High rates of inappropriate opioid use, physician drug dispensing and the increased utilization and cost of pharmaceuticals in the California workers’ compensation system have been well documented by public policy research. These issues are now associated with another emerging cost driver — drug testing.

Prior CWCI research on the topic, published in May 2012, documented the viral-like growth in the volume of drug testing in the system that began a decade ago. This new CWCI study builds on that initial research, using more recent and detailed data. Utilization of quantitative drug tests between 2007 and 2014 increased by 2,431 percent. Quantification of opiates remains the leading test by volume, followed by quantification of substances (PCP/Cocaine/Ethanol) that would be illicit or problematic in conjunction with the use of prescribed medications. Among the injured workers who were drug tested, the average number of tests per employee per date of service more than tripled driving the average amount paid per date of service up from $96 in 2007 to $307 in 2014 – a 220 percent increase.

There is evidence of a migration to physician in-office/non-laboratory drug testing. In 2008, 74 percent of Urine Drug Tests (UDT) services were provided by just four laboratories, but during the ensuing four years the mix of providers shifted, with the big laboratories accounting for a declining share of the market while the number of non-laboratory providers billing for these services increased. Between 2008 and the end of 2014, the total number of UDT providers receiving workers’ compensation reimbursements more than doubled from 428 to 876.

Absent an accepted empirical, evidence-based protocol on the appropriate level and scope of testing, it is difficult to reconcile the noted increases in the volume and variety of drug testing with clinical appropriateness and favorable outcomes for the injured worker. There is likely a dearth of empirical evidence showing improved clinical outcomes when UDT is used for patient adherence.