Racial/Ethnic Differences in Workplace Drug Testing and Policy on Positive Drug Tests in the United States

Background/Purpose: Drug testing has drawn more interest since the 1980s’ War on Drugs as a means for substance use identification and prevention among employees. Evidence indicates drug testing’s disproportionate impact on racial/ethnic minorities including African American workers who are over-represented in workplaces conducting drug tests. However, limited is the understanding of the latest extent of racial/ethnic patterns of workplace drug testing (including Hispanic workers) as well as organizational policy on positive drug test results. To fill the gap, the present study aims to examine the extent and nature of workplace drug testing policy and responses to positive drug tests across racial/ethnic subgroups.

Methods: We used data from the 2015-2019 National Survey on Drug Use and Health, a nationally representative cross-sectional study of noninstitutionalized US civilians. The analytic sample was restricted to 121,988 adults working full or part time at the time of survey, including 61,015 respondents whose workplaces conduct drug tests. Measures included workplace’s drug testing status and timing (at hiring stage, on random basis, or both), policy on the first positive test result for illicit drugs (being fired, treatment/counseling referral), and sociodemographic characteristics. For statistical analyses, we estimated the rates of employed individuals whose workplaces conduct drug tests and tested significance of the trends, separately for racial/ethnic subgroups. Second, we examined the associations between workplace drug testing status/timing and sociodemographic characteristics. Lastly, multinomial logistic regression analysis was conducted to assess the associations between policy on first positive drug tests (separately for being fired and referred to treatment and counseling) and sociodemographic characteristics. The estimates were then used to compute the predicted probabilities of being fired and referred to treatment/counseling for each racial/ethnic group.

Results: About 50.6% of employed individuals reported that their workplaces have a drug testing policy. The rates among Blacks were 15-20 percentage point higher than other racial/ethnic groups, with 96.4% (AOR=1.964, 95% CI=1.1.848-2.086) higher odds of having a such policy during the study period than their White counterparts. When tested positive for illicit drugs, Blacks and Hispanics had 56.3% (95% CI=44.5-68.9) and 37.2% (95% CI=25.8-49.6) higher odds of being fired than Whites, respectively. For treatment/counseling referral, we found 41.9% (AOR=1.419; 95% CI=1.256-1.603) higher odds for Blacks, but 20.3% (AOR=0.797; 95% CI=0.727-0.879) lower odds for Hispanics. These estimates are translated into 45.8% (Blacks) and 46.9% (Hispanics) likelihood of being fired when tested positive for illicit drug use, higher than Whites’ 37.7%. Also, 13.0% of Hispanic were likely to be referred to treatment/counseling, significantly lower than Blacks (19.8%) or Whites (18.0%).

Conclusions and Implications: Our findings showed disproportionate impacts of drug testing and punitive measures for positive test results on racial/ethnic minority workers. Also, Hispanic workers’ lower likelihood of treatment and counseling referrals when tested positive may widen unmet behavioral health needs among racial/ethnic minority workers. While further research is needed how variations in occupational contexts might have contributed to the racial/ethnic patterns in drug testing, efforts to promote equitable workplace policies on drug testing and positive test results for racial/ethnic minorities, especially Blacks, are needed.