Eight problems examined that point out serious inadequacies in testing for drug use

Introduction This paper attempts to summarize some of the major criticisms of drug testing. Eight problems with drug testing are discussed. These are: • It does not measure something employers have a reasonable need to know, • It is a distortion of priorities, • Drug use is not known to be associated with increased risk of occupational injuries, • Drug testing is proposed as a dangerously simplistic solution to poorly conceived problems, • In the absence of safeguards, it is unacceptably inaccurate, • In the absence of treatment commitments and confidentiality protection for persons dependent on drugs, it is an unethical practice of medicine, • Drug testing is an invasion of privacy, and • It will have a negative effect on treatment of persons with drug or alcohol dependencies. Employers' need to know It does not measure something employers have a reasonable need to know. It is reasonable for employers and fellow workers to want to know if workers are functionally impaired (intoxicated) while on the job. Drug testing does not measure impairment. It measures the concentration of drug metabolities in urine or blood. Unlike measurements of blood alcohol concentration (BAC), drug metabolites are not correlated with impairment or intoxication. They indicate only drug use in the one to two weeks before a urine sample. And, in some instances, they indicate chronic use. Impairment caused by drug use, on the other hand, occurs immediately and declines rapidly within hours. Drug metabolites may linger for days afterwards. Drug metabolite concentrations in urine are a function of (Morgan, 1984; Schartz and Hawks, 1985; MMWR, 1983): • the amount and purity of drug consumed before taking the test, • when the drug was consumed, • whether the person was a chronic user, in which case a certain amount of drug metabolites would be stored in body fat and slowly released, • the person's metabolic rate, and • for metabolites in urine, any dilution effects of urine. Only the first two factors has