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I found a good article on the challenges of drug testing and what employers face.
Twenty years after the U.S. Supreme Court upheld the right to test for drugs in the workplace. In 1986, the U.S. Customs Service imposed a drug testing program for "employees seeking transfer or promotion to positions having direct involvement in drug interdiction," required to carry firearms, or have access to classified information. The National Treasury Employees Union sued and alleged that the program was violative of the Fourth Amendment, which prohibits unreasonable search and seizure. The Court of Appeals for the Fifth Circuit ruled in favor of the government.
The union then appealed to the Supreme Court. The Supreme Court upheld the Court of Appeals ruling with regard to positions involving drug interdiction and firearms. The ruling for classified information was held over, as the Supreme Court determined that the U.S. Customs Service too broadly included employee groups who would not generally have access to high levels of classified information.
Now, employees who take certain medications that may pose a safety hazard are a concern. The growing reliance of Americans on powerful prescription drugs for pain, anxiety and other illnesses suggests that many are reporting to work with drugs in their systems, and employers are "grappling for ways to address that."
There is a dearth of data from independent groups regarding impairment from prescription drugs in the workplace, partly because the issue has not drawn broad scrutiny. But Quest Diagnostics, a prominent provider of workplace drug tests, said that the rate of employees testing positive for prescription opiates rose by more than 40 percent between 2005 and 2009, and by 18 percent last year alone. The data, culled from the results of more than 500,000 drug tests, also indicated that workers who were tested for drugs after accidents were four times more likely to have opiates in their systems than those tested before being hired.
Read more here.