Toxicology Testing in Fatally Injured Workers: A Review of Five Years of Iowa FACE Cases

Abstract

Toxicology testing of fatally injured workers is not routinely conducted. We completed a case-series study of 2005–2009 occupational fatalities captured by Iowa’s Fatality Assessment and Control Evaluation (FACE) Program. The goals of our research were to: (1) measure the proportion of FACE cases that undergo toxicology testing, and describe the factors associated with being tested, and (2) measure the rate of positive toxicology tests, the substances identified and the demographics and occupations of victims who tested positive. Case documents and toxicology laboratory reports were reviewed. There were 427 occupational deaths from 2005 to 2009. Only 69% underwent toxicology testing. Younger workers had greater odds of being tested. Among occupational groups, workers in farming, fishing and forestry had half the odds of being tested compared to other occupational groups. Of the 280 cases with toxicology tests completed, 22% (n = 61) were found to have positive toxicology testing. Commonly identified drug classes included cannabinoids and alcohols. Based on the small number of positive tests, older victims (65+ years) tested positive more frequently than younger workers. Management, business, science, arts, service and sales/office workers had proportionately more positive toxicology tests (almost 30%) compared with other workers (18–22%). These results identify an area in need of further research efforts and a potential target for injury prevention strategies.

Alcohol and the Risk of Injury

“…Despite growing use of alcohol and drug testing in the workplace, international research evidence for alcohol as a major contributor to workplace accidents and injuries (except impaired driving) is surprisingly under-developed. Although single studies have continued to support a causal relationship [ 92 , 93 , 94 ], almost three decades have passed since Stallones and Kraus’ [ 95 ] review of epidemiological evidence regarding alcohol’s role in workplace injuries.…”

Prevalence of Drugs and Alcohol Identified in Fatal Work-Related Injuries: A Two Office Experience

“…Analysis of the Bureau of Labor Statistics data, which compile submitted toxicology reports from participating states showed rates of positive illicit or alcohol testing in 15%, 27%, and 19% in 1993 (9), 1994 (9), and 1998 (10), respectively. Other studies performed in individual counties, states, provinces, or countries showed positive blood alcohol concentrations in 2–22.4% or positive illicit drugs in 0.6–18.8% of all fatal occupational injuries with available toxicology testing (11–19). Our current study shows a similar rate of positive testing (18%) among occupational fatalities in northeastern Ohio.…”

Medical marijuana laws and workplace fatalities in the United States

“…9,[16][17][18][19] For instance, Anderson et al found that legalization of medical marijuana was associated with a 5% reduction in beer sales 9 , while Bachhuber et al found that legalization of medical marijuana was associated with a 20% to 33% decrease in deaths involving opioids. 16 Because the use of alcohol at work is associated with a substantial increase in the risk of injury [44][45] , and because nonhabitual opioid use slows reflexes and impairs cognitive functioning 46 , the enactment of MMLs could, in theory, make workplaces safer.…”