Drug testing has become a very common practice in our current society. There are a number of reasons for this increase. First, the actual tests themselves have become relatively easy to perform. They often require only a urine dipstick. More complex confirmatory testing is readily available at any number of labs for very reasonable prices. A second reason is the parallel objectives of employers and industries to screen out drug abusers prior to employment consideration, and to maintain later vigilance by subsequent random testing. The Government has mandated certain workplace safety requirements, and drug abuse is considered to have a negative impact on this workplace safety. The goal of employers is to have a drug-free work environment. It is common practice for Workman's Compensation to require drug testing before benefits are granted after an injury in the work place. In specialized jobs, such as driving a truck or a bus, the DOT will require drug testing at the time of each physical examination.
A second relatively frequent use of drug screening is in the medical environment. Testing is often ordered after emergency presentations for trauma treatment, especially when it concerns adolescents and teenagers. A physician who is following a patient for pain management may order drug testing to look for illicit drugs, and even to see if the patient is taking the prescribed medication. In following a patient for drug rehabilitation, it is often considered necessary to screen for drugs at the initial visit and randomly thereafter. Interestingly, The American Academy of Pediatrics has come out with a policy statement against in-home drug testing by parents or random testing by schools until more strenuous research is done. The pediatricians believe that there is more chance of worsening the parent-child or teacher-child relationships than there is of obtaining useful information for drug use intervention. Finally, drug testing may be commonly used in forensics and pathology to determine possible causes of death.
A third overlapping use of drug testing is in law enforcement. After an accident, drug testing is commonly ordered to determine if drugs may be a causative factor. Individuals who are on drug-related probation may have to submit a urine sample for testing at each visit. When there is a question of parental fitness, drug testing may be required by child advocacy agencies to determine issues of visitation and custody. Again, court-ordered drug rehabilitation may require random drug screening for continued participation versus punitive action.
A fourth area of drug testing is in academic and professional sports. There is more emphasis on the use of enhancement producing drugs ("doping"), but stimulants and other drugs of abuse are also of concern. The Olympics institutes the most exacting drug testing, which is required by each participant before the games, and then again by the individual winners of events.
One other area of drug testing is by the insurance industry. When a company is calculating risks and insurability of an individual, drug testing may provide very useful information. They often check for urinary nicotinine, a metabolite of nicotine, to see if a prospective client is truly an ex-smoker. An individual who is a drug abuser at any level is not a good insurance risk.
There are basically five biological sources for drug testing. They are the hair, the saliva, the sweat, blood and the urine. The urine is the best biological specimen for this purpose with the possible exception of alcohol testing with hair samples. Certain ester fats which are deposited on the hair with alcohol use are testable for up to eighteen months. Blood is not considered to be as good a sample because it requires an invasive procedure and drugs are not concentrated to the same degree as they are in urine.
The approximate times that drugs remain in the body are generally known and there may be specific tests to ensure this time length. Alcohol is present for 2-4 hours, amphetamines 2-4 days, barbiturates 2-3 weeks, benzodiazepines 4-6 weeks, cocaine 2-4 days, marijuana 18 hours-5 days, methadone 3 days, and opiates 8 days. There are drug users who continually try to beat the tests. They can use home test kits to see if their urine is clean ahead of time. Some try to put tap water in the cup or drink 2 liters of fluid prior to the test to dilute it. Standard testing will, however, reveal a urine sample which is too dilute or not the right temperature. Some try to put Clorox in the urine, but this is detectable. Lots of "Head Shops" have commercial products to confound urine tests like "Urine Luck" and "Whizzies", but a savvy lab tech can pick up on these methods and advise retesting. Often confirmatory testing is then required to directly observe the collection of the urine sample which is then subject to more stringent and precise methods of testing.
The best decision to which to commit, if one is going to be employed in any of the work places which require urine testing, is not to use drugs which are subject to testing and identification as drugs of abuse. That's the long and the short of it. The health and financial cost of drug use can otherwise be devastating. This is not a sermon: it's just common sense. You can be a carhop, a drug dealer, or otherwise while using drugs, but the best jobs and opportunities in business, industry, and the military will go to those who do not abuse drugs. It is expected that drug testing will become more extensive and precise, and that if you do make the choice to abuse drugs you will be identified and excluded from the mainstream work force. The question you have to ask yourself is whether this joint, oxycodone or Ecstasy tablet, this sniff of cocaine, is worth what it could cost in the long run.
Douglas Beatty M.D.
Doctors Medical Center
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