PERSPECTIVES ON LIBERTY (1987)

Chapter 4

Drugs

The first of the two major recent issues dealing with the public consequences of private conduct is drug abuse.

Since about 1983, the media have flooded is with stories about drug abuse in high places (most notably, cocaine in professional sports). During this time, companies have become more cognizant of the costs of employee drug abuse in terms of safety and lost productivity; as technology has made a variety of tests (mainly of urine) availble, many employers have rushed into requiring their employees to undergo mandatory screening, with resulting publicity and court cases over the controversy concerning "invasion of privacy." Of course, drug abuse did not come upon us suddenly; but the public's increased concern about it is rather recent.

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A BIG CRACKDOWN?

In 1986, the Reagan administration talked extensively about deterring the drug abuser as well as the dealer and smuggler. Should society launch a draconian crackdown on personal drug use with widespread mandatory testing, and then either rehabilitation or job dismissal and possible incarceration? Would this amount to a new era of prohibition?

LEGAL ISSUES

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A more appropriate argument is that, while the ingestion of drugs may have taken place in private, doing a potentially hazardous job, jeopardizing the safety of others, while drugs are in one's blood or other body fluids, is not a private act. In some industries, this observation would apply to many legal medications with sedation as a side effect. The obvious analogy is DWI, against which the public crackdown was entirely appropriate. Employers, including government employers, ought to have reasonable methods to ensure that persons are medically fit to work once they enter the premises.

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The cheaper test is called the EMIT (manufactured by Syva Co., a subsidiary of Syntex) and generally costs $8-$24. A similar test, Abuscreen, is made by Hoffman-La Roche and is widely used by the military. EMIT tests for substances indirectly, by looking for specific chemical markers after the body breaks them down, by using an enzyme and antibody (for these byproducts) and scanning the preparation with light beams to measure chemical presence in nanograms. EMITs are prone to false positives, especially when the subject has taken certain over-the-counter medications, such as decongestants and antihistamines (even nasal sprays) which may cause false positives for marijuana (espcially with Advil or Nuprin) or amphteamines (Sudafed, Congestac, Contac, or anything containing phenylalinine, which "decongests' by increasing adrenaline flow, not such a good thing). Poppy seeds on hamburger buns have been known to give false positive results for opiates (morphine) by EMIT. One company, Syntex, offers a supplementary kit to eliminate false positives for amphetamines. A more reliable test is the gas chromatograph / mass spectrometer (GC/MS), which runs over $100 per unit. (50) Syntex claims that, administered properly, EMIT and GC/MS are nearly 100% accurate. Other tests have been proposed, including one which could detect cocaine in human hair up to three years after use. (20)

During 1985 and 1986, the media have reported a large number of complaints by workers who maintain that they were disciplined or fired after erroneous drug tests. One Southern Pacific employee, not involved in actual operations, was required to attend an expensive rehabilitation program (at his own expense, involving confinement in a "hospital") after three EMIT tests were positive; the employee maintained that the positive results had been caused by legal over-the-counter medications.

Legislation should be passed to require that employee drug testing meet stipulated standards of accuracy. According to Dec. 1986 Nation's Business, an industry standards organization is being formed to measure the accuracy of tests and to certify drug testing laboratories. "Once the standards are issued, federal agencies and private contractors doing federal work will be required to patronize certified labs for any drug testing that they do" (60). Of course, such standards would have to specify exactly which drugs or chemicals would be defined as "true" positives. It will be reassuring to have certification procedures in place; they seem to be needed. In 1985, the Centers for Disease Control sent specimens to 13 laboratories. Each lab missed at least one drug present, and numerous false positives were sent back (70). One is reminded of "unknowns" in college qualitative analysis (chemistry "201") coursework.

In measuring tests, there are two important concepts, "sensitivity" and "specificity." Sensitivity is a measure of how well a test identifies truly positive individuals. Specificity means, how reliable is a given positive test. Let A=num of true positives, B=number of false positives, C=number of true negatives, D=nunber of false negatives. Then specificity = A / (A+D) and sensitivity = C /(B+C). A signficant false positive rate can seriously undermine a test. For example, suppose that out of 1000 subjects 100 are true positives, and a test has a specificity of 99% and sensitivity of 99%. Then it would be expected to identify 99 of the 100 abusers correctly, but it would also identify 9 out of 900 non-abusers. For every 11 abusers "caught", 1 additional non-abuser would be unjustly identified. For a test to be effective and reasonably fair, there must be a genuine suspicion that a reasonable portion of persons are abusers. Of course, careful retesting and consideration of other medical information would reduce false positives further.

Another important observation is that THC (marijuana), being fat soluble, is excreted in the urine for as long as 30 days afer use, when an employee is presumably no longer "impaired." A positive result can result from merely breathing second-hand pot smoke, as at a party or bar. Chearly, the test for THC can potentially be abused as a form of "social control" when there are no real safety issues.

  

CIGARETTES

Another drug abuse issue that has received increasing attention recently is cigarette smoking. Yes, nicotine is a drug, albeit legal, and smoking is a serious national health and insurance issue. (The circulatory system damage from nicotine makes men go bald in the legs.)

During the past few years, newspapers have reported many accounts of companies that ban smoking on the job and ask prospective employees about smoking and do not hire smokers. Health insurance companies are likely to pressure more employers to do so. There is one motel chain, Non Smokers Inn, that rents rooms only to non-smokers and gives employees lie detector tests (see below) to assure itself that they don't puff even at home.

LIE DETECTION

About 20 states outlaw polygraphs in most situations (at least in deciding whether to retain an employee) and the House of Representatives has passed a bill in 1986 banning their use in most employment situations, other than those in law enforcement or where national security is involved. There is a similar measure under consideration in the Senate, sponsored by Senator Orin Hatch of Utah.

(20) Editors: "Battling the Enemy Within: Companies Fight to Drive Illegal Drugs out of the Workplace." Time, March 17, 1986 127-11.52.

(50) Bedell, Doug. "When Tests Fail: Colleges' Drug Exams not Foolproof." The Dallas Morning News, Feb. 6, 1987:1.

(60) Hoffner, William. "A New Focus on Drugs." Nation's Business, Dec. 1986, 74-12:57.

(70) Editors, Time, Jan. 19, 1986.