On-site instant drug testing growing, but OH professionals should be careful
On-site instant drug testing growing, but OH professionals should be careful
They're not always the right choice, but employers will be interested
When it comes to testing employees for drug use, what could be better than a test that is easy to administer and provides almost instant results instead of waiting for a lab report? That's the pitch for many on-site drug testing kits being marketed to occupational health professionals, and they may indeed represent a major step forward in drug testing abilities. But even so, there are a few issues you should consider before investing in this new approach.
The on-site, instant drug screens are a fairly new development in occupational health, and there are several manufacturers promoting the test kits. Most are promoted for pre-employment testing for alcohol and a wide range of illegal drugs. Generally, the test is performed with a test card or stick that is dipped in a urine sample. With some products, the sample cup itself contains the testing medium. The tests can be inexpensive, but even if you charge more than for other testing options, many employers are willing to pay extra for results that come in under five minutes. (For a list of companies providing instant drug test kits, see p. 46.)
At Personnel Solutions, a temporary employment agency in Spartanburg, SC, instant test kits have been used to screen potential employees for about two years. Kim Whisnant, vice president of operations, tells Occupational Health Management that the company turned to the instant test kits because clients demanded faster results than what was available by sending specimens to a lab.
"A lot of our job orders require someone to be there today or tomorrow, and a lot of our clients have a drug-free environment that requires the employee be tested before showing up," Whisnant says. "If I have to send off drug tests and wait for results, that can't happen. With these kits, the person can be tested right here and go straight to work."
Tests are simple to administer
At Whisnant's company, the tests are administered by any of the 10 account executives, all of whom underwent a few hours of training by the test manufacturer. Whisnant says that while the class makes staff feel confident they can administer the tests effectively, she also says, "you don't have to be a genius to do this. It's easy."
Personnel Solutions uses a test by Roche Diagnostic Systems in Somerville, NJ. The company offers several versions of instant drug testing kits, most notably the OnTrak Testcup, which is a self-contained specimen cup and testing unit. The specimen cup is tilted to allow urine to flow into the testing mechanism, and then test results are read on the side of the cup within a few minutes.
Whisnant says her company used the Testcup system for a while but then switched to OnTrak slides, another product from Roche that involves putting a urine sample on a slide. (See photos, pp. 43 and 44.)
"The only reason we decided to go with the slides is that it's easier for us to put the slide on a copier and keep a record of the test results," she explains. "Plus, the results are a little easier to read, and people in the office are more comfortable with it because it's easier to use than the cup."
Regardless of which instant test kit you choose, Whisnant compared the ease of use with a home pregnancy test. A urine sample is applied in some way, and then the test results are easily read as positive or negative. The test kits usually include automatic tests for agents commonly used in tampering, such as bleach and vinegar. If the kit detects the presence of such tampering agents, it will fail to indicate the sample is "valid."
The company uses thousands of the instant test kits every year, and Whisnant says they are cost-effective. As with most testing, the cost per unit depends on the volume of testing. But Whisnant says the Roche instant test kits cost slightly less than the laboratory testing that was used before. However, she also explains that her company and its clients probably would be willing to pay a premium for instant test results.
"It's a matter of giving the clients what they're demanding," she says. "They need the test results immediately, so we have to do whatever it takes to get those results."
Instant results new to occupational health
Instant drug test results - or "on-site testing" as it often is called by manufacturers - is not a new concept but is just now becoming com-mon in occupational health settings, explains Robert Aromando, marketing manager for Roche Diagnostic Systems.
In 1990, the tests were developed for criminal justice use, but then employers and occupational health providers slowly showed interest in the products over the next few years.
"In workplaces, we're seeing that employers are demanding better service from providers," he explains. "They're constantly demanding quicker results because they have to hire people faster. It's highly unlikely that you'll have clients go back to laboratory testing once they've tried these kits and see how quickly and easily they get results."
Though employers can use the instant test kits themselves, Aromando says his company sells a lot of instant test kits to occupational health providers who then use the product to improve the service they provide to local employers.
