Seven years of workplace drug testing in Italy: A systematic review and meta‐analysis

Abstract

In Italy, Workplace Drug Testing (WDT) has been compulsory by law for specific categories of workers since 2008, offering the opportunity to compare studies conducted within a single regulatory framework. The aims of this paper are to estimate the overall prevalence of WDT positivity (at screening survey) among Italian workers and evaluate the percentage of true and false positives at confirmation analysis. A systematic review and meta-analysis of the scientific literature on WDT in Italy from January 2008 to March 2015 was carried out, according to the MOOSE guidelines. A random effects model was utilized to calculate pooled prevalence. Potential sources of heterogeneity were explored using sensitivity test and subgroup analysis. The overall meta-analytical prevalence of positivity at WDT among Italian workers was 1.4% [95% confidence interval (CI) = 1.1-1.7%]. It was significantly lower among workers screened with an on-site test (1%; 95% CI = 0.5-1.5%), compared with a bench-top test (1.7%; 95% CI = 1.3-2.1%). Nine studies provided data on false positives at the screening test, with a combined prevalence estimate - calculated on positive cases - of 30% (95% CI = 16-44%). In Italy, the number of true positives at first-level workplace drug testing is low, while the frequency of false positives is relatively high. A revision of the Italian legislation on the subject seems advisable. Copyright © 2017 John Wiley & Sons, Ltd.

Policies and Toxicological Screenings for No Drug Addiction: An Example from the Civil Aviation Workforce

“…The average rate of confirmed samples was 69%, thus determining the rate of screening test false positives to be about 31%. This finding is in line with the results of other analyses that have reported a prevalence of false positives of 30% [22].…”

Should NPS be included in workplace drug testing?

“…The Italian WDT experience for traditional drugs of abuse has shown a very low prevalence of positive results, possibly because the mandatory "surprise sample collection" is rarely respected, while the short detection window of consumed substances in the urine matrix allows even habitual consumers to keep off the drugs for just a few days before control. 33 The latter example proves that even adequate analytical procedures turn out to be ineffective if the whole procedure from sample collection to data reporting is not under control. Transposing this concept into NPS testing, it is clear that systematic monitoring of the data arising from an extended WDT program would be highly recommended, together with the assessment of its effectiveness.…”

“…33 The latter example proves that even adequate analytical procedures turn out to be ineffective if the whole procedure from sample collection to data reporting is not under control. The Italian WDT experience for traditional drugs of abuse has shown a very low prevalence of positive results, possibly because the mandatory "surprise sample collection" is rarely respected, while the short detection window of consumed substances in the urine matrix allows even habitual consumers to keep off the drugs for just a few days before control.…”

Abuse of Licit and Illicit Psychoactive Substances in the Workplace: Medical, Toxicological, and Forensic Aspects

“…The use of psychoactive substances in the workplace (or during working hours) is usually governed by health and safety laws that address the potential health and safety risks for themselves or co-workers [75][76][77]. Therefore, these laws usually legitimate the fact that the tests should be restricted to categories of workers whose activity may endanger their physical or third party integrity and make employers responsible for preventing psychoactive substance use in the workplace and impose them to carry out risk assessments and preventive measures [78].…”