Construction worker driving a tractor.

Dangerous Trends and Challenges in Drug Testing in Construction

By Michelle Hopkins | 04/01/2020

Confusion about drug testing and potential safety ramifications of drug use/abuse may be more pernicious in construction than some other industries due to the safety-sensitive environments. Also, construction employers face three unique challenges in efforts to foster drug-free work sites:

  1. The highly physical nature of construction work and the inevitability of painful injuries that may or may not require pain medication
  2. Construction employees are more likely than employees in more than a dozen industries to use cocaine and misuse opioids. They are second most likely to use marijuana.1
  3. Construction can struggle with finding skilled labor, narrowing the candidate pool due to positive drug tests from otherwise qualified candidates may seem counterproductive.

Employers may also have questions about CBD (cannabidiol) oil, a hemp plant derivative, which is heavily advertised. “CBD oil typically wouldn’t cause a positive urine drug screen, unless it had a high THC component, which is rare,” says Anne-Marie Puricelli, MD, JD, Concentra’s national medical director for transportation. (THC is delta-9-tetrahydrocannabinol, the main mind-altering ingredient that creates the “high” associated with marijuana.)

Construction employers must weigh complex factors to make decisions about drug testing, especially when operating in multiple states and municipalities where laws may differ. Consulting a legal advisor about drug testing laws in jurisdictions in which construction operations take place is recommended. Nothing in this article should be construed as legal or medical advice.

Risk: drug use by employees in construction

A New York University study published in Drug and Alcohol Dependence examined 10 years of data from the National Survey on Drug Use and Health. Nearly 300,000 employees in 14 professions, including 16,610 employees in construction, extraction, and mining, were represented. Construction employees had a higher prevalence of opioid misuse (3.4 percent to 2.0 percent) and cocaine use (1.8 percent to 0.8 percent) than all other professions and the second highest prevalence of marijuana use.1 The same source notes construction employees are seven times more likely than other employees to die from an opioid overdose.

Risk & Insurance reported in November 2019 that employees in construction have a 60 percent higher rate of substance misuse disorders than the national average.2

Quest Diagnostics, a global clinical laboratory, examined 17 industrial and business sectors. Quest reported that construction is one of only five sectors with a rate of increase in positive drug tests (13.2 percent) from 2015 to 2018, which was more than double the national rate of increase for that period (6.2 percent).3 The construction industry is caught in a dilemma: on one hand, drug use is increasing; on the other hand, builders are desperate to find skilled labor, a pain point for 80 percent of contractors, as reported by the construction association, Associated General Contractors.4 Even so, there are good reasons for employers in construction not to look the other way and forego drug tests.

High price of foregoing drug testing in construction

Drug testing can be performed in several situations: pre-placement, when there is reasonable suspicion of substance use, post-accident, and before returning to work after a drug or alcohol violation. Depending on the panel type/size, testing method, laboratory involvement, and the number of employees to be tested, the costs of drug testing may worry some employers.

But the costs of not doing drug tests may be larger. Consider what happens if an accident occurs. Prime contractors generally try to ensure subcontractors have workers’ compensation insurance. But, if an injury is determined to be drug-related and a subcontractor’s coverage falls short of covering costs, other parties to the construction project and/or equipment or materials in use also may become responsible for costs. There is also the possibility of costly litigation, project delays, and damaged public trust and reputation. Regular drug testing in all situations is a solid risk- and cost-reduction strategy.

Benefits of drug testing in construction

As of October 2018, 13 states provided discounts on workers’ compensation insurance to employers who established a drug-free workplace.5 (Conversely, a company with employee drug abuse can face higher insurance premiums.6) Discounts can be substantial. As an example, one construction company reported 50 percent lower insurance premiums after drug testing was implemented.7

In addition to discounts on workers’ compensation premiums, other benefits of a drug-free environment in construction may include lower injury rates/better safety performance,8 fewer employee absences, fewer workers’ compensation claims, and increased productivity and profitability.

A Cornell University study of the construction industry – including large international contractors to comparatively small local contractors – showed companies that implemented drug testing programs achieved a 51 percent reduction in company incident rates within two years of implementation. The incident rate fell from 8.92 to 4.36 per 200,000 work hours. More than 72 percent of the companies in the study said the benefits of drug testing outweigh the costs. Only 11 percent believed the costs were higher.9

If you want benefits like these, contact Concentra to get started on your own drug testing program. If you have more questions about drug testing, read on.

Frequently asked construction industry drug testing questions

In November 2019, Concentra expert Michael Berneking, MD, medical review officer, presented the webinar, “What Employers Need to Know About Drug Testing.” Experience the webinar again or for the first time and read the transcript. You can also view our latest webinars.

