Seven years of workplace drug testing in Italy: a systematic review and meta-analysis

In Italy, Workplace Drug Testing (WDT) has been compulsory by law for specific categories of workers since 2008, offering the
opportunity to compare studies conductedwithin a single regulatory framework. The aims of this paper are to estimate the overall
prevalence of WDT positivity (at screening survey) among Italian workers and evaluate the percentage of true and false positives
at confirmation analysis. A systematic review and meta-analysis of the scientific literature on WDT in Italy from January 2008 to
March 2015 was carried out, according to the MOOSE guidelines. A random effects model was utilized to calculate pooled
prevalence. Potential sources of heterogeneity were explored using sensitivity test and subgroup analysis. The overall
meta-analytical prevalence of positivity at WDT among Italian workers was 1.4% [95% confidence interval (CI) = 1.1–1.7%]. It
was significantly lower among workers screened with an on-site test (1%; 95% CI = 0.5–1.5%), compared with a bench-top test
(1.7%; 95% CI = 1.3–2.1%). Nine studies provided data on false positives at the screening test, with a combined prevalence
estimate - calculated on positive cases – of 30% (95% CI = 16–44%). In Italy, the number of true positives at first-level workplace
drug testing is low, while the frequency of false positives is relatively high. A revision of the Italian legislation on the subject seems
advisable.