Six operating administrations under DOT have issued regulations requiring antidrug programs in the aviation, highway, railroad, mass transit, pipeline, and maritime industries. Antidrug programs for commercial truck drivers are regulated by the Federal Motor Carrier Safety Administration (FMCSA), which is the operating administration responsible for enforcing FMCSA regulations and establishing who is tested and when they are tested. FMCSA antidrug regulations require that employers of commercial motor carriers, including those who are owner-operators, conduct drug testing according to the DOT “Procedures for Transportation Workplace Drug Testing Programs.” These DOT regulations mandate that motor carriers must conduct pre-employment, reasonable suspicion, random, and post-accident drug testing on their employees. While these scenarios are all different, DOT requires collectors and collection sites to follow uniform collection protocols regardless of the reason for the test. Collection sites are privately run facilities, where the collectors at the sites do not have to be certified by DOT, but must meet DOT regulations by completing the required training and following DOT protocols. Because collection sites are spread throughout the nation, it is easy for an employee in any of the drug testing scenarios, from pre-employment to post-accident drug testing, to get to a collection site within the given time frame. According to DOT regulations, collection sites must promote privacy, incorporate the scientific and technical guidelines of the Department of Health and Human Services (HHS), utilize a scientifically recognized testing method, and require that specimens be labeled and secured in the presence of the tested employee to prevent tampering. To help collection sites comply with these regulations, DOT’s Office of Drug and Alcohol Policy and Compliance issued revised protocols in December 2006. The protocols indicate that the collector has a major role in the success of the DOT drug testing program because he or she is the one individual in the testing process with which all employees have direct, face-to-face contact. The protocols also state that the test may lose validity if the collector does not ensure the integrity of the specimen and collection process. DOT protocols have specific requirements that collection sites must meet, including procedures to (1) prevent unauthorized access to the urine collection site; (2) prevent the tested employee or anyone else from gaining unauthorized access to the collection materials/supplies; (3) ensure that the tested employee does not have access to items that could be used to adulterate or dilute the specimen such as soap, disinfectants, cleaning supplies, and water; and (4) ensure that the tested employee is under the supervision of a collector or appropriate site personnel at all times when permitted into the site. To document the collection of the specimen, DOT requires that urine collection sites correctly complete the Federal Drug Testing Custody and Control Form (CCF) for every collection under the DOT drug testing program. This form is also used to document the transfer of the specimen to the HHS-approved, private sector laboratories, where the urine specimen is sent to be tested for marijuana, cocaine, amphetamines, opiates, and phencydidine (PCP) as identified by HHS regulations. It is important to note that the laboratories that test the specimen are separate entities than the urine collection sites. The collection sites must follow DOT protocols and their role is to collect the urine specimen, while the laboratories must be certified by HHS and their role is to perform the drug testing of the specimen. The laboratories are authorized to also conduct validity testing to determine if the specimen is consistent with normal human urine, whether adulterants or foreign substances are present, or if the specimen was diluted or substituted. The HHS organization, Substance Abuse and Mental Health Services Administration (SAMHSA), administers the Federal Workplace Drug Testing Program and revised the guidelines in 2004 to require that specimen validity tests be conducted on all urine specimens of federal employees due to the increase in the number of chemical adulterants that were marketed on the Internet and in certain magazines. DOT did not adopt this update in their regulations------so currently drug testing laboratories are only authorized, not required, to perform validity testing for all DOT required commercial motor carrier drug tests. As an additional quality control check, DOT requires that a Medical Review Officer (MRO) serve as an independent, impartial authority to verify the lab results. After the results are verified, the MRO, who is a licensed physician, informs the designated company official whether the employee passed or failed the drug test. The MRO may also designate test results as cancelled in the case of an invalid test. An invalid test results when a drug screening lab identifies an unidentified adulterant, substitute, or abnormal physical characteristic in the specimen that prevents the lab from obtaining a valid test result. In the case of a cancelled test, the MRO conducts an interview with the employee to determine if there is a legitimate medical reason for the result. If the MRO determines there is a legitimate medical reason, no