Here are some of the questions we heard from you, along with brief responses

Q1: Is drug testing mandatory in construction?

If a business or organization has received a federal contract of $100,000 or more or a grant of any size, the Drug-Free Workplace Act of 1988 requires the creation and distribution of a drug-free workplace policy, and establishment of a drug-free awareness program with steps taken to ensure employees understand reporting and other requirements. Drug testing is not explicitly required.

Three federal agencies – the Department of Transportation (DOT), the Department of Defense (DOD), and the Nuclear Regulatory Commission (NRC) have specific regulations on drug-testing requirements for industries that perform public safety and national security roles under their purview.10

Q2. Is marijuana (cannabis) permissible now?

If the Drug-Free Workplace Act applies to your business or construction project, use of marijuana and/or cannabis derivatives is expressly prohibited. Marijuana is a Schedule 1 controlled substance* under federal law. In states where cannabis has not been legalized, employees are prohibited from using marijuana. As of January 1, 2020, 44 states have legalized marijuana (11 recreational and medical use and 33 medical marijuana only).

There is a perception that the 2018 Farm Bill legalized all CBD oil, but that is not precisely true. “CBD generally remains a Schedule I substance under federal law. The Farm Bill – and an unrelated action by the Department of Justice – creates exceptions to this Schedule 1 status in certain situations,” says John Hudak, senior fellow of governance studies. “The Farm Bill ensures that any cannabinoid, or set of chemicals found in the cannabis plant, that is derived from hemp is legal, if and only if that hemp is produced in a manner consistent with the Farm Bill.” Read more here.

To ascertain legal requirements affecting your business or project, consult with your legal counsel. Concentra is prohibited from providing legal opinions to an employer.

Q3. What are common signs and symptoms of substance use?

Employees who have a substance abuse problem may exhibit a host of different signs, but some of the most common are:

  • Lack of focus
  • Poor coordination
  • Declining work performance
  • Mood swings
  • Chronic illness
  • Poor attendance
  • Poor physical appearance
  • Lethargy

Q4. What should I do if I suspect my employee is impaired due to marijuana?

Employees who are suspected of being impaired from the use of marijuana or any other substance should be removed from safety sensitive work immediately and should be evaluated by an appropriately trained clinician. When impairment is suspected, the employee should not be returned to safety-sensitive duties until test results are available, and/or when pre-established company policy protocol suggests they should return to their duties. A job description for the employee being evaluated should be provided by the employer and reviewed by the clinician. The employee should not be allowed to drive or perform safety-sensitive duties.

Q5. How would you summarize Concentra’s “best practice” recommendations for workplace drug testing?

  • Know your industry
  • Become familiar with local, state, and federal testing guidelines
  • Have a written workplace substance abuse policy
  • Provide policy training to leadership and document all training
  • Make sure your workforce understands all policy guidelines
  • Be consistent in your enforcement of policy
  • Partner with an occupation health provider to structure your policy and ensure testing compliance

Every month, one of our Concentra experts presents a webinar highlighting the most up-to-date information on a high-interest occupational safety and health topic. Our expert answers questions from business decision makers, safety leaders, risk managers, and more. This is a great opportunity to get your questions addressed by a leading occupational medicine expert, so sign up to get notified about upcoming webinars.

1. “Of all professions, construction workers are most likely to use opioids and cocaine,” Science Daily, October 30, 2019.       
2. “11 Crucial Trends That Are Impacting the Construction Industry Today,” Risk & Insurance, November 1, 2019.       
3. “Workforce Drug Positivity Increases in More Than One-Third of US Industry Sectors Examined, According to Quest Diagnostics Multi-Year Analysis,” Quest Diagnostics Drug Testing Index, September 11, 2019.   
4. “Eighty Percent of Contractors Report Difficulty Finding Qualified Craft Workers to Hire,” Associated General Contractors, August 27, 2019.
5. “Will a Drug-Free Workplace Lower Your Workers Comp Premium,” The Balance, December 20, 2018.
6. Hinze J, Olbina S. Current US Drug Testing Practices (in the Construction Industry), University of Florida School of Building Construction.
7. Minchin RE, Glagola CR, Guo K, Languell JL. Case for Drug Testing of Construction Workers. Journal of Management in Engineering. 2006; 22(1): 43-50.
8. Wickizer TM, Kopjar B, Franklin G, Joesch J. Do Drug-Free Workplace Programs Prevent Occupational Injuries? Evidence from Washington State. Health Services Research. 2004; 39(1): 91-110.
9. Gerber JK. An Evaluation of Drug Testing in the Workplace: A Study of the Construction Industry.
10. “Considerations for Safety- and Security-sensitive Industries,” Substance Abuse and Mental Health Services Administration (SAMHSA).