{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T17:39:43Z","timestamp":1776447583410,"version":"3.51.2"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,1,28]],"date-time":"2022-01-28T00:00:00Z","timestamp":1643328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Introduction: Since 2008, Italian legislators, with the aim of ensuring public safety, have made it mandatory for an occupational doctor (OD) to assess specific categories of workers to exclude those who may have consumed drugs of abuse. Due to the relevance of work activities relating to the civil aviation and airport sector, a policy based on the use of training and information tools, as well as a health surveillance protocol, has been undertaken since 2009. Materials and methods: A total of 61,008 workers at a commercial airline underwent health surveillance between 2009 and 2019. Following \u226424 h notification, their urine was screened for opiates, cocaine, cannabinoids, amphetamines, methamphetamines, and methylenedioxymethamphetamine (MDMA) using an immunochemical test. Positive results were confirmed using Gas Chromatography-Mass Spectrometry (GC\/MS) or Liquid Chromatography -Mass Spectrometry (LC\/MS). In confirmed cases, the workers were declared unfit and sent to a specialized laboratory for a second level analysis. Results: Positive results, initially &gt;1%, have halved in the last four years (&lt;0.5%). The percentage of positive results was consistently very low among pilots and, moreover, the rare positive cases detected were due to a cross-reactivity phenomena. The highest and most discontinuous percentages seen occurred in the population undergoing a pre-employment examination. Regarding the types of substance used, a prevalence of cannabis (58.52%) and cocaine (35.2%) use was observed. Conclusions: The data presented indicate that the air transport sector, in all its components (ground workers and air crews), has a very limited number of substance abusers, and this number tends to decrease over time and with work seniority. Another aspect of particular interest, and which is more specific to toxicology, concerns the detection of cross-reactivity in urinary immunochemical screening between the antibodies to drugs of abuse and certain other drugs, such as anti-inflammatories or antibiotics; as well as foods, and other commonly used substances.<\/jats:p>","DOI":"10.3390\/ijerph19031501","type":"journal-article","created":{"date-parts":[[2022,1,29]],"date-time":"2022-01-29T05:26:17Z","timestamp":1643433977000},"page":"1501","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Policies and Toxicological Screenings for No Drug Addiction: An Example from the Civil Aviation Workforce"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9434-2604","authenticated-orcid":false,"given":"Michele","family":"Treglia","sequence":"first","affiliation":[{"name":"Section of Legal Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3169-2906","authenticated-orcid":false,"given":"Margherita","family":"Pallocci","sequence":"additional","affiliation":[{"name":"Section of Legal Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgio","family":"Ricciardi-Tenore","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavio","family":"Baretti","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanna","family":"Bianco","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Castellani","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Pizzuti","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1491-413X","authenticated-orcid":false,"given":"Valeria","family":"Ottaviano","sequence":"additional","affiliation":[{"name":"Section of Legal Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierluigi","family":"Passalacqua","sequence":"additional","affiliation":[{"name":"Section of Legal Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9348-5574","authenticated-orcid":false,"given":"Claudio","family":"Leonardi","sequence":"additional","affiliation":[{"name":"Substance Abuse and Mental Health Services (Ser.D)\u2014Local Health Authority (ASL) RM2, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2470-6107","authenticated-orcid":false,"given":"Luca","family":"Coppeta","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agostino","family":"Messineo","sequence":"additional","affiliation":[{"name":"Section of Legal Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Tittarelli","sequence":"additional","affiliation":[{"name":"Section of Legal Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1111\/add.14234","article-title":"Global statistics on alcohol, tobacco and illicit drug use: 2017 status report","volume":"113","author":"Peacock","year":"2018","journal-title":"Addiction"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1002\/j.1875-9114.2011.01089.x","article-title":"Drug testing in the workplace","volume":"32","author":"Phan","year":"2012","journal-title":"Pharmacotherapy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1002\/dta.1326","article-title":"Regulatory aspects of workplace drug testing in Europe","volume":"4","author":"Pierce","year":"2012","journal-title":"Drug Test. Anal."},{"key":"ref_4","unstructured":"(2021, October 25). Presidential Decree No. 309 dated 9 October 1990. Available online: https:\/\/www.gazzettaufficiale.it\/eli\/id\/1990\/10\/31\/090G0363\/sg."},{"key":"ref_5","unstructured":"(2021, October 25). Legislative Decree No. 81 Dated 9 April 2008. Available online: https:\/\/www.gazzettaufficiale.it\/eli\/id\/2008\/04\/30\/008G0104\/sg."},{"key":"ref_6","unstructured":"(2021, October 25). Legislative Decree No. 106 Dated 3 August 2009. Available online: https:\/\/www.gazzettaufficiale.it\/atto\/serie_generale\/caricaDettaglioAtto\/originario?atto.dataPubblicazioneGazzetta=2009-08-05&atto.codiceRedazionale=009G0119&elenco30giorni=false."},{"key":"ref_7","unstructured":"(2021, October 25). State-Regions Conference Provision No. 99\/CU 30.10.2007. Available online: https:\/\/www.gazzettaufficiale.it\/eli\/id\/2007\/11\/15\/07A09622\/sg."},{"key":"ref_8","unstructured":"(2021, October 25). State-Regions Agreement REP. ACTS No. 178 Dated 18.09.2008. Available online: https:\/\/www.gazzettaufficiale.it\/atto\/serie_generale\/caricaDettaglioAtto\/originario?atto.dataPubblicazioneGazzetta=2008-10-08&atto.codiceRedazionale=08A07139&elenco30giorni=false."