Drug testing is the assessing of drug use (or non-use) by a person. The drugs for which one tests fall into three main types: illegal drugs, alcohol, and performance-enhancing drugs. Illegal drugs include marijuana, cocaine, amphetamines, and phencyclidine (PCP, the hallucinogen known as "angel dust"). Alcohol is, of course, a legal drug for adults, but since such activities as driving under its influence are illegal, it is sometimes very important to test for the level of alcohol in the bloodstream. Performance-enhancing drugs may be legal, but their use by athletes may be forbidden by the rules of an athletic association sponsoring a competition, rules designed to be fair to all the players.
Description
One line of attack in the "war against drugs" in the United States involves compulsory drug testing. Specific drug-test laws vary from state to state, but drug tests are commonly administered in schools, athletic competitions, and the workplace. When results of some tests are being evaluated, it is important to keep in mind the fact that sometimes legitimate prescription drugs for such conditions as arthritis and asthma can produce test results that falsely suggest illegal drug use.
Some schools test students in general for drug use; others focus on student athletes because drug use increases the risk of sports-related injury, and also because the use of performance-enhancing drugs would give the athletes who use them an unfair advantage over the other athletes. The United States Supreme Court ruled in 1995 that schools may test entire teams of student athletes, even if individual team members are not suspected of using drugs. On the state level, courts are divided on the circumstances under which such testing can legally
occur. Some states provide more protection than others for the rights of students to privacy and due process.
In the 1970s, the issue of performance-enhancing drug use among athletes came into the forefront. Many athletes use performance-enhancing drugs (ergogenic drugs) such as anabolic steroids, growth hormone, and erythropoietin. Some athletes also use stimulants because of their ability to mask fatigue. Athletes are tested for use of forbidden drugs at many major meets.
The federal government laid the groundwork for drug testing in the workplace when, in the late 1980s, it initiated mandatory drug testing of federal employees, and began to require that government contractors establish drug-testing programs for their workers. Today, many large companies in the United States administer drug tests to their employees, but testing in smaller organizations is significantly less common.
Some workplace drug-testing policies are considerably stricter than others. Federal employees can be subject to compulsory random drug tests, as can private-sector employees with responsibility for the lives and safety of others. It is obviously not as dangerous to the public for the person raking leaves in a park to take illegal drugs as for an airplane pilot, a truck driver, or a person producing atomic weapons. Much workplace testing is conducted under such circumstances as the following:
Pre-employment. Employers offer employment on condition of a negative drug test.
Reasonable suspicion. Employers test an employee after direct observation of drug use or possession, patterns of erratic behavior, or drug-related arrests.
Post-accident. Employees involved in accidents are sometimes asked to take a drug test immediately after an incident to determine whether alcohol or drug use was a factor.
Treatment follow-up. Employees returning to work after treatment for substance abuse are often subject to follow-up testing.
Urine is the most common sample used in drug testing. Urine tests for federal employees are first analyzed by laboratories certified by the Substance Abuse and Mental Health Services Administration (SAMHSA), and any samples that come up positive are double-checked by gas chromatograph mass spectrometry, the "gold standard" test that identifies the exact molecular structure of a substance. Some private employers also follow SAMHSA procedures and use federal laboratories for testing, but others use commercial drug-testing kits. These commercial kits have often been criticized for generating a high rate of false positives. The problems associated with urine testing have sparked interest in alternative techniques, such as the testing of hair, sweat, or saliva.
Viewpoints
SAMHSA advocates drug testing in order to help businesses achieve a drug-free workplace. A survey from the United States National Institute on Drug Abuse (NIDA) estimated that employee drug misuse cost the country billions of dollars in lost productivity, as well as in medical expenses and in worker-compensation claims. Mandatory drug testing in the workplace deters those who abuse drugs and alcohol from engaging in this unhealthy behavior at least while they are on the job, and it may deter non-users from ever starting to abuse drugs and alcohol. Also, it can sometimes help those with abuse problems to admit them and so to start getting help, but some abusers are in such deep denial that they cannot be helped in this way.
Opponents of these views point out problems with drug testing. Workplace testing may actually dampen company productivity because it is time-consuming, has the potential to violate the confidentiality that medical personnel are obliged to practice, and undermines staff morale and loyalty. More importantly, it may needlessly
KEY TERMS
Amphetamine—A chemical mixture that can strongly stimulate the central nervous system. Over time, users tend to need stronger doses, and eventually they may develop a physical dependence on it and thus become addicted.
Anabolic steroid—A synthetic or semisynthetic substance that promotes the production within the body of the proteins that build up tissues, especially muscle tissues.
Cocaine—An alkaloid chemical obtained from the leaves of the coca plant (or from some related species). It is addictive, it can cause mental and physical problems, and an overdose can lead to coma and death.
Ergogenic—Giving rise to, or enhancing, work, activity, functioning, and the like.
Erythropoietin—A protein produced mostly in the kidneys, and now available synthetically, that stimulates the production of red blood cells in the bone marrow.
False negative—A test result that erroneously gives a negative finding when the actual condition should have given a positive finding.
False positive—A test result that erroneously gives a positive finding when the actual condition should have given a negative finding.
Gas chromatograph mass spectrometry—A technique by which complex organic compounds are identified by the use of two sophisticated instruments. First, a gas chromatograph heats the compounds until they vaporize into gases which ascend a column and emerge one at a time. Then, each separate fraction of these gases is sent to a mass spectrograph which identifies the fragments of the molecules according to their mass. One thus gets a kind of chemical fingerprint of the substance being tested, and checks in a data base of thousands of such fingerprints of known substances to see which substance one has just tested.
