A warning signal about tests` integrity

If drug testing is to be an effective and integral component of the effort to prevent substance-related harms, every element of the testing sequence must be considered reliable and must provide reasonable defense against attempts to tamper with the process. Confidence in a critical aspect of testing was certainly shaken to a degree with November testimony to Congress from the Government Accountability Office (GAO) on flaws detected at collection sites used in the U.S. Department of Transportation's (DOT's) drug testing program.

Gregory D. Kutz, the GAO's managing director of forensic audits and special investigations, delivered to Congress the results of a report based on undercover visits to 24 DOT program collection sites in four metropolitan areas (Washington, D.C., Los Angeles, New York City/Northern New Jersey, and Dallas/Fort Worth). Examining adherence to 16 DOT protocols determined to be critical in preventing an employee from beating a drug test, the investigators found that nearly all the visited sites did not adequately follow the protocols.

As one example of a common problem at the sites, three-quarters of the locations failed to restrict access to items that persons taking a urine drug test could use to adulterate or dilute a specimen. Greg Elam, MD, medical review officer at National Toxicology Specialists in Nashville, Tennessee, a company that implements drug-free workplace programs, said the GAO findings about collection sites are not surprising but still have generated a strong reaction since their release.

“We've always known that the collection site is the weakest link in the process,” Elam says. “This is true in part because their workers are the lowest-paid. Big, burly truck drivers can intimidate the young people who work at these sites. And these workers are not just doing collections; they're taking blood pressures, doing vision screenings, etc.”

Elam says that while laboratories where drug tests are analyzed are subject to thorough inspections twice a year, collection sites in general need to be monitored more closely than they have been, both in terms of safeguards against deceptive activity and in how workers are trained.

Elam believes the situation probably is better in addiction treatment programs that conduct drug testing. He thinks, for example, that staff members in these programs might be less hesitant to require direct observation of someone taking a test in instances where there is a reasonable suspicion that someone may seek to beat the test. But even some treatment programs could be doing a better job of ensuring reliable test results, he says.

“A lot of the programs for testing [addicted] professionals are using non-observed samples. What I tell them is their programs probably aren't worth much,” Elam says.

GAO findings

In just a few minutes on the Internet, anyone can find a treasure trove of products designed to elude a positive drug test and the consequences it might bring. While Elam believes the effort involved in obtaining and using some of these products does serve to deter drug use to a degree, the fact remains that collection sites need to enforce consistent procedures to guard against use of readily available methods for adulterating a sample.

The GAO investigation found that the DOT program collection sites it examined were falling well short of adhering consistently to accepted protocols. In the investigation, in which GAO created two fictitious trucking companies and produced fake driver's licenses for its investigators posing as truck drivers, all investigators successfully used the fake licenses to gain access to the site—mimicking how drug users might be able to find a stand-in for a test without raising suspicion.

DOT regulations for what amounts to the world's largest drug testing program, covering more than 12 million employees of motor carriers overseen by six DOT operating administrations, include protocols requiring that no clear water source be available in the collection area for possible use to dilute a specimen. In addition, there should be no access to soap, air freshener, or other chemicals that could be used to adulterate a specimen. However, investigators had access to at least some of these items at 75% of the collection sites visited, and two-thirds of the time were at sites where not all sources of clear water in the restroom were secured.

According to the report, investigators were able to use adulterants at four sites and to substitute synthetic urine at another four sites—the latter made possible because many sites did not require the “employees” to empty their pockets and show the contents before entering the restroom. In no cases did a drug screening lab detect the drug-masking products that were used. “Provided the adulterant we used would be able to mask drug use as advertised, a drug user would likely be able to use the substances we tested to obtain a passing result on his or her test,” the report states.

Policy implications

The GAO reported that DOT agreed with the overall findings and added that it has taken some steps to improve practices at collection sites, such as by distributing to these privately run sites a set of posters that clearly specify the various collection protocols. But more substantive reforms might take much longer to implement.

DOT has consistently supported legislation to ban the sale of drug-masking products, but such a measure has not been adopted. Elam believes the agency will begin to look at alternative testing matrices such as hair testing, but hair testing technology remains in relative infancy and there is no guarantee that adulterants won't become a problem for this and other forms of testing as well.

In the short term, Elam expects DOT soon will issue a notice of proposed rulemaking to strengthen a number of collection-related provisions. Beyond that, he believes that while privacy concerns make direct observation for all urine testing unlikely, employers and other testers should not hesitate to enforce direct observation in cases where there is reasonable suspicion of improper activity or when a previous test has been invalidated.

“Employers must be less squeamish about reasonable-suspicion testing,” Elam says.