector, BAT, laboratory, MRO, or SAP, you should continue to provide services to DOT-regulated employers if it is possible to do so in accordance with State or local mandates related to COVID-19. Should you have concerns about COVID-19 when testing or interacting with employees, please follow your company policy, directions from State and local officials, and guidance from the Centers for Disease Control and Prevention (CDC).”

The Federal Motor Carrier Safety Administration (FMCSA) has issued specific guidelines to address instances when covered employers are unable to comply with the regulations during the pandemic.¹¹ Visit other DOT modal websites for specific guidance on complying with their respective regulations.

Lab-based Urine Testing. For more than 30 years, lab-based urine testing has been the most common drug testing method. Currently, many laboratories continue to offer urine drug testing services, and when essential support services—such as specimen collections at facilities away from the workplace—can be arranged, this testing method remains a viable option during the COVID-19 pandemic. However, there are reports that it is challenging to find collection sites that are open for urine collections while other facilities are simply not available. Mobile collection services represent an alternative that makes lab-based urine testing possible.

Lab-based Oral Fluid Testing. Recently endorsed by the federal government,¹² lab-based oral fluid testing eliminates some of the challenges employers are experiencing. Oral fluid collections, for example, do not require the use of an off-site collection facility where most urine collections typically take place or the use of a secured restroom, thus eliminating sanitation concerns. As employers encounter more and more collection facilities that are closed, have reduced hours of operation or are unable to offer urine collections at this time, an on-site oral fluid collection conducted by a trained employee is a viable alternative.

In a typical oral fluid collection, the donor and collector are in proximity with one another during the entire collection process making every collection fully observed. However, because the collection is donor-driven, the donor and collector can easily maintain at least six feet of distance between themselves per guidance from the Centers for Disease Control and Prevention (CDC).¹³ The collector also can wear a protective mask and gloves.

Additionally, drugs are usually detectable in an oral fluid sample within minutes after usage. This makes oral fluid testing ideal for detecting recent use, which may be of heightened concern for safety-sensitive occupations during COVID-19.

POCT Urine and Oral Fluid. In accordance with applicable state laws, the use of point-of-collection (POCT) oral fluid or urine test devices also represent viable options. Sometimes referred to as instant- or rapid-result tests, POCT devices are single-use, disposable tests that render an immediate result at the location of the test. Though these tests can be conducted at a collection facility, mobile collection services can visit a worksite and administer tests or employees can be trained to supervise the collection.

POCT devices render qualitative (positive or negative) results. A presumptive positive sample can be sent to a certified laboratory for confirmation testing.

Instrumented POCT. Some POCT devices are part of an instrumented testing system, which eliminates the need for an individual to interpret a POCT result, the instrument or machine renders the result. If the qualitative result is positive, the sample can be sent to a lab for confirmation and, if confirmed positive, verification by a Medical Review Officer (MRO).

Saliva Alcohol. Saliva alcohol screens are also easy to conduct and represent an alternative to the use of evidentiary breath testing (EBT) if such testing is unavailable. In fact, some providers are reporting an increase in agencies and clinics discontinuing the use of breathalyzers during COVID-19 pandemic due to concerns over deep-lung air being delivered at the site of testing facilities. DOT permits the use of approved saliva alcohol screening devices, though an EBT is still required for confirmation of a screen positive.

Conclusion

Studies suggest that, perhaps, the only thing that can cause drug abuse to increase faster than legalizing marijuana is a national crisis. We know that substance abuse will likely increase in the coming months. We know that some industries and occupations that are essential to our collective survival tend to experience higher rates of substance abuse. We also know that because of the present circumstances, some employers may be questioning the importance of drug testing or are experiencing problems maintaining their existing drug testing programs.

As we continue to work our way through the COVID-19 pandemic, employers should remain committed to their drug-free workplace goals and rely on drug testing to help them achieve those objectives. The services provided by third-party administrators (TPAs), laboratories, mobile collectors, device manufacturers, trainers, policy consultants and medical review officers are essential.

Working together we can maintain safe workplaces during these uncertain times and help the country survive the challenges of the day.

REFERENCES

¹ https://www.webmd.com/balance/news/20040319/new-yorkers-after-9-11

² https://archives.drugabuse.gov/publications/stress-substance-abuse-special-report-after-911-terrorist-attacks

³ “Booze buying surges; senators push airlines for cash refunds.” Associated Press. March 31, 2020. https://apnews.com/c407ecb931c6c528b4cceb0ecc216f0c

⁴ “Drinking Alcohol When Working from Home.” https://www.alcohol.org/guides/work-from-home-drinking/

⁵ “Legal cannabis industry sees record sales as customers facing coronavirus crisis stock up.” CNBC. March 25, 2020. https://www.cnbc.com/2020/03/25/legal-cannabis-industry-sees-record-sales-in-coronavirus-crisis.html

⁶ Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. P. 16. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf

⁷ “These are the workers the U.S. government deems ‘essential’ amid the coronavirus pandemic.” Fortune. https://fortune.com/2020/03/20/essential-workers-government-list-employees-coronavirus/

⁸ Occupations Associated with Substance Abuse. August 21, 2019. https://americanaddictioncenters.org/occupational-stress-influences

⁹ https://www.questdiagnostics.com/home/physicians/health-trends/drug-testing/industry-insights.html

¹⁰ DOT Guidance on Compliance with DOT Drug and Alcohol Testing Regulations. March 23, 2020. https://www.transportation.gov/odapc/compliance-with-dot-drug-and-alcohol-testing-regulations

¹¹ FMCSA COVID-19 Drug & Alcohol Testing Guidance. In effect until June 30, 2020. https://www.fmcsa.dot.gov/emergency/fmcsa-covid-19-drug-alcohol-testing-guidance

¹² Mandatory Guidelines for Federal Workplace Drug Testing Programs— Oral/Fluid. October 25, 2019. https://www.samhsa.gov/sites/default/files/programs_campaigns/division_workplace_programs/final-mg-oral-fluid.pdf

¹³ Schools, Workplaces & Community Locations. Coronavirus Disease 2019 (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/community/index.html

This article originally appeared in the June 2020 issue of Occupational Health & Safety.