Current practice and experience in drug and alcohol testing in the workplace.

The present paper presents a review of the current practice and experience in drug and alcohol testing in the workplace, focusing primarily on the United States of America. After reviewing the history of workplace drug screening, the author describes the growth and impact of the drug-testing industry. He outlines the four most common rationales for workplace drug testing: safety, productivity, decreasing drug use and legislative/regulatory requirements. He summarizes the best studies on the prevalence of workplace drug testing in the United States and describes employer attitudes in that country. The author reviews in some detail the association between drugs, alcohol, occupational injuries and other adverse employment outcomes. He then reviews the literature on cost-benefit analysis of workplace drug testing. The author concludes that relatively little is known about the role of alcohol and drugs in the workplace. The important association between substance abuse and occupational injury has not been established. If there is such an association, it is much weaker than previously believed. The contradictory findings in different studies suggest that substance abuse may well play different roles in different occupational and cultural settings. Thus, caution should be exercised in transposing results from one setting to another. Finally, the review of cost-benefit analyses suggests that any economic analysis of workplace drug screening is likely to be greatly influenced by the prevalence of drugs in the population screened.