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Chapter 20 : Workplace Drug Testing and the Clinical Laboratory

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Abstract:

Technical competence and quality assurance are the foundation of any laboratory. This is also true for any workplace drug testing program. The hiring of qualified laboratory staff and maintenance of a safe working environment for the laboratory are direct benefits of a well-designed workplace drug testing policy. This chapter discusses the rationale for and differences between regulated and nonregulated testing. Majority of laboratories are in the state or private employment sector and must be considered for nonregulated testing. While some states may have specific requirements for workplace drug testing of laboratory employees, private sector laboratories are free to design their own programs. Workplace drug testing is designed to provide a safe work environment, discourage drug use, and provide assistance in the treatment, recovery, and return to work of individuals with substance abuse problems. The basic component of any workplace drug policy is the preemployment drug test. The chapter provides guidelines for collection, testing, and reporting of results in workplace drug testing. Having completed the collection, the initial step in testing is receipt of the sample, while verifying and maintaining the chain of custody. The chapter also provides insights to the commonalities and differences between clinical and forensic drug testing. While standards and requirements for clinical and workplace drug testing share commonalities, the intertwining of clinical and forensic specimens is to be avoided. Instrumentation utilized for analysis of both specimen types may be the same, but it is important to have separate policies and procedures for each.

Citation: Lea J. 2014. Workplace Drug Testing and the Clinical Laboratory, p 408-417. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch20

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Figures

Image of Figure 20.1
Figure 20.1

N onregulated custody and control form containing multiple forms to serve as documentation for donor, collector, laboratory, and medical review officer. The choice of drugs to be tested is dependent upon the client's requirement. doi:10.1128/9781555817282.ch20.f1

Citation: Lea J. 2014. Workplace Drug Testing and the Clinical Laboratory, p 408-417. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch20
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Image of Figure 20.2
Figure 20.2

Federal custody and control with mandated drugs/drug classes to be tested. Although the formats differ slightly, documentation for donor, collector, laboratory, and medical review officer is included. doi:10.1128/9781555817282.ch20.f2

Citation: Lea J. 2014. Workplace Drug Testing and the Clinical Laboratory, p 408-417. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch20
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Image of Figure 20.3
Figure 20.3

Specific and detailed instructions for the chain-of-custody collection are essential. Specimen collection remains the most vulnerable component of forensic drug testing. Inaccurate or incomplete information may invalidate the collection as a “fatal error.” doi:10.1128/9781555817282.ch20.f3

Citation: Lea J. 2014. Workplace Drug Testing and the Clinical Laboratory, p 408-417. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch20
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Download as Powerpoint

References

/content/book/10.1128/9781555817282.chap20
1. Chamberlain, R. T. 1988. Legal issues related to drug testing in the clinical laboratory. Clin. Chem. 34(3):633636. [PubMed]
2.Clinical and Laboratory Standards Institute. 2007. Toxicology and Drug Testing in the Clinical Laboratory; Approved Guideline, 2nd ed. CLSI document C52-A2. Clinical and Laboratory Standards Institute, Wayne, PA.
3.Federal Register. 2008. Substance Abuse and Mental Health Services Administration: mandatory guidelines for federal workplace drug testing programs. Fed. Regist. 73(228):71858.
4. Kapur, B. M. 2012. Drug testing methods and clinical interpretation of test results. eNotes. http://www.enotes.com/drug-testing-methods-clinical-interpretations-test-reference/drug-testing-methods-clinical-interpretations-test (accessed May 21, 2012).
5. Kenna, G. A.,, and D. C. Lewis. 2008. Risk factors for alcohol and other drug use by healthcare professionals. Substance Abuse Treatment Policy 3:3. [PubMed][CrossRef]
6. Shults, T. F. 2009. Medical Review Officer Handbook, 9th ed. Quadrangle Research, LLC, Research Triangle Park, NC.

Tables

Generic image for table
Table 20.1

Analytes and cutoff concentrations for federally regulated testing

Effective date: October 1, 2010. See reference .

Delta-9-tetrahydrocannabinol-9-carboxylic acid (THCA).

Morphine is the target analyte for codeine/morphine testing.

Either a single initial test kit or multiple initial test kits may be used, provided the single test kit detects each target analyte independently at the specified cutoff.

Methamphetamine is the target analyte for amphetamine/methamphetamine testing.

To be reported as positive for methamphetamine, a specimen must also contain amphetamine at a concentration greater than or equal to 250 ng/ml.

Methylenedioxymethamphetamine (MDMA).

Methylenedioxyamphetamine (MDA).

Methylenedioxyethylamphetamine (MDEA).

Citation: Lea J. 2014. Workplace Drug Testing and the Clinical Laboratory, p 408-417. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch20
Generic image for table
Table 20.2

Drug categories and cutoff concentrations for nonregulated testing

Modified from: , http://www.clr-online.com (4 April 2012). See Table 20.1 for abbreviations.

Some laboratories use 200 ng/ml as the screening cutoff concentration for these drugs while others use 300. The confirmation cutoff must be the same concentration as used for screening.

Citation: Lea J. 2014. Workplace Drug Testing and the Clinical Laboratory, p 408-417. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch20

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