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Workforce Drug Positivity Rate Still Peaking

Workforce use of illicit drugs across the board—including cocaine, marijuana and methamphetamine—remains at its highest rate in a decade, a new study by Quest Diagnostics found.

Overall positivity in urine drug testing among the combined U.S. workforce in 2017 continued to hold at 4.2%, which is still 0.7% higher than the positivity rate from 2012, which represented a 30-year low. The findings were made from analysis of more than 10 million workforce drug test results.

“It’s unfortunate that we mark 30 years of the Drug-Free Workplace Act with clear evidence that drugs continue to invade the country’s workplaces. Not only have declines appeared to have bottomed out, but also in some drug classes and areas of the country drug positivity rates are increasing,” Barry Sample, senior director of science and technology at Quest Diagnostics, said in a statement. “These changing patterns and geographical variations may challenge the ability of employers to anticipate the ‘drug of choice’ for their workforce or where to best focus their drug prevention efforts to ensure a safe and healthy work environment.”

The new data indicates shifting patterns of drug use, with cocaine and amphetamines positivity surging in some areas of the country and marijuana positivity rising sharply in states with newer recreational use statutes.

Opioids
The one bit of good news is that prescription opiate positivity rates declined dramatically on a national basis. Quest reported that the positivity rate for opiates in the general U.S. workforce in urine drug testing declined 17% between 2016 and 2017 (0.47% versus 0.39%). More notably, oxycodones (oxycodone and/or oxymorphone) positivity declined 12% between 2016 and 2017 (0.69% vs. 0.61%), hydrocodone positivity declined 17% (0.81% vs. 0.67%); and hydromorphone positivity declined 22% (0.59% vs. 0.46%). Opiates other than codeine were at their lowest positivity rate in more than a decade.

This data is supported by the Centers for Disease Control and Prevention (CDC), which shows that the overall national opioid prescribing rate in 2017 fell to the lowest it had been in more than 10 years, although rates vary by state and are high in some areas of the country.

The topic was explored during an educational session at RIMS 2018, where it was noted that the decrease in opioid use may be attributed to corporate initiatives like prescription drug monitoring policies (PDMP), which can limit employees’ ability to refill scripts, in addition to states that had comprehensive reforms.

“This shows that the more queries there are, the bigger the drop in opioid prescribing,” said John Ruser, president and CEO of the Workers Compensation Research Institute (WCRI), last month in San Antonio. He said WCRI used Kentucky as an example of a successful PDMP. Kentucky’s HB1 law mandated the use of the PDMP and between 2011 and 2013, WCRI information indicated a 10% decline in prescriptions in the state, whereas prescription levels were flat in others that did not have similar reforms.

Methamphetamine
Methamphetamine positivity, however, is increasing. An analysis of trends in the general U.S. workforce based on the four U.S. Census regions identified large increases of methamphetamine positivity rates. Between 2013 and 2017, methamphetamine positivity increased: 167% in the East North Central division of the Midwest (Illinois, Indiana, Michigan, Ohio, Wisconsin); 160% in the East South Central division of the South (Alabama, Kentucky, Mississippi, Tennessee); 150% in the Middle Atlantic division of the Northeast (New Jersey, New York, Pennsylvania); and 140% in the South Atlantic division of the South (Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia). The percentage increase in these four divisions ranged between 9% and 25% between 2016 and 2017.

Marijuana
Overall, marijuana positivity continued its five-year upward climb for both the general U.S. workforce and the federally-mandated, safety-sensitive workforce. Marijuana positivity increased 4% in the general U.S. workforce (2.5% in 2016 versus 2.6% in 2017) and nearly 8% in the safety-sensitive workforce (0.78% versus 0.84%).

Increases in positivity rates for marijuana were most striking in states that have enacted recreational use statues since 2016. Those states include: Nevada (43%), Massachusetts (14%) and California (11%). These three states also saw significant increases in marijuana positivity in federally-mandated, safety-sensitive workers: Nevada (39%), California (20%), and Massachusetts (11%). Federally-mandated, safety-sensitive workers include pilots, rail, bus and truck drivers, and workers in nuclear power plants, for whom routine drug testing is required by the Department of Transportation.

“These increases are similar to the increases we observed after recreational marijuana use statues were passed in Washington and Colorado,” Sample said. “While it is too early to tell if this is a trend, our data suggest that the recreational use of marijuana is spilling into the workforce, including among individuals most responsible for keeping our communities safe.”

LIRR Misses Critical Juncture for Positive Train Control

Last week, the Long Island Rail Road (LIRR) confirmed interruptions in its ability to fully install positive train control (PTC) across its system by the end of the year. Newsday reported that the LIRR system, which is a unit of the Metropolitan Transportation Authority’s (MTA) network, failed 16 out of 52 factory tests performed in early March using a computerized simulation of the new technology.

