In an effort to enhance the effectiveness of pre-employment and random drug testing for holders of a commercial driver’s license (CDL), among other industries, the Department of Transportation (DOT) and the Department of Health and Human Service (HHS) are mulling the inclusion of hair tests. Currently, fleets may conduct these on top of the mandated urine test, which monitor a shorter time period.
A criticism of the current setup is that failing a hair test does not count against the driver or get logged in the federal drug and alcohol clearinghouse, so that person can then go to another company where they have a better chance to beat the test. The range for hair tests is far greater, but illegal substances take a few days to metabolize and enter the follicle, which poses another problem. The HHS method would call for the hair test along with a saliva or urine sample.
On Sept. 10, HHS will begin taking comments on proposed changes to the Mandatory Guidelines for Federal Workplace Drug Testing Programs to allow for hair testing.
Recently, FleetOwner discussed the advantages and disadvantages of these various tests and how to institute them with Jared Rosenthal, founder and CEO of Health Street, a workforce screening provider.
FleetOwner: How did you get started?
Jared Rosenthal: Ten years ago, I had this idea of doing post-accident testing and being available for companies and just jumping in my car in the middle of the night, or getting a bunch of technicians together, to go out and respond to accidents or reasonable suspicion calls — 24/7, 365 days a year. I suspected it would be really hard for companies to find that and I thought maybe this was a way that I could make a living and help make the road safer.
I bought an RV, because it had a bathroom, and would come on-site to test companies once a month or once a quarter, upwards of a 100 people per visit. We now manage random pools for over 1,000 DOT companies, and we manage all their reporting. We also have a network of over 10,000 clinics nationally.
FO: Has anything changed significantly on the testing side since you started?
JR: We deal with a lot of literally mom-and-pop companies, where it's one driver and the spouse is managing the business. Up until even a few years ago DOT had no electronic chain of custody, so everything was paper. You had to mail the paper and they had to have it with them, and when it came time to actually getting the test, they couldn't find it. You might not get picked for a random test for a year or two years, so to have that paper sitting around was always a problem. The fact that we can do it electronically, authorize stuff and just send a barcode to the phone is super important.
We also used to run into a lot of times where companies would really resist the notion that they even had to comply with this regulation. It's hard to believe some of them were in business for over 10 years or more. How do you not comply?
It was a very common thing six, seven, eight years ago. Companies would just say, “I'm not going to comply with that.” We rarely run into that now. Auditing on the side of the road and making sure that they're getting pre-employment testing is much more universally adopted, at least for the companies we're talking to now.
FO: For random DOT tests, how do you feel about hair tests?
JR: The deal with hair is that [the drug] doesn't get metabolized into the hair for about five days. If you take a drug, it's in your blood system, and your blood is nourishing your hair follicles, but the hair follicle doesn't grow out into hair that you can actually cut it off from for at least five to seven days. So for something like post-accident, a reasonable suspicion is really not even a consideration. Now, for randoms or pre-employment, there's more possibility. Generally speaking, there are about twice as many positives on hair, because it just has a much longer look-back window. So it goes back about 90 days.
There is some variability in that people's hair grows at different paces. And then the part of your body that you get the hair from. And people might have different levels of dormancy in the hair. It's been reported that body hair can go back up to a year. If you grow your hair at a half-an-inch per month, which is the average growth rate for hair, that's three inches long, which could actually test back six months. If you had 10 inches of hair, you could test back 20 months. What happens is hair gets cut off at an inch and a half, so it's intended not to go back further than a month and a half. But that relies on the technician to cut from the base, then place it in the foil with the base marked so that the lab knows which end to cut off.
The other problem for something like DOT, there's such a motivation for people with good pensions, such as on a rail system, you could shave your body from head to toe, and there's nothing they can do to stop you from that. So the problem for DOT moving everyone to hair is that it's not necessarily egalitarian for everybody.
FO: What are some of the reasons for doing it?
JR: There are still ways to cheat a DOT drug tests. Hair is a lot harder to cheat, and the drugs last so much longer there. You can clean up for a pre-employment urine test, but you really can't clean up for a hair test unless you wait three months or longer.
FO: What are the benefits for urinalysis?
JR: Urine is far more studied and there's a lot more research into it and a lot more evidence that this really establishes the window. And, of course, it’s universal.
FO: Is saliva a valid test?
JR: If the drug stays in the body for 24 hours, it could make sense to do saliva for something like post-accident. The biggest difference is with marijuana, which can last a week in the urine, even up to a month for regular smokers. We use something in non-DOT situations when somebody cannot provide urine. It’s not technically saliva, but it's called an oral fluid test, which sounds the same but it's slightly different.
That would more likely to tell you if somebody was using a particular drug that day. But the stance has always been these drugs are illegal and you can't use them at all. In other words, for alcohol we do the breathalyzer that tells you if you're drunk right now. We don't care if you drank last night because it's a legal drug. Whereas, if you're talking about cocaine or PCP or heroin, I don't see that DOT has an interest in shortening the window because they just want people who don't use drugs at all, so I wouldn't see them switching to saliva.
If they change their stance on marijuana, which is a whole other conversation, the Holy Grail would be a breathalyzer for marijuana.
FO: Speaking of marijuana, how hard is it to figure out the various rules due to it being legal in certain states?
JR: Most of the problems are for the employers, because it's very difficult to tell somebody they're not going to get a job for taking something that's legal in the place that they're living. With DOT, there’s really no ambiguity. It's just illegal according to federal guidelines. It's a really tricky one because it's so different than any other drug. Let's just take a common drug like Adderall. If somebody is taking Adderall and comes up positive for Adderall, or "non negative," our doctor calls them and they say, 'Oh, I got a prescription.' And he says, 'OK, fine. I'm gonna report it as a negative because you're legally taking that drug,' and the employer never finds out. The employer doesn't know you're on a medication, doesn't know you have a condition due to ADA [Americans with Disabilities Act] issues and discrimination. Whereas, marijuana gets reported because it's illegal at the federal level. If the person says, 'Well, I got a prescription just like a guy that's taking Adderall. How come my employer has to see that?'
So, it's really complicated, it's in flux, and every state is different. Then you have hiring across state lines where this comes up. It's really it's kind of a mess. But I imagine at some point that's going to change. I don't see that staying that way forever.
FO: When you do the urinalysis, do you also test for different chemicals and supplements that can cheat the system?
JR: They do check for adulterants, so if there's something in there, you can get caught if you're drinking some of those flushes and washes. There are like three different integrity variables. It's never a good idea. People get caught for that stuff all the time. Despite what many message boards on the internet talk about this flush or that flush works to clean your system, none of that is proven.
FO: What are some of the advantages of going through a third party company like Health Street for the drug clearinghouse and testing requirements?
JR: The clearinghouse is not a ton of work either way. Ultimately, if they don't want to deal with the clearinghouse or calling any employers, they can just register, assign it to us, and then we can take it over from there.
It's not a good idea for companies with less than 100 drivers to manage their own random pools because you have to comply with the algorithm. And that's really hard to substantiate on your own. DOT comes in to audit and wants to know if you are choosing truly randomly. And as long as I've been doing it, every time somebody gets picked for random, people think, 'Yeah, sure, they really told you to take me.'
But if you're a company doing it on your own, you'd have to prove to an auditor that you're actually doing it the right way, because you might have a vested interest in not doing it truly randomly. Maybe you're trying to protect someone you related to works for the company, and you know they’re using drugs, so you don't pick them that much.
When they're intentionally doing something wrong, they could end up in jail. You don't want to mess around with the DOT.