Growth hormone—A substance produced naturally in the body, and now available synthetically, that promotes the development of flesh and bone, and influences the metabolism of proteins, carbohydrates, and fats.
Hallucinogen—A drug that can cause false sensations, such as hearing voices when there are no voices and no other sounds that could reasonably be confused with voices, or seeing persons or things that are not present.
Marijuana—The dried leaves, stems, and flowers of plants of the cannabis family. It is often smoked, sometimes eaten. It can produce distorted perceptions (which the users consider to be a form of elevated consciousness) and sometimes causes out-right hallucinations.
Phencyclidine—A chemical used legally as a veterinary anesthetic and illegally as a drug that alters consciousness (a psychedelic drug).
harm the careers of employees whose legitimate use of prescription medicines causes confusing or ambiguous test results. Also, it may identify substances at insignificant doses because of recreational drug use outside working hours, use that has no bearing on employee performance, according to civil-rights groups such as the American Civil Liberties Union (ACLU). The ACLU advises that employees in safety-sensitive positions such as airline pilots should indeed be tested for impairment, and that any individuals found to be impaired should then be referred to special programs called Employee Assistance Programs (EAPs). EAPs can in turn direct these persons to the appropriate substance-abuse programs. The ACLU also recommends more rigorous reference-checking to avoid hiring someone with a history of drug-abuse problems in the first place. However, if the person no longer has a drug problem, such an approach could illegally and unfairly violate this person's rights.
Many health-care organizations that provide qualified support for drug testing oppose its more radical uses, such as random testing or testing without suspicion. The American Nurses Association (ANA) opposes random drug testing of health-care workers, viewing it in violation of the basic principle of "innocent until proven guilty," but provides qualified support for testing under reasonable suspicion, and with evidence that job performance has been impaired by alcohol or drug usage. Employees who initially test positive for drugs should be offered a reassessment of the test results and should be given the chance to explain what legitimate medications they are taking which might have produced false-positive results. Even when the drug use is confirmed, counseling and treatment are recommended before any disciplinary action is taken, according to the ANA. The American Hospital Association (AHA) advocates pre-employment testing, suspicion-based testing, testing after certain incidents or injuries, and testing following drug rehabilitation, but not random testing without cause.
Some health-care organizations have also issued position statements on drug-testing policies in the community. The American Academy of Pediatrics has stated opposition to drug testing without cause as a prerequisite to student participation in school activities. And the American Medical Association (AMA) is opposed to the practice of reporting positive drug results for pregnant women to law-enforcement officials. Proponents say such practices protect unborn children, but the AMA states they are an invasion of medical confidentiality and a violation of the provider/patient relationship. Such practices may also discourage some women from seeking prenatal care.
Professional implications
Nurses may draw blood samples, for example, when testing for alcohol level. They must be certain that they have the informed consent of the person from whom they are drawing blood, or else that they have clear-cut legal authorization, such as a court order, to do so. In the case of testing of urine, hair, saliva, and sweat, nurses should instruct the person being tested and then properly store and label the specimen provided. Medical technologists or clinical-laboratory scientists are responsible for running the tests, for reporting the results accurately, and in some cases for estimating the margin of error or assessing the likelihood that the result is a false positive or a false negative. All health personnel must see that the results of such tests are disclosed only to those authorized to have them, and must otherwise maintain strict professional confidentiality.
PERIODICALS
Annas, G. J. "Testing Poor Pregnant Women for Cocaine— Physicians as Police Investigators." New England Journal of Medicine 344, no. 22 (31 May 2001): 1729–1732.
Kennedy, M. M. and R. B. Pickett. "An Uncomfortable Issue: Dealing with Substance Abuse." Clinical Laboratory Management Review: Official Publication of the Clinical Laboratory Management Association/CLMA 15, no. 3 (May–June 2001): 183–184.
Kraus, J. F. "The Effects of Certain Drug-Testing Programs on Injury Reduction in the Workplace: An Evidence-Based Review." International Journal of Occupational and Environmental Health: Official Journal of the International Commission on Occupational Health 7, no. 2 (April–June 2001): 103–108.
Kunsman, K. "Oral Fluid Testing Arrives." Occupational Health and Safety (Waco, TX) 69, no. 4 (April 2000): 28–30, 34.
Laws, J. "Rewriting the Testing Rulebook." Occupational Health and Safety (Waco, TX) 69, no. 4 (April 2000): 36–38.
ORGANIZATIONS
American Civil Liberties Union. 125 Broad Street, New York, NY 10004-2400. (212) 549-2500. aclu@aclu.org. <http://aclu.org>.
American Nurses Association, ANA, 600 Maryland Avenue, SW, Suite 100 West, Washington, DC 20024-2571. (800) 274-4ANA. <http://www.nursingworld.org>.
American Society of Addiction Medicine. 4601 North Park Avenue, Arcade Suite 101, Chevy Chase, MD 20815-4520. (301) 656-3920. <http://www.asam.org>.
Division of Workplace Programs, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration. 5600 Fishers Lane, Rockwall II Building, Room 815, Rockville, MD 20857. (301) 443-6780. <http://workplace.samhsa.gov>.
National Clearinghouse for Alcohol and Drug Abuse Information (NCADI) Center for Substance Abuse Prevention. 5600 Fishers Lane, Rockville, MD 20857.(301) 443-0365. <http://www.health.org>.
National Institute on Drug Abuse. 6001 Executive Boulevard, Bethesda, MD 20892. (301) 443-1124. www.nida.nih.gov.
NSNA, National Student Nurses Association, 555 West 57th Street, New York, NY 10019. (212) 581-2211. <http://www.nsna.org>.
