“Opponents have objected that drug testing is an unwarranted violation of privacy and a search without probable cause, but supporters have successfully countered that the supposed hazards of drug abuse necessitate urine testing.”
~Dale H. Gieringer, PhD, The Untold Costs of Drug Testing Abuse
Once only used by the military and by jobs that impacted public safety or security, urinalysis tests are now very common in the workplace. According to the American Civil Liberties Union, random drug testing at work has risen 277% since 1987. In many cases, you have to submit to a urinalysis drug test as part of the application process.
That’s not even counting UA’s that are mandated by a Court-ordered drug treatment program for matters like DUIs, DWIs, or probation. Even child custody cases now often hinge upon a provable track record of clean drug tests.
It is understood that employers have the right to a workplace where employees are drunk or high while in performance of their duties. Likewise, a person who has committed some crime should accept that this minor infringement upon their person liberty comes as a result of their own infractions, and that drug testing is infinitely preferable to additional jail or prison time.
However, a significant percentage of informed experts and a growing sector of the public at large have begun to question the necessity, the practicality, the efficiency, and even the morality of random UA testing.
Let’s take a closer look at both sides of the argument:
Against – Degrading Rules
Even though drug testing is now “routine”, the rule that the subject of the test must be observed by an attendant is intrusive and degrading. Even very modest applicants/workers with no history of drug use have to remove their outer clothing and urinate in full view of the observer.
Against – Invasion of Privacy
The procedure itself can be a violation of a person’s right to privacy. Conditions completely unrelated to the presence of illegal drugs – disease, pregnancy, etc. – can be revealed by the test. For example, Washington DC’s Police Department has disclosed that in the past, female employees were screened to see if they were pregnant, with neither their consent nor knowledge.
Against – Testing Errors
There are no federal guidelines that establish a minimum negative threshold for levels of tested illicit substances. Furthermore, every laboratory has its own proprietary procedures and guidelines, which means different tests, different specificity, and different test sensitivity.
And that is before other external factors like defective test kits and human error are considered.
Dwight Smith, M.D., from the VA Medical Center in Black Hills, South Dakota, says, “One in 20 (tested patients) are going to have inaccurate results, and those are more likely to be false positive than false negative.”
For example, it is well known that even a small amount poppy seeds – no more than are found on an ordinary bagel – can trigger a false-positive result on a drug test, and that erroneous result can show up days after the bagel was consumed.
Even more, a recent study testing 116 formulary medications found that 25 of them, –21.5 % gave false-positive results. These results were across the board and included analgesics, antihistamines, antibiotics, and antidepressants, among others.
Against – Useless in Many Ways
This is one of the stronger arguments made by opponents of urinalysis drug testing. A UA generally only shows past usage, not present impairment that would affect job performance or safety. Using marijuana even one time can result in a positive test up to a week later, and heavy users can still test positive a month and a half after stopping.
This is in marked contrast to other so-called “harder” drugs. Heroin and cocaine usually will be undetectable by most tests 2-3 days after usage. LSD, bath salts, and “Spice” never show up, while other abused drugs, such as many opioids and benzodiazepines, usually slip through.
Opiate screening tests for codeine and morphine, but not oxycodone, fentanyl, tramadol, methadone, or buprenorphine. Similarly, while benzodiazepines such as oxazepam, nordiazepam, and diazepam show up, but drugs of abuse – Xanax, Ativan, and Klonopin – are not usually screened.
Surprisingly, one recent study has shown that almost 90% of doctors are unaware that oxycodone is not screened unless a special assay is requested, and approximately half do not know that poppy seeds can create false-positive results.
Opponents of UA drug tests also point out that most kits don’t detect the most dangerous, most-abused drug of all – ALCOHOL. Using this argument, the implication is that supposedly minor recreational drug use (not abuse) can have life-changing consequences, while alcoholism is potentially ignored.
Against – Gray Morality
There is also a moral question when treatment centers perform their own urinalysis drug tests. Residential treatment centers, outpatient rehab programs, and sober homes all want to be able have their own labs and perform their own tests so they can receive the payments for services rendered.