},{"key":"ref_9","unstructured":"(2021, October 25). Lazio Region Decision No. 332 Dated 29th April 2009. Available online: https:\/\/www.alco-service.it\/Doc-MDL\/Regione-Lazio.pdf."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"8566","DOI":"10.1021\/ac201905q","article-title":"Screening of several drugs of abuse in Italian workplace drug testing: Performance comparisons of on-site screening tests and a fluorescence polarization immunoassay-based device","volume":"83","author":"Basilicata","year":"2011","journal-title":"Anal. Chem."},{"key":"ref_11","unstructured":"National Transportation Safety Board (2014). Drug Use Trends in Aviation: Assessing the Risk of Pilot Impairment Safety Study NTSB\/SS-14\/01 PB2014-108827."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1111\/j.1360-0443.2011.03388.x","article-title":"Drug violations and aviation accidents: Findings from the US mandatory drug testing programs","volume":"106","author":"Li","year":"2011","journal-title":"Addiction"},{"key":"ref_13","unstructured":"Canfield, D.V., Dubowski, K.M., Chaturvedi, A.K., and Whinnery, J.E. (2021, October 25). Drugs and Alcohol in Civil Aviation Accident Pilot Fatalities From 2004\u20132008, Available online: www.faa.gov\/library\/reports\/medical\/oamtechreports."},{"key":"ref_14","unstructured":"Civil Aviation Department (2016). Screening Programme for Air Crew in Hong Kong on Psychoactive Substances, Civil Aviation Department. In accordance with ICAO Document 9654."},{"key":"ref_15","unstructured":"ICAO (2019). ICAO Safety Report 2019, ICAO."},{"key":"ref_16","unstructured":"(2021, October 25). Guidelines for Workplace Drug Testing in Urine\u2014ISS. Available online: https:\/\/www.iss.it\/doping\/-\/asset_publisher\/Pslu1rErQn8D\/content\/id\/3405463."},{"key":"ref_17","first-page":"118","article-title":"Guidelines: Applicability to screening and confirmatory drug tests in the determination of drugs of abuse","volume":"2","author":"Jug","year":"2001","journal-title":"Riv. Med. Lab. JLM"},{"key":"ref_18","first-page":"323","article-title":"La prevenzione ed il controllo dell\u2019assunzione di sostanze psicotrope o stupefacenti nei luoghi di lavoro: Una nuova ed importante opportunit\u00e0 per il medico del lavoro","volume":"100","author":"Riboldi","year":"2009","journal-title":"Med. Lav."},{"key":"ref_19","unstructured":"ENAC (2020). ENAC Circular of 10.01.20\u2014Implementation of the Regulation: Healthcare Organization and Medical Fitness Certificates for Aeronautical Licenses and Certificates, ENAC."},{"key":"ref_20","unstructured":"EMCDDA (2017). EMCDDA 2017 European Drug Report."},{"key":"ref_21","unstructured":"Prime Minister\u2019s Office\u2014Department of Anti-Drug Policies (2021, October 25). Annual Report to Parliament (Years 2015\u20132016\u20132017\u20132018\u20132019), Available online: https:\/\/www.politicheantidroga.gov.it\/it\/attivita\/relazioni-annuali-al-parlamento\/."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1002\/dta.2189","article-title":"Seven years of workplace drug testing in Italy: A systematic review and meta-analysis","volume":"9","author":"Rosso","year":"2017","journal-title":"Drug Test. Anal."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1093\/jat\/bku075","article-title":"False-positive interferences of common urine drug screen immunoassays: A review","volume":"38","author":"Saitman","year":"2014","journal-title":"J. Anal. Toxicol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.cll.2016.07.006","article-title":"Common Interferences in Drug Testing","volume":"36","author":"Smith","year":"2016","journal-title":"Clin. Lab. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"122251","DOI":"10.1016\/j.jchromb.2020.122251","article-title":"Identification of characteristic heroin metabolites in urine based on data-mining technology and multivariate statistics analysis combined with a targeted verification approach for distinguishing heroin abusers","volume":"1152","author":"Qiao","year":"2020","journal-title":"J. Chromatogr. B Anal. Technol. Biomed. Life Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.forsciint.2007.03.004","article-title":"Prevalence of psychoactive substances in truck drivers in the Nord-Pas-de-Calais region (France)","volume":"174","author":"Labat","year":"2008","journal-title":"Forensic Sci. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s002280050728","article-title":"Workplace drug testing (WDT) likely to increase in Europe. Report from the First European Symposium on WDT including selected abstracts","volume":"56","author":"Beck","year":"2000","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/S0379-0738(01)00445-5","article-title":"Workplace drug testing in Europe","volume":"121","author":"Verstraete","year":"2001","journal-title":"Forensic Sci. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.forsciint.2011.03.009","article-title":"Prevalence of drug abuse among workers: Strengths and pitfalls of the recent Italian Workplace Drug Testing (WDT) legislation","volume":"215","author":"Kazanga","year":"2012","journal-title":"Forensic Sci. Int."},{"key":"ref_30","unstructured":"Prime Minister\u2019s Office\u2014Department of Anti-Drug Policies (2021, October 25). Annual Report to Parliament 2012, Available online: https:\/\/www.politicheantidroga.gov.it\/it\/attivita\/attivita-e-progetti\/le-pubblicazioni\/emcdda-national-report-2012-italy\/."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"931","DOI":"10.3357\/AMHP.4813.2017","article-title":"Pilot Certification, Age of Pilot, and Drug Use in Fatal Civil Aviation Accidents","volume":"88","author":"Akparibo","year":"2017","journal-title":"Aerosp. Med. Hum. Perform."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/3\/1501\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:10:10Z","timestamp":1760134210000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/3\/1501"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,28]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["ijerph19031501"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19031501","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,28]]}}}