Although its PTC contractor continues to investigate the cause of the failures, MTA officials said they believe it stems from the complexity and density of the LIRR, which is the busiest commuter railroad in the country averaging more than 311,000 daily riders.

PTC is designed to eliminate human error by using four components: GPS satellite data, onboard locomotive equipment, the dispatching office and wayside interface units. The system communicates with the train’s onboard computer, allowing it to audibly warn the engineer and display its safe braking distance based on its speed, length, width and weight, as well as the grade and curvature of the track, according to railroad operator Metrolink. If the engineer does not respond to the warning, the onboard computer will activate the brakes and safely stop the train.

An approved PTC System must protect against:

  • Passing a stop signal.
  • Train-to-train collision.
  • Overspeed on curves and other civil restrictions.
  • Unauthorized incursions by a train into a work zone.

The installation began in January as part of a $1 billion safety upgrade, although it had been on the LIRR’s strategic plans for years. So far, substandard testing results are not instilling much confidence that PTC will be complete by the federal deadline of Dec. 31, 2018. If that deadline is missed agencies without properly-installed PTC may face fines of up to $25,000 per day, as enforced by the U.S. Rail Safety Improvement Act of 2008.

MTA Board member Neal Zuckerman told Newsday he is less concerned about meeting a federal deadline than he is about “having a system that works for riders.”

“It is better to have this right than fast,” Zuckerman said. “A nonfunctioning system is not worthwhile. It’s a waste of money and time and ultimately will not serve the needs of the riders.”

The LIRR is not the only major transit system to be missing the mark. Risk Management Monitor reported on Amtrak’s struggle to meet the deadline in February and that by the end of 2017, only 8% of NJ Transit’s locomotives and none of its tracks were updated with PTC.

Efforts to upgrade train technology has been a nationwide priority. There have been a number of accidents in recent years. The most recent was a major derailment occurring on Dec. 18, 2017 when an Amtrak train derailed near Tacoma, Washington, killing three passengers and injuring about 100. That crash was the result of excessive speed in a steep curve, which experts suggested could have been prevented with PTC’s automatic braking technology. Amtrak Train No. 501, on its inaugural run, was traveling 80 miles per hour in an area limited to 30 miles per hour when it derailed on an overpass, sending the train’s 12 coaches and one of its two engines careening onto the highway below.

As previously reported in Risk Managementa similar derailment in Philadelphia in May 2015 that killed eight, was also blamed on excessive speed and could have been avoided if PTC had been in place.

After Congress passed the PTC Enforcement and Implementation Act of 2015 it also authorized the FAST Act, which allocated $199 million in PTC grant funding and specifically prioritized PTC installation projects for Railroad Rehabilitation and Improvement Financing funding. The Association of American Railroads estimates that freight railroads will spend $10.6 billion implementing PTC, with additional hundreds of millions each year to maintain. The American Public Transportation Association has estimated that the commuter and passenger railroads will need to spend nearly $3.6 billion on PTC.

2 Fertility Clinic Failures a ‘Bad Coincidence’

Equipment failures on the same day at two fertility clinics located across the country from each other—in California and Ohio—may have damaged or destroyed thousands of frozen eggs and embryos. The simultaneous “black swan events” appear to have no connection to each other and have experts mystified.

Dr. Carl Herbert, president of the Pacific Fertility Clinic in San Francisco, told ABC News in an interview released Monday that a senior embryologist noticed the nitrogen level in one tank was very low during a routine check of the tanks on March 4. The embryologist, he said, “immediately rectified” the problem by refilling the tank. The embryos were later transferred to a new tank.

Dr. Kevin Doody, lab director at the Center for Assisted Reproduction in Texas and past president of the Society for Assisted Reproductive Technology, told The Associated Press that the nearly simultaneous storage failures are “beyond stunning” but appear to be “just a bad, bad, bad coincidence.”

The Washington Post reported that the services of fertility clinics — and therefore egg- and embryo-freezing — have become increasingly popular in the U.S.

The number of egg-freezing patients jumped from 475 in 2009 to 7,518 in 2015, the most recent year for which figures are available from the Society for Assisted Reproductive Technology. In total, about 20,000 American women have had their eggs preserved.

According to the clinic’s website, its fees for egg freezing are $8,345 for the initial cycle and $6,995 for each subsequent round. Herbert said, for patients still eager to use their eggs or embryos to try to become pregnant, the physicians and other staff will first thaw them to find out whether they are viable. If they are not, he said, “we are going to make our patients happy one way or another.”

Meanwhile, a Pennsylvania couple and an Ohio couple that lost embryos have filed a class action lawsuit against the Cleveland hospital where officials estimate about 2,000 frozen eggs and embryos may have been damaged.

As for risk management of such facilities, Doody noted that the industry in the long run will end up being safer because there will be investigations and other facilities will examine their own backup measures and alarm systems.