Examine the financial possibilities. For example, if a facility can bill 100 dollars per panel, with each patient being tested for 15 substances, the monetary incentive to test can be hard to resist. Jeffrey Lynne, a Florida-based lawyer who usually represents treatment programs, says, “If I have a sober house with eight residents, and I can bill 1500 dollars a day for each, you do the math.”
The profits for a facility can be enormous. One urine testing company, Liberty Diagnostics of Pasadena, California, printed a brochure that stated “Average $400 profit per screen“, without a need for additional overhead such as equipment or added staff.
On the same brochure, physicians are enticed with a chart that says that a doctor performing 10 urine tests a week can make over $280,000 extra per year, from the tests and follow-up reviews with patients.
Lynne continues, “People need to know that urinalysis testing should not be viewed as a source of revenue. It should not be part of the business plan.” In other words, a drug test should only be performed to improve a patient’s care, not increase a treatment center’s profit margin.
The Case FOR Drug Testing
“Since the inception of medication-assisted treatment for opioid addiction (MAT), drug testing has provided both an objective measure of treatment efficacy and a tool to monitor patient progress.
~Medication-Assisted Treatment for Opioid Addiction and Opioid Treatment Programs, The Substance Abuse and Mental Health Services Administration, Treatment Improvement Protocol 43
For – Legal Grounds
Opponents of random drug testing will cite the First and Fourth Amendments to the Constitution, which guarantee individual privacy. However, the United States Supreme Court has already determined that individualized suspicion of drug use is not needed to uphold drug testing, under the “administrative search exception”, which basically weighs the interest of the State and the public against the privacy of the individual.
The “administrative search exception” originally began as a means for the military to test service members for illicit drug use, but over the years, particularly during the beginning of the War on Drugs, that concept was expanded to other industries and the general public at large.
For – the Right of Companies
In the workplace, this means that companies have the right to expect a workplace that is drug-free – an environment where the company’s productivity and the safety of all employees is not jeopardized or adversely affected by any individuals who might potentially be impaired by substance abuse.
In other words, a company has the right to ban drug use among its employees, and as an extension of that right, it can require periodic and/or random drug testing as a condition of employment.
This includes marijuana, which enjoys decriminalization and legalization in certain parts of the country but which remains illegal on a federal level. Even in locations where marijuana is legal, companies are still allowed to prohibit its use among their employees.
For example, in June, 2015, the Colorado Supreme Court determined that companies can fire employees who used marijuana – even for medical reasons, even if the employee was never impaired at work, and even though marijuana is legal in that state.
Justice Allison H. EidH I wrote, “Employees who engage in an activity such as medical marijuana use that is permitted by state law but unlawful under federal law are not protected by that statute.”
For – the Goals of the Judicial System
According to data published by the US Department of Justice, drugs and crime are closely related, with up to 79% of male arrestees and up to 85% of female arrestees across the country testing positive for drug use.
In an effort to deal with the issues of prison overcrowding and underfunding, recidivism, and substance abuse as a disease, many jurisdictions use drug court as an alternative to traditional punitive sentencing. Participants in drug courts are given the chance to enroll in treatment programs in lieu of jail time.
One of the requirements of all drug courts, regardless of jurisdiction, is that the offender submits to regular and random UA drug testing. Because a failed drug test can mean immediate jail time, this acts as a very strong deterrent.
“…the accumulated evidence suggests that adult drug courts are effective in reducing recidivism and the policy implications of this conclusion is that continued funding, development, and operation of adult drug court is warranted.”
~ the Journal of Criminal Justice , “Assessing the effectiveness of drug courts on recidivism: A meta–analytic review of traditional and non-traditional drug courts”
For – to Enhance Treatment
UA drug testing can be an invaluable tool for detox and rehab centers, because it gives treatment professionals a more accurate picture of what they are dealing with.
