Employee Drug Testing

August 10, 2020 | Health System Risk Management


The goal of an employee drug testing program is not to ensure that employees do not have drugs or drug metabolites in their systems or to determine whether an employee is impaired. The goal is to ensure that employees are not using illicit drugs that can impair their ability to work safely. An illicit drug is defined as any controlled substance that is used for nonmedicinal purposes. Thus, if an employee has a prescription for a controlled substance, the drug test can be reported as negative. However, just because the employee is using a drug as prescribed does not mean that his or her performance may not be impaired (see the discussion Americans with Disabilities Act. With the exception of testing for alcohol intoxication, drug testing will indicate the presence of drugs or metabolites only in the specimen tested, but there is virtually no way to correlate this finding with the level of impairment. Research on this correlation has been largely hampered by the illegal nature of the substances to be studied.

Discussion of substance use disorders in healthcare professionals is outside the scope of this guidance article.

Employers and employees in safety- or security-sensitive industries, including federal contractors and grantees, are subject to drug-testing requirements from the Department of Transportation (DOT), the Department of Defense (DOD), and the Nuclear Regulatory Commission (NRC). Accepting Medicare or Medicaid patients does not make a facility a federal contractor or grantee, but there are healthcare entities that otherwise may qualify for this status. However, most healthcare entities do not fall under these regulations. (SAMHSA "Federal Laws") Some states have laws and regulations that govern employee drug testing, but not all do. The American Civil Liberties Union (ACLU) has compiled a list of state laws on employee drug testing.

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