To the Editor:
Mental distress, risky behaviors, and injury rates are high in the male-dominated US construction industry in which close to 7 million adults were employed in 2017.1,2 Limited secondary data and national epidemiologic studies suggest that drug abuse remains high within this worker population.2,3 Drug use among working adults includes not only the use of illicit drugs, but also the misuse of prescription drugs such as analgesics, sedatives, and stimulants.2 Substance misuse assessment in the work environment can be challenging, however, there is a need to conduct research on the relationship between drug use and related measures including worksite physical exposures, mental health, work-related injuries, productivity, worksite safety behaviors, and return to work following an injury.4 Despite these critical research gaps and data needs, securing voluntary biological samples from workers at the jobsite for drug screening can be difficult. Construction workers can be reluctant to disclose drug use information or provide biological samples that could negatively impact their employment.5
Drug surveillance programs are often limited to pre-employment screenings or specific parameters around major post-accident events.6–8 This surveillance approach creates a gap in continuous monitoring for substance abuse during the employment period of the construction worker where health protection and health promotion activities could be provided at the worksite to support the safety profile of the workforce. Fortunately, enacting a drug testing program has been proven to help improve workplace safety in the construction industry. Using both secondary data from US National Council on Compensation Insurance and primary data collected from the Associated General Contractors membership, researchers documented that construction firms with drug-testing programs report a 51% reduction in injury incident rates within 2 years following the implementation.9,10 While drug surveillance programs have been shown to reduce the hiring of workers with risky drug use behaviors that can lead to injuries, surveillance opportunities for substance abuse throughout the employment period are limited. It may be possible that impaired workers due to drug abuse during the employment period could contribute to worksite injuries or accidents, yet data to assess how drug abuse during employment impacts safety behavior and injuries is limited.
In this present proof of concept pilot study, we collected discarded bottles containing worker urine from the construction site for drug and alcohol screening as an alternative approach to passive substance abuse surveillance.
In collaboration with a general construction firm in Florida, our research team collected five discarded water (n = 3) and power sports drink (n = 2) plastic bottles containing human urine from a large condominium construction site during the weekday in November 2017. The construction worksite is fenced across the entire perimeter and accessible to construction workers only. Using universal precautions our team collected the bottles off the ground during two regular mid-morning construction site walkthrough with the safety manager, labeled each bottle with a study number, placed a Crystaline-II temperature sticker at the base of the bottle, and placed a multistix Siemens urinalysis test strip in each bottle. Bottles were capped at the construction site and transported to the University's toxicology lab. Each bottle was evaluated for available volume, quality, and possible contamination. All five samples were analyzed with a 48 target drug panel utilizing Liquid Chromatography tandem-Mass Spectrometry (LC-MS/MS) for a variety of drugs including cannabis, opiates, stimulants, and depressants. Following the initial screen, an alkaline drug screen by GC–MS was carried out on all specimens to screen for an extensive array of drugs.11 Ethanol quantitation was carried out using headspace-gas chromatography-flame ionization detection (HS-GC/FID). Field collection notes (ie, date collected, bottle ID, collector, bottle make, location, surface temperature, presence of residual liquid, and collector notes) were recorded. The University Institutional Review Board determined the study protocol to be non-human subjects research.
Analysis of bottle characteristics and urine alcohol and drug toxicology are presented in Table 1. Three of the five bottles collected mid-morning during a regular workday tested positive for a combination of alcohol use, amphetamines, cocaine, and marijuana. One bottle (bottle ID#1), with a water label contained urine the resulted positive on toxicological screening for amphetamine, methamphetamine, and Δ9-carboxy-terahydrocannabinol (THC), a metabolite of marijuana consumption. Another bottle (ID#5), resulted positive for cocaine, cocaethylene, benzolyecgonine, ecgonine methyl ester, levamisole, and Δ9-carboxy-terahydrocannabinol. A third bottle, (ID#3) resulted positive for alcohol with 0.035 G/100 mL suggesting recent alcohol ingestion by the worker.
We identified a mechanism to safely collect and evaluate discarded urine for substance abuse surveillance among a low socio-economic worker population. The confirmation of the controlled substances identified, including three schedule one drugs, cocaine, cannabis, and methamphetamine, in two of the collection bottles as well as alcohol use in a third bottle poses some safety questions in regards to drug impairment and working in a potentially dangerous construction environment. Worksite time pressures appear to increasingly force workers to micturate in bottles instead of traveling to available worksite portable toilets. Future epidemiologic studies should collect and drug test discarded urine bottles across various construction sites over a longer period of time to properly characterize the landscape of substance abuse in this high-risk worker group. Linking substance abuse to worker safety behaviors and injuries may shed additional light on possible worksite-based interventions healthcare professionals can use to engage this population.
The authors would like to thank the construction company that provided guidance on this project.
1. Jacobsen HB, Caban-Martinez A, Onyebeke LC, Sorensen G, Dennerlein JT, Reme SE. Construction workers struggle with a high prevalence of mental distress and this is associated with their pain and injuries. J Occup Environ Med
2. Bush DM, Lipari RN. Substance Use and Substance Use Disorder by Industry. The CBHSQ Report. Rockville, MD: Substance Abuse and Mental Health Services Administration (US); 2013.
3. Schofield KE, Alexander BH, Gerberich SG, Ryan AD. Injury rates, severity, and drug testing programs in small construction companies. J Safety Res
4. Pidd K, Roche AM. How effective is drug testing as a workplace safety strategy? A systematic review of the evidence. Accid Anal Prev
5. Taylor Moore J, Cigularov KP, Sampson JM, Rosecrance JC, Chen PY. Construction workers’ reasons for not reporting work-related injuries: an exploratory study. Int J Occup Saf Ergon
6. Sorock GS, Smith EOH, Goldoft M. Fatal occupational injuries in the New Jersey construction industry, 1983 to 1989. J Occup Environ Med
7. Lehtola MM, van der Molen HF, Lappalainen J, et al. The effectiveness of interventions for preventing injuries in the construction industry: a systematic review. Am J Prev Med
8. Snashall D. Occupational health in the construction industry. Scand J Work Environ Health
9. Gerber JK, Yacoubian GS Jr. An assessment of drug testing within the construction industry. J Drug Educ
10. Gerber JK, Yacoubian GS Jr. Evaluation of drug testing in the workplace: study of the construction industry. J Construct Eng Manag
11. Reidy LJ, Junquera P, Van Dijck K, Steele BW, Nemeroff CB. Underestimation of substance abuse in psychiatric patients by conventional hospital screening. J Psychiatr Res