“If you’re coming into my detox, I need to test you once to see what you’re on and how much of it”, opined Lynne.
Drug testing can make a significant positive impact and improve care in three separate phases of addiction treatment –
- Screening/Diagnostic Evaluation – UA drug testing can provide an objective source of data which can be compared to what was gathered from the self-report of the patient. With accurate information, the detox facility can make an appropriate plan for withdrawal management.
- Formal Treatment – During primary treatment, UA drug testing can help verify abstinence. Treatment staff is made aware of any positive results, so that appropriate strategies and treatment options can be re-focused on an individual basis.
In an inpatient facility, UA drug testing also helps ensure that the therapeutic environment is in fact drug-free, and not compromised by any illicit substances that may have been smuggled in.
The opportunities for drug use are much greater if the patient is enrolled in an outpatient treatment program, so random drug testing takes on an even greater significance.
In any primary drug treatment program, the first, most fundamental goal is to help the patient establish and maintain sobriety by abstaining from drug use. Drug testing can help identify those patients experiencing the greatest difficulty in achieving or maintaining this goal, so that additional efforts and revisions can be made.
- Long-Term Monitoring/Aftercare – As in other chronic diseases, it is necessary for recovered addicts to return periodically to have their progress checked. Because anyone suffering from a is often reticent to disclose that fact, random UA testing can have great utility in helping addiction professionals deal with facts, rather than simply relying on the patient’s word.
For – the Antidote for Gray Morality
The mere fact that an addiction rehab facility does its own UA testing is not, in and of itself, a cause for apprehension, because as explained above, the tests can be extremely valuable as diagnostic and monitoring tools.
However, the issue of a possible conflict of interest – the patient’s best interests versus the financial interests of the facility – is too big of a concern to be blithely ignored.
So the question that arises is this – How can the two issues be reconciled? Or, more to the point, how can a person be sure that the rehab facility they are considering is conducting itself ethically when it comes to UA drug testing?
Although there is no surefire, comprehensive “checklist” that can be ticked off, there are a few guidelines that an individual performing their due diligence can refer to –
- Frequency of Testing – a thorough test for assessment should be conducted when the individual enters the detox facility and when treatment commences. Subsequently, UA’s should only occur at random intervals as a monitoring deterrent, except when otherwise directed by a court order or in severe instances, as determined on a case-by-case basis by qualified a physician.
- Proper Accreditation – A facility’s affiliations and accreditations show that it adheres to certain established standards. Two prominent and well-regarded institutions include The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), whose membership is comprised of professionals from the private medical sector that have come together to create standards for the quality of care in the country’s medical facilities, and The Commission on Accreditation of Rehabilitation Facilities (CARF), which for half a century has operated as an independent, nonprofit accreditor of rehabilitation-related providers.
- Transparency – If there is a relationship between the rehab facility and the drug testing company, each should be forthright about the connection.
Along those same lines, the drug rehab facility should, upon request, be able to disclose all costs associated with treatment, including the cost of UA drug testing. Often, it is easy to get an impression based upon that pricing. Overly-inflated pricing, combined with excessive frequency might indicate improper motivation on the part of the facility.
There are valid points on each side of the conversation. In the end, however, there are three very strong supportive factors that override any concerns about privacy and individual liberties.
First, companies should absolutely have the right to mandate that their employees abstain from illegal activities, especially when those activities have the potential to negatively impact productivity or create safety concerns. If the requirement is across the board and no specific demographic is singled out, it is entirely appropriate to make a clean UA drug test both part of the application process and a condition for continued employment.
Secondly, Courts should absolutely be able to order that offenders participate in drug rehabilitation programs that include periodic and random drug testing. The proven fact that drug testing reduces recidivism trumps any argument to the contrary.
Thirdly, and most importantly, the proven efficacy of UA drug testing as an assessment and diagnostic tool for detox/drug rehab facilities means that treatment centers should absolutely be allowed to perform their own testing, provided that industry best practices are followed and there is no conflict of interest between what is best for the patient and what is best, financially, for the facility.