[MCOH-EH] Discrepancy screening

[Swift, Melanie D., M.D., M.P.H.]

Darlene, can you please clarify what type of testing program you're asking about? Preemployment, for cause, random tests, follow-up/recovery support?

The pitfalls with occupational hair testing are myriad - primarily because it cannot be used to determine impairment. Employers are on safe footing to act on a test that indicates the person has the substance in their system at work at a level likely to be impairing. However employers need to be careful regarding medication or substance use that did not occur at work or cause impairment at work.

As for trying to evaluate "an employee's narcotic usage...compared to others in the same department" - this concept doesn't make sense to me. Drug testing of any sort will not tell you dosages, and individuals have different prescribed medications. If reviewed by an MRO (and I hope all your tests are MRO-reviewed) tests are either positive, negative, or cancelled (with some specifics in those categories of course - positive via refusal to test, negative dilute, cancelled for a list of reasons some of which have nothing to do with the donor.) It would not be appropriate for an employer to try and compare quantitative levels of drug metabolites between workers, for so many reasons it precludes enumerating here!

Probably the most valid reason to consider use of occupational hair testing would be for individuals getting follow-up testing as part of recovery support following treatment. Hair testing could identify interval unreported substance use that may constitute a violation of an abstinence agreement. But if you don't have an agreement that requires complete abstinence, you couldn't use this to identify whether the individual had the substance in their system or were impaired by it at work.

Melanie

Melanie Swift, MD, MPH, FACOEM
Vice Chair, Division of Public Health, Infectious Diseases and Occupational Medicine
Medical Director, Mayo Clinic Physician Health Center
Associate Medical Director, Occupational Health Service
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905

-----Original Message-----
From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Darlene Sims
Sent: Monday, February 24, 2025 11:24 PM
To: mcoh-eh at mylist.net
Subject: [EXTERNAL] [MCOH-EH] Discrepancy screening

 Recently, one of our pharmacist made the request and pushing for our system to change to hair screening vs UDS.  I was just curious if anyone uses the hair method for discrepancies, particularly in situations where there are an employee's narcotic usage is higher than compared to others in the same department. We have not had an issue with our current process; however, he feels there may be missed cases.


Thank you,

Darlene Sims, FNP
Director, Infirmary Employee Health
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