Five hundred routine preemployment urine toxicology examinations were performed on prospective hospital employees in 1981. Thirty-three (6.6%) examinations were positive for one or more of either Valium, barbiturates, amphetamines, phencyclidine or opiates. Only 13 (2.6%) were confirmed to be positive. Of those with confirmed positive results, only one applicant was denied employment. Significantly, that case would have been suspected during the clinical preemployment examination. These results indicate that including a routine urine toxicology screen in a preemployment examination may not be cost-effective.