Compulsory urinary drug screening among high risk of accident workers in Italy: state of conforming to the law and technical problems to solve

Introduction
Since 2007 in Italy a law enforcing annual urinary drug screening among high risk of accident workers has been adopted. After four years we tried to verify results of the law and problems that must be solved to increase law effects in work accidents prevention.

Methods
We evaluated application of the law in 1022 firms in which 5448 high risk of accident workers were engaged. In every firm we verified: correct definition of list of high risk workers transmitted by Employers to Occupational Doctors, correct way of urine sampling, eventual positivity of one or more workers to the test since 2007, problems arisen from positivity in firm organization, influence of law on relationships between firms and trade unions, activities of structures of national health system which have a relevant role assigned by law.

Results
In 981 on 1022 firms we verify an at least partial application of the law; only 41 little firms, did not activate drug screening at all. List of workers was correct and complete only in 85,4% of firms. Urine samples have been correctly collected in 97,1% of workers. On 12998 samples examined since 2007 we evidenced 391 positive workers. In 112 firms difficulties in relationships with structures of public health system (differences in controlling positive workers, delay in control time, different cost for the access to public laboratories) have been referred. Only in 27 firms discussions with trade unions have been referred.

Discussion
Drug screening have been able to evidence a relevant number of positive workers who have been temporarily defined not suitable at high risk works, decreasing the possibility of work accident in work places. A better organization of public health system structures and an enlargement of the professional categories for which the drug screenings are compulsory, could increase the efficacy of the law.