Ethical approach and professional responsibility in workplace drug testing: An update on the eff ectiveness of the Italian current legislation

Introduction: The Italian legislation on workplace drug testing (WDT), applied to “at-risk workers” since October 2008, calls for mandatory procedures about screening tests on urine performed by occupational health specialists and confirmation tests by gas chromatography/mass spectrometry performed by forensic laboratories. Aim: Evaluating the impact of the current law on WDT on trends of drug use in workers and discuss some ethical implications and professional responsibility connected to the management of the toxicological controls. Materials and Methods: The toxicological analyses performed from 2001 to 2014 on 73,656 workers (aged between 19 and 65 years; 92% males and 8% females), mainly employed in transports were selected for the present study. Confirmation analysis has been requested on urine samples (n = 3934) previously identified as positive for one or more drugs by immunoassay screening tests for opiates, methadone, cannabinoids, cocaine, buprenorphine, amphetamines, and analogues. Results: Relevant differences were observed, both in the incidence and in the type of drugs used, before and after the mandatory law application. At screening the positive urine were n = 2455 during 2001-2008 and n = 1479 since 2009. Among those of this second period, only 14.6% were confirmed as true positive versus the 74% of urine confirmed during 2001-2008. Moreover, the polydrug use, since 2009, decrease from 32% to 8% of cases. Cannabis and cocaine were most frequently used, alone or together with other drugs. The use of opiates, methadone and amphetamines has been observed for <5% of the workers without significant differences before and after 2009. Conclusion: To explain the decrease of our epidemiological data, two factors were considered as the prevailing ones: The deterrent effect of the mandatory nature of the drug tests and the behavior often adopted by the occupational physicians in order to avoid professional liability or disputes by workers representatives. The ethical principles, that occupational health physicians and toxicologists need to employ, to avoid the violation of the workers’ rights were discussed.