further action is required. However, if the MRO determines there is no legitimate medical reason, the employee is required to take another drug test under direct observation—effectively getting another opportunity to take the test, but without the privacy afforded previously. In the case of a positive result, which is defined as a failed drug test, a supervisor or company official is required to immediately remove the employee from the job. Employees who test positive and continue to perform safety-sensitive functions and employers who permit them to do so are both subject to criminal and civil fines. In our tests of the selected 24 urine collection sites in four major geographic areas throughout the United States, we determined that 22 of the 24 sites showed varying degrees of failure in complying with the protocols that we tested. While all urine collection sites followed DOT protocols by asking our undercover investigators to provide identification, we successfully used bogus driver’s licenses to gain access to all 24 sites— demonstrating that a drug user could send someone else to take a drug test in their place. This fact in and of itself shows that in 100 percent of our tests we successfully used a form of substitution. However, we did not count these instances as a failure of protocol because the collectors are not required to validate the identity of the employee—they are only required to ensure that an employee presents identification. Twenty-two of the 24 tested collection sites failed to comply with many of the remaining DOT protocols we tested. In table 2, we provide a summary of the results of our testing of the 16 protocols by geographic area in the order that we tested them. The table identifies the number of protocols with which each site failed to comply. For a summary of the protocols we tested and their rationale, see figure 1. Some of the criteria above relate to preventing the employee from having access to items at the collection site, such as water or cleaning products, which could be used to adulterate or dilute the specimen. These types of products might be detected by drug testing laboratories, however, we did not test this. We provide detail on our findings of the tested urine collection sites by area in the order of our testing below. In our testing of the Washington, D.C., metropolitan area we determined that, in five of the six sites tested, there were varying degrees of failure in complying with the 16 protocols. Most of the sites failed only two protocols, while site 3 did not fail any of the protocols and site 5 performed poorly by failing 12 protocols—75 percent of the protocols tested. In the case of site 5, we determined that although this collection site failed to comply with most of the protocols, the drug screening lab identified errors and cancelled the test due to the inappropriate collection process. We provide additional detail below on our experiences at three of the Washington, D.C., metropolitan area collection sites. Washington D.C., Area, Site 3: This collection site did not fail any of the protocols that we tested. However, our investigator used substitute synthetic urine he brought with him to contaminate the urine specimen during the test and the laboratory did not detect the presence of the synthetic urine. Washington D.C., Area, Site 4: At this collection site, the investigator had access to water which could be used to dilute a specimen. In addition, the investigator brought in and used an adulterant at this site and the laboratory did not detect the presence of the adulterant. Washington D.C., Area, Site 5: This site failed to comply with 12 of the 16 protocols that we tested. Although it was not one of the protocols we tested at other facilities, one of our investigators exhibited a “shy bladder” at this site and could not provide a full urine specimen of 45 mL. The collector permitted our investigator to provide half of the specimen, leave the facility, and return approximately 1 hour later—a violation of DOT protocols, which state that the employee should not be allowed to leave the collection site and should be monitored during the waiting time. When completing the collection process, the collector used half of the specimen from the original collection and half from what the investigator provided later. The drug screening lab identified this error and cancelled the test due to the inappropriate collection process. See appendix I for a site-specific breakdown, by protocol, of the results of our testing in the Washington, D.C., metro area. In our testing of the Los Angeles area we determined that, of the six sites tested, there were varying degrees of failure in complying with the 16 protocols—including one site that failed 8 of the 16 protocols. Other selected sites in the Los Angeles area failed up to 5 and 6 protocols while the remaining sites failed 3 protocols or less. We provide additional detail below on our experiences at four of the Los Angeles area collection sites. Los Angeles, Site 1: The investigator was not instructed to wash his hands before providing the specimen. This could have allowed a tested employee to hide a drug-masking product in his hand when taking the test. In addition, there was no bluing agent in the toilet. That means a tested employee could have used the clear water in the toilet to dilute his or her specimen.