Alcohol and drug abuse is estimated to cost our nation more than $160 billion per year in lost productivity, health care costs and crime. Preemployment screening for substances of abuse has become a standard in some industries, including the health care industry. Samaritan Health Services of Phoenix, Arizona, a large health care provider (11,244 employees) began preemployment drug screening and for-cause substance abuse testing March 1, 1991. This paper presents 1-year's statistics for that provider, including problems peculiar to the health care industry, eg, forensic testing stipulation agreements from professional boards. Problems are addressed including the ease of obtaining prescription medications by health care workers ("curbstone consultations") and dealing with a professional population knowledgeable about prescription drug use. It was this corporation's experience that preemployment drug screening can be performed without great hardship to a large health care provider.