The white paper, authored by former United States National Institute on Drug Abuse Director (and present-day drug testing consultant and profiteer) Robert Dupont (along with input from staffers at various drug testing labs and corporations) argues: “The major need today is the wider and smarter use of the currently available drug testing technologies and practices. … This White Paper encourages wider and ‘smarter’ use of drug testing within the practice of medicine and, beyond that, broadly within American society. Smarter drug testing means increased use of random testing rather than the more common scheduled testing, and it means testing not only urine but also other matrices such as blood, oral fluid (saliva), hair, nails, sweat and breath.”
ASAM’s paper calls for the expanded use of random drug screening among patients undergoing palliative care as well as those seeking emergency medical treatment, psychiatric treatment or obstetric care. Adolescent patients, as well as geriatric patients – “The geriatric population has been the target of drug dealers, who may even take them to medical appointments and then trade prescriptions for cash,” it alleges – also ought to be targeted for increased drug test monitoring. “Drug testing (in clinical settings) needs to become as common in medical practice as clinical diagnostic testing is in the management of hypertension and diabetes,” Dupont writes. (This outcome seems unlikely since most testing in clinical settings would arguably need to be voluntary. To date, the Supreme Court has only upheld mandatory random drug screening to apply to certain safety-sensitive public employees and/or public school students engaged in athletics or other extra-curricular activities.)
Predictably, the paper argues for expanded drug testing practices in both the workplace and in public schools even though the supposed benefits of such programs have never been established in either forum and have been associated with adverse effects, such as the increased use of so-called ‘hard’ drugs, in school settings. It also calls for greater drug testing of motorists suspected to be under the influence of drugs. (Dupont has previously called for the imposition of zero tolerant per se laws, which mandate that the act of driving with any detectable level of a controlled substance or its inactive metabolite present in one’s body is a criminal act, despite acknowledging that there exists no evidence demonstrating that such laws reduce incidences of drugged driving behavior.) The paper also suggests more parents engage in the random drug testing of their children – a practice that is not recommended by the American Academy of Pediatrics since such home tests have not been demonstrated to be accurate or efficacious, and “may be perceived by adolescents as an unwarranted invasion of privacy.”
Of course, similar criticisms can be (and have been) lobbied at the practice of warrantless drug testing in general. To date, federal guidelines only exist overseeing the practice of urinalysis (and only in cases in which public employees are among those tested), a biological matrix that solely detects the presence of inert drug metabolites (non-psychoactive by-products that linger in the body’s blood and urine well after a substance’s mood-altering effects have subsided), not the actual drugs themselves. (This why the US Department of Justice acknowledges: “A positive test result, even when confirmed, only indicates that a particular substance is present in the test subject’s body tissue. It does not indicate abuse or addiction; recency, frequency, or amount of use; or impairment.”) Other proposed alternative matrices for drug detection – such as breath, saliva, hair, and sweat – are not standardized nor are they subject to any type of federal regulations.
Further, even urine tests – when the results are confirmed and federal guidelines are followed – may be subject to false positive results and human error. According to a 2012 report published by the National Workrights Institute, “[Government] certified drug testing laboratories have significant reliability problems and that the government’s assurances that false positive test results are a thing of the past is untrue.” It adds, federal regulations “allow labs to make mistakes on ten percent of the blind samples used in the certification process.”
Finally, in the case of cannabis detection, both urine and blood testing are especially problematic – and discriminatory – since both THC and its primary metabolite, carboxy-THC, are lipid soluble and may be linger in the body in more regular consumers for days (in the case of THC in blood) or even weeks or months (in the case of carboxy THC in urine) after a person has ceased using pot. This is not the case with most other commonly screened for controlled substances, which are often water soluble and therefore undetectable some 24 hours (or sooner) or so after ingestion.
Nonetheless, ASAM concludes, “(Our) principal goal in drug testing is for today’s impressive drug testing technology to be far more widely used.” If and when that day comes, expect Dupont – whose website brags, “(Our) years of experience can help your organization to implement and maintain a viable drug testing program.” – and many of the other drug testing industry insiders affiliated with the American Society of Addiction Medicine to benefit while the rest of us pay the price.
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