Back to Basics, Health and Wellness

Back to Basics: Drug and Alcohol Impairment

Back to Basics is a weekly feature that highlights important but possibly overlooked information that any EHS professional should know. This week, we examine drugs and alcohol, and impairment on the road and in the workplace.

Drug and alcohol abuse can leave workers and commercial motor vehicle (CMV) drivers impaired. As more states have decriminalized cannabis, its growing acceptance has become a special challenge for those employing workers in safety-sensitive positions.

But impairment isn’t the only risk controlled substances pose. Opioid overdoses can also be fatal. Unintentional workplace overdose deaths reached an all-time high of 464 in 2021, according to the National Safety Council (NSC). The Department of Labor’s Bureau of Labor Statistics (BLS) also noted an annual increase in deaths from unintentional overdoses due to nonmedical use of drugs or alcohol while at work.

However, a new tool has become available for treating opioid overdoses in the workplace: The U.S. Food and Drug Administration (FDA) recently approved an over-the-counter (OTC) nasal spray for the treatment of opioid overdoses. Narcan, a 4-milligram naloxone hydrochloride nasal spray, is the first naloxone product approved for use without a prescription.

Naloxone is effective in reversing opioid overdoses, and emergency medical service technicians, police officers, and other responders carry the drug for that purpose.

The NSC was “thrilled” with the approval and encouraged employers to add OTC Narcan to their workplace first-aid kits.

Opioids may be prescribed to manage the pain from a work-related injury, according to the National Institute for Occupational Safety and Health (NIOSH). Workplace conditions like slip, trip, and fall hazards or heavy workloads can lead to injuries associated with prescription opioid use.

Some people who use prescription opioids may misuse them and/or develop a dependency. Prescription opioid misuse can even lead to heroin use.

Opioids include natural opioids such as morphine and codeine derived from the opium poppy; semisynthetic opioids that include the illicit drug heroin and prescription drugs hydrocodone and oxycodone; and synthetic opioids such as fentanyl, methadone, and tramadol.

Addressing opioid and other substance use disorders in the workplace remains a priority for NIOSH’s Total Worker Health program, and the institute supports ongoing research into the opioid crisis in the workplace.


While the list of states that allow the medical and recreational use of marijuana continues to expand, at the federal level, marijuana use and possession are still illegal. The drug is also still considered a Schedule I substance under the federal Controlled Substances Act.

As new states enact laws allowing recreational marijuana use, the NSC raises concerns about the impact of cannabis use on roadway and workplace safety. It continues to warn employers and the public about the impairing effects of marijuana and supports employers’ right to insist on having drug- and alcohol-free workplaces.

The NSC also maintains that when legislatures pass laws to decriminalize or legalize cannabis possession, they should simultaneously pass laws restricting marijuana-impaired driving and marijuana impairment at work.

According to the NSC, the effects of decriminalizing recreational cannabis use can include:

  • Increased risk of injury on roads and in the workplace due to marijuana’s effect on cognitive dexterity, judgment, and reflexes—effects similar to those of alcohol consumption and opioid use.
  • The different effects of cannabis due to an individual’s body composition and how the drug is consumed. Tetrahydrocannabinol (THC), the psychoactive agent in marijuana, is stored in body fat.
  • An increase in motor vehicle accidents involving THC in states following the passage of medical or recreational marijuana laws.

The NSC also offers assistance for employers faced with opioids in the workplace, including an “Opioids at Work Employer Toolkit” containing fact sheets, posters, presentations, and scripts for 5-minute safety talks, as well as reports, sample policies, videos, and white papers, to help employers address the workplace impacts of the ongoing opioid crisis.

The NSC has continued to survey employers about their concerns with substance use and abuse. A survey on opioids in the workplace found that:

  • Employers were most concerned about the costs of benefits (86%), their ability to hire qualified workers (90%), and the costs of workers’ compensation (86%).
  • Over 75% of employers reported having been affected by employee opioid use, with 38% experiencing absenteeism or impaired worker performance.
  • Only 17% of employers believe their organization is extremely well prepared to deal with opioid use in the workplace.


Trends in drug testing results should concern you.

Last year, testing laboratory Quest Diagnostics reported the rate of positive drug test results among American workers reached its highest rate since 2001. The company’s own data analysis showed the positivity rate was up more than 30% in the combined U.S. workforce from an all-time low from 2010–2012.

After 5 years of steady declines in several drug categories, positivity rates based on urine drug tests for federally mandated, safety-sensitive positions increased in 2021, according to Quest’s reports.

The positivity rate in post-accident urine testing in the general workforce for marijuana was 63.4% higher and 266.7% higher for cocaine compared with preemployment tests.

Drug testing is required in safety-sensitive transportation occupations.