"We see this as a means for occupational health providers to generate revenue, but more importantly, it allows them to expand their services," he says. "The name of the game is providing your customer with the best service possible, and you're doing that when you give them negative results within a few minutes."
Traditional drug testing laboratories also offer the option of instant drug testing, an especially useful option if your state requires that all drug testing be performed by a certified laboratory. In that case, you still can offer instant drug testing to your clients by having the laboratory send technicians to the work site to perform the instant tests. The employer still gets immediate results, but the cost will be higher than if the employer or your occupational health staff conducted the on-site tests.
On-site drug testing is just becoming known to employers, says Melissa D. Tonn, MD, MBA, MPH, medical director of occupational health services at Memorial/Sisters of Charity Health Network in Houston and Presbyterian Healthcare System in Dallas. Employers often become aware of the tests because they hear about parents using them to screen teen-agers for drug use. Tonn says she frequently is asked about on-site testing.
"I'd say less than 2% of employers are using them now, but there's a trend to using them more," she says. "I expect to see an increase as people hear more about the on-site tests and start demanding faster results."
Primarily for industries with high turnover
The fast results are mostly desired by construction companies and others with high turnover rates and mass hiring, Tonn says. Her own program offers on-site drug testing to clients with those special needs, but she finds that most of her employers are still satisfied with the traditional laboratory testing.
She adds that she knows of another hospital that was forced to offer on-site drug testing to clients because competing occupational health programs were drawing away clients by offering faster results and lower prices.
One concern with on-site drug testing is that it is so convenient employers may decide to do it on their own, bypassing the occupational health program altogether. That is a possibility, but Tonn says she does not worry much about that scenario.
"A lot of employers think about doing it themselves instead of hiring us to do it. And some have to do it themselves after hours, but most employers don't want to be in the position of testing their own employees," Tonn says. "There's enough case law to show them that it's not a good idea to ask employees about what medications they're on, so employers don't want to get into that kind of questioning at all. There's still a real benefit in having a third party administer the test."
The instant kits available from several manufacturers vary in price, method, and the type of drug screens performed. With Roche products, the cost of a test kit is about $15 to $20. Compared to the cost of a typical specimen collection and laboratory drug screen, a $20 cost is inexpensive enough that an OH provider can either add a profit margin or offer a cost savings to the client.
Low price a big incentive
Aromando notes that some occupational health providers have found employers will expand their use of drug testing when the individual test price is lower than conventional lab testing. If the client broadens the use of drug testing, that can bring ancillary benefits to the provider in terms of more confirmation testing of positive results, as well as other health care.
Another benefit of on-site testing is that the occasional positive result often prompts an immediate confession by the worker, according to David Evans, JD, an attorney in Lawrenceville, NJ, and author of two books on the legal issues regarding drug testing. Because the worker sees the test result immediately, not days later, denial often seems pointless and the worker tells the truth upfront.
"In a majority of cases, when [employees] test positive in an on-site test, they just admit on the spot that they used the drugs," Evans says.
"Once they've admitted it, that's considered the proof. It can make things a lot easier than when you get a test result back from a lab and the worker feels less connected to that test result and more eager to deny everything." (For another possible reaction to positive test results, see related story, p. 45.)
There are some important limitations to instant testing kits. The tests are used almost exclusively for pre-employment testing because that is when the negative test result is most likely, most useful, and needed the fastest. Pre-employment also is when most drug testing, of any type, takes place.
An instant test kit can be used in other circumstances, such as for post-accident testing, but then the instant results are less valuable than for pre-employment testing. You're more likely to get a positive result in post-accident testing than in pre-employment testing, and the reliability of the screening test depends on the likelihood that you will get a negative result.
"These on-site kits are not meant to find your positive results and help you act on those," Aromando explains. "They're meant as a screening tool to help you say this person is negative and can go on to work. If the result is positive, you've still got more work to do." (For more limitations of instant testing, see related story, below.)
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