ACOEM Recommends SAMHSA Withdraw Proposed Guidelines to Included Hair Testing

November 7, 2020

Docket Management Facility
U.S. Department of Transportation
1200 New Jersey Avenue, S.E.
West Building, Ground Floor, Room W12-140
Washington, DC 20590-0001

Re: Docket No. SAMHSA–2020–0001

To Whom It May Concern:

The American College of Occupational and Environmental Medicine (ACOEM) welcomes the opportunity to comment on questions posed by the Substance Abuse and Mental Health Services Administration (SAMHSA) on scientific and technical guidelines for the inclusion of hair specimens in the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Guidelines).
ACOEM is a national medical society representing 4,000 occupational medicine physicians and other health care professionals devoted to promoting optimal health and safety of workers, workplaces, and environments.  ACOEM is dedicated to improving the care and well-being of workers through science and the sharing of knowledge.
Many of our members serve as medical review officers (MROs). It is the responsibility of the MRO to interview the donor after reviewing a laboratory non-negative drug testing result, and to verify any reason the laboratory results may be the result of legal and proper medical care, including prescription medication use. Lastly, the MRO is to report out the result of the drug test to the proper stakeholders. 
As you know, MROs also serve a “gatekeeper” function for the entire drug testing process. As such, MROs frequently interact and communicate with a number of stakeholder groups, including laboratories, collectors, TPAs, employer groups, unions, and others. As a result, we feel that we can provide a comprehensive perspective of the implications of this proposed rule change.
While we understand the requirement to publish the Guidelines and the desire of some to extend the window of detection of those who may be using illegal/illicit substances, ACOEM is concerned that the proposed process does little more than increase the time, cost and resources of the testing process without demonstrating a significant enhancement of safety.  .
The Department proposes to expand the drug testing program for federal agencies to permit the use of hair specimens. Yet, the procedures surrounding the use of hair specimens render this method into a cumbersome and ineffective option that raises safety concerns.
Faced with a positive result from the hair specimen test, the MRO would be forbidden to report the positive result unless the employee voluntarily admits to illicit use of the drug that caused the test. This is unrealistic in a workplace environment. Employees would quickly learn that denial of drug use is the best strategy, given the limitations placed on the MRO. While the MRO waits for the test results of an alternate specimen, the employee is able to operate his vehicle or perform other safety sensitive job functions. This is an aspect of the proposal that is of serious concern. The MRO is placed in an impossible position of remaining silent when he or she has evidence that the employee poses a public safety risk.
While hair testing has a longer window of detection, reliance by employers on hair testing for random drug tests may cause them to miss instances of recent use, potentially just before the employee must perform safety sensitive duties.
The proposed process will discourage most employers from using hair testing. Because this rulemaking will not enhance safety, ACOEM recommends that SAMHSA withdraw the proposed Guidelines.
Thank you for your consideration of these comments.

Beth A. Baker, MD, MPH, FACOEM