The positive cash flow at Spokane's largest medical test lab is yellow, not green, and comes in 30-milliliter bottles shipped from around the western United States.
Pathology Associates Medical Laboratories, owned by Providence Health and Services, has seen a steady increase in the number of tests it does on urine specimens provided by companies and facilities from as far away as Wyoming and Alaska.
Six years ago PAML's labs performed tests on about 600 urine specimens per day, collected in the Inland Northwest.
Today it handles 1,000 urine specimens gathered by employers or agencies and shipped by courier or airplane to Spokane. About 85 percent of the samples come from companies that want to know if workers are using illegal drugs or if those drugs played a part in a work-related accident or event.
By far the largest percentage of those companies want to test for the "NIDA 5" the five most commonly used illegal drugs identified by the National Institute on Drug Abuse.
Those five marijuana, cocaine, methamphetamine, PCP and opiates including morphine are the five drugs the federal government specifically looks for when testing its employees and others in private industries involved in safety-sensitive jobs.
When bus drivers for Spokane Transit need to go through a random urine test, their results are shipped to PAML, where workers process the specimens using expensive equipment that can produce 2,400 test results an hour. Each specimen, after delivery, can be tested for a wide array of drugs.
When county or city governments think of hiring firemen or police officers, one of the first steps in the process is for PAML to collect a specimen and test if they're using drugs.
PAML's drug-testing group called forensic toxicology has been in operation about 20 years. In recent years it has grown about 15 percent a year, and is expected to continue at that pace, said Dave Michaelsen, PAML's toxicology group manager.
That growth, at least in recent years, is tied to an expanding regional economy, said Tom Tiffany, chief executive of PAML, whose offices are on the South Hill two blocks south of Sacred Heart Medical Center.
"When the job market is strong and hiring is up, we get an increase in business (for drug tests)," Tiffany said.
PAML's overall business doesn't depend on workplace drug tests; toxicology only accounts for about 10 percent of the company's total revenue, said Tiffany.
But the annual 15 percent to 20 percent growth in the toxicology group is impressive: "It's more (growth) than the entire PAML total figure," he said, which is closer to half of the toxicology group's growth rate.
Of those 1,000 daily urine samples coming in, about 85 percent are from workers, either looking to be hired or required to take a test on a recurring basis. The other 15 percent are tests done for clinics and drug treatment programs needing information to track patients and ensure they're either not using controlled drugs or are correctly taking medications at prescribed doses.
Mike Mackay, owner of Mackay Manufacturing Inc. in the Spokane Valley, requires all job applicants to submit to drug tests as a condition of hiring. He's done that for 10 years and considers the cost of the test about $120 worthwhile. That $120 is for more than a drug screen at PAML; it includes a complete physical exam and hearing test provided by other firms, Mackay said.
He knows the screening eliminates some qualified workers in a tough hiring market. "But I know it's worth the trouble. We end up with a better quality work crew," he said.
The money PAML charges for drug tests varies widely, depending on the complexity of the tests, the volume of specimens a company produces yearly and the overhead involved in collecting and shipping the specimens to the Spokane lab.
For most tests for the NIDA 5, PAML would charge a customer an average of $15 per specimen, said Michaelsen.
He and others in the industry keep track of how their competitors in the drug-test market are doing. PAML's major regional competitor is the Seattle office of LabCorp., a national company with more than $3 billion in annual sales.
"There are a triad of factors we offer speed, accuracy and price," said Michaelsen. "But you can't get all three. If you want cheap and fast, you won't get accurate. If you want fast and accurate, you give up (low) price," he said.
Accuracy is a key issue for customers. Many companies have a human resources employee whose job includes tracking drug test results and insuring that any positive test results can be confirmed.
Each time a urine sample tests positive for a substance, PAML's technicians then have to take a second sample from the specimen and verify the results.
The second step in the process usually weeds out false positives and results that come about due to the equipment reacting to other chemicals or drugs in the urine, said Michaelsen.
For instance, out of all tests conducted at PAML in 2005 for the presence of marijuana, about 3.2 percent of samples tested positive at first. The number of confirmed marijuana tests dropped to 3.04 percent when additional tests were done from 5,660 to 5,337 instances according to Michaelsen.
That PAML number, incidentally, is higher than the national rate reported by Quest Diagnostics Inc., a New Jersey-based publicly traded firm that performs millions of workplace drug tests each year. Quest officials reported that marijuana was positively identified in 2.65 percent of all workplace tests it did for its U.S. customers during 2005.
PAML keeps all positive test samples for at least a year. Tests that are clean are discarded in about three days.
Tiffany sees nothing but positive growth numbers for PAML's toxicology services over the next few years. But changes in the toxicology industry will lead PAML to invest in new equipment, he said.
One change on the horizon is the introduction of saliva testing and hair testing, both of which are considered more accurate, less-error prone methods of screening. Both methods would cost more to do and will require PAML to invest in additional technology, said Tiffany.
The industry is already moving in that direction, said Barry Sample, the director of science and technology for employer accounts at Quest Diagnostics.
"It's become a big discussion nationwide, the need for a more accurate system of testing for workplace drugs," he said. New methods could allow companies like PAML to end the cat-and-mouse game of tracking the assorted ways people adulterate urine samples, said Sample.
He pointed to the 2005 incident at a Minnesota airport when a professional football player was found carrying a product sold as a way of disguising the presence of marijuana in a drug test.
"Using hair or oral fluids will make the collection of samples much simpler. There will not be the question of unobserved collection. You just get the hair or the oral fluid, and put it in a sealed container," said Sample.
Michaelsen said the best way to spot invalid or adulterated urine samples is a lab test of specific gravity a number closely tied to its chemical composition.
"If people try to add water, or even Mountain Dew, it changes the specific gravity that we should be seeing in our tests," he said.
As PAML continues to watch where the workplace drug test market is headed, it also listens to the changing needs of individual customers, said Michaelsen.
Every year, it adds tests to track for the presence of drugs now on its customers' radar screens. In recent years, for example, PAML added tests to identify MDMA, the clinical term for the drug Ecstasy.
This year, PAML will be adding two or three new drugs to its sexual assault date-rape panel. In cases of suspected date rape, law enforcement asks hospitals to gather a victim's urine sample. It's then sent to PAML to identify which drug was used, said Michaelsen.
A focus on customer satisfaction also means learning when not to report some drug results, Michaelsen said.
In recent years some customers have told PAML not to report positive results for marijuana use among some employees.
"My guess is that the company has no problem tolerating what it considers a social drug," he said. "Or it may be that they don't want to lose a large number of their workers" who might test positive for marijuana, he surmised.
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