It is critical that claims administrators and treating physicians obtain an accurate history of illegal substance use and abuse from an injured workers. This history is important when there is a physical injury for purposes of appropriately prescribing an opioid pain medication. This history is important when there is a psychiatric injury in order to determine causation and apportionment.

With regard to physical injuries, the DWC is currently in the process of developing the Medical Treatment Utilization Schedule with a new 137 page Opioid Treatment Guideline. Section 3.3.1.1 “Screening for Drug Misuse/ Abuse” mandates that physicians “use validated screening tools for predicting the risk of drug misuse … before beginning chronic opioid treatment.” These screening tools document the claimant’s “personal history of substance abuse” in order to determine risk of abuse of pain medication. This new proposed DWC guideline makes the importance of obtaining a drug history from a claimant not only quite clear but also a mandatory requirement.

Yet it is rare to see a claimant actually admit to illicit drug use in a workers’ compensation claim. What are the odds that illicit drug use is as rare as these common California workers’ compensation histories suggest?

The New York Times reports that all over the country, employers say they are struggling to find workers who can pass a pre-employment drug test. That hurdle partly stems from the growing ubiquity of drug testing, at corporations with big human resources departments, in industries like trucking where testing is mandated by federal law for safety reasons, and increasingly at smaller companies.

But data suggest employers’ difficulties also reflect an increase in the use of drugs, especially marijuana – employers’ main gripe – and also heroin and other opioid drugs much in the news.

Drug use in the work force “is not a new problem. Back in the ’80s, it was pretty bad, and we brought it down,” said Calvina L. Fay, executive director of the Drug Free America Foundation. But, she added, “we’ve seen it edging back up some,” and increasingly, both employers and industry associations “have expressed exasperation.”

Data on the scope of the problem is sketchy because figures on job applicants who test positive for drugs miss the many people who simply skip tests they cannot pass. Nonetheless, in its most recent report, Quest Diagnostics, which has compiled employer-testing data since 1988, documented an increase for a second consecutive year in the percentage of American workers who tested positive for illicit drugs – to 4.7 percent in 2014 from 4.3 percent in 2013. And 2013 was the first year in a decade to show an increase.

In Colorado, “to find a roofer or a painter that can pass a drug test is unheard-of,” said Jesse Russow, owner of Avalanche Roofing & Exteriors, in Colorado Springs. That was true even before Colorado, like a few other states, legalized recreational use of marijuana. In a sector where employers like himself tend to rely on Latino workers, Mr. Russow tried to diversify three years ago by recruiting white workers, vetting about 80 people. But, he said, “As soon as I say ‘criminal background check,’ ‘drug test,’ they’re out the door.”

A much broader data trove, the federal government’s annual National Survey on Drug Use and Health, reported in September that one in 10 Americans ages 12 and older reported in 2014 that they had used illicit drugs within the last month – the largest share since 2001

If this data is correct, a random sample of 100 open workers’ compensation claims in a typical inventory should have 10 cases with an admission of use of illicit drugs within the prior month. Should any inventory of claims show a lower percentage, or worse yet, not a single case of an admission of illegal drug use, the odds are high that several of the claimants are lying. Then the question of course is “which ones?”