The current minimum annual percentage rate of random drug testing for CMV drivers is 50%. The minimum rate for random alcohol testing is 10%. The Federal Motor Carrier Safety Administration (FMCSA) raised the minimum random drug testing rate from 25% beginning in calendar year 2020.

The administrator must increase the minimum annual random testing percentage rate whenever the rate of positive tests is equal to or greater than 1%, and it may only lower the rate to 25% if the positivity rate is less than 1% for 2 consecutive calendar years.

CMV drivers are subject to random testing even when at home in an off-duty status. In addition to random drug and alcohol testing, the FMCSA requires preemployment and post-accident testing.

Department of Transportation (DOT) drug and alcohol testing requirements for all safety-sensitive transportation positions appear in 49 Code of Federal Regulations (CFR) Part 40. The Part 40 requirements apply to CMV drivers and aircraft mechanics, armed transit security officers, bus drivers, locomotive engineers, pilots, pipeline controllers, ships’ captains and others operating commercial vessels, and subway operators. The FMCSA also has motor carrier-specific drug and alcohol policies, which appear in 49 CFR Part 382.

The DOT drug testing requirement for all safety-sensitive transportation positions is a five-panel test for controlled substances, including amphetamines and methamphetamines (such as MDA, MDEA, and MDMA), cocaine, marijuana, opiates (opium and codeine derivatives), and phencyclidine (PCP).

While transportation employers must test employees for marijuana use, the DOT doesn’t require employers to test employees in safety-sensitive positions for cannabidiol (CBD) use. However, hemp, hemp oil, and CBD products may contain very low concentrations of THC, which could trigger a positive test result for marijuana.

The use of CBD products is not a legitimate medical explanation for a laboratory-confirmed positive result for marijuana.

If tests confirm the presence of THC at appropriate cutoff levels, a motor carrier’s designated employer representative (DER) is authorized to remove a driver from duty immediately. The removed driver then must complete the return-to-duty process under the guidance of a substance abuse professional (SAP).

Additionally, the driver must complete directly observed return-to-duty drug testing and is subject to at least six follow-up tests in the year following a return to duty. SAPs may prescribe follow-up testing for a maximum of 5 years.

Transportation employers typically use contract diagnostic laboratories to perform urinalysis and rely on medical professionals to review test results. However, employers remain responsible for their testing contractors’ compliance.

The technicians and professionals in a drug and alcohol testing program can include:

  • Breath alcohol technicians and screening test technicians, or individuals trained to conduct alcohol screening and confirmation tests, document test results, and transmit results in a timely and confidential manner;
  • Consortium/third-party administrators (C/TPAs),or service agents who coordinate a variety of drug and alcohol testing services for employers;
  • Department of Health and Human Services (DHHS)-certified laboratories that evaluate urine specimens submitted by collectors, including an analysis to determine the existence and concentration of controlled substances;
  • Medical review officers (MROs), or licensed physicians trained and certified to review lab results and validate whether a test is positive;
  •  SAPs, or licensed or certified healthcare professionals with knowledge of the diagnosis and treatment of alcohol and controlled substance-related disorders; and
  • Urine collectors, or individuals trained to collect and ship urine specimens and ensure collection site security and integrity.

Testing, return to duty

Drivers must submit to drug and alcohol tests under “direct observation” conditions, under which an observer of the same gender as the employee must watch the employee urinating directly into a collection container.

If a driver tests positive or refuses a drug test, the driver should be removed from duty, and the employer must provide the driver with a list of acceptable SAPs. The driver must then begin the treatment and return-to-duty process.

Once a driver has completed the return-to-duty process and tested negative for drug use, an SAP may sign a return-to-duty report. However, the driver is subject to follow-up testing, which consists of a minimum of 6 unannounced, directly observed tests, conducted during the first 12 months following the return-to-duty test.

SAPs also submit reports to the FMCSA’s Drug and Alcohol Clearinghouse detailing a driver’s return-to-duty activities, including:

  • Driver’s name, date of birth, commercial driver’s license (CDL) number, and state of issuance;
  • Date of initial SAP assessment; and
  • Date the SAP determined the driver demonstrated successful compliance with education and treatment requirements and is eligible for return-to-duty testing.

Drug and Alcohol Clearinghouse

The Clearinghouse is a central repository of records of CMV drivers’ drug and alcohol violations, and its purpose is to prevent drivers from concealing drug or alcohol violations simply by moving to another job or another jurisdiction. The FMCSA maintains the Clearinghouse database, and motor carriers must check the records of current and prospective drivers in this database for any drug or alcohol violations and compliance with return-to-duty requirements.

Clearinghouse records include records of driver drug and alcohol violations, as well as whether a driver has completed the return-to-duty process and follow-up testing after a positive test or refusal to test.

Employers must make annual checks of Clearinghouse records for all current employees, but they must first get drivers’ electronic or written consent before querying the Clearinghouse database.

Employers also must query the Clearinghouse when considering any CMV drivers for employment.

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