URINALYSIS OR UROMANCY PART II

RANDOM URINALYSIS

By far the most dreaded and intrusive form of drug testing is the
random test, which is specifically designed to take workers by surprise.
Under random testing, workers may be called on to provide a urine sample at
any time, typically on no more than an hour or two's notice (however, in
some shops, workers have been known to receive as much as a weeks' advance
alert). A corollary of random urinalysis is to prevent workers from using
any marijuana, even at home on weekends, at the risk of losing their jobs.

While private employers have tended to shy wawy from random testing
on grounds of expense, government drug warriors have successfully
campaigned to impose random testing through federal regulations. Random
urinalysis is now required for the military, many public employees and
contractors, and the nation's entire interstate transportation workforce --
including not only airline pilots, train engineers and truck drivers, but
also flight attendants, mechanics, and gas pipeline workers.

The NORML hotline receives many complaints about random testing
from transportation workers. Most not only resent the intrusion on their
private lives, but also insist that illicit drug abuse is not a safety
problem. "Alcohol is the worst abused drug, especially pilots," says one
angry flight attendant, a view repeatedly expressed by others in the
industry.

According to air industry spokesmen, not a single passenger airline
crash had been attributed to alcohol or drug abuse. (14) Administration
officials lamely pointed to a 1988 plane crash in Durango, Colorado, in
which the pilot's blood showed evidence of cocaine use. Yet investigators
determined that the pilot was not high at the time of the crash, and it was
the co-pilot who was controlling the plane at the time of the crash! (15)
The fact that drug testing is widely opposed by the very airline workers
whose lives are most at stake would seem to raise obvious questions about
the supposed dangers of drug abuse in the air industry.

Drug testing of transportation workers was mandated by Congress in
response to a highly publicized 1987 train collision in which 16 passengers
were killed. (16) The accident was blamed on the negligence of an
engineer and brakeman, who were determined to have been smoking marijuana
shortly before the crash. A subsequent investigation revealed that both
men had an extensive record of drunken driving offenses and were known to
be problem drinkers. Furthermore, some of the train's safety equipment had
been disabled. The engineer admitted to culpability for ignoring warning
signals, but denied that marijuana had anything to do with the accident.
An investigation by the National Transportation Safety Board concluded that
the railroad should undertake management reforms and equipment
improvements, but did not recommend drug testing. Nonetheless,
Transportation Secretary James Burnley argued for drug testing, pointing to
evidence that a significant percentage of accident-involved rail personnel
tested positive for drugs. (17) In fact, however, Federal Railroad
Administration statistics showed that only 4-6% of "reasonable cause" urine
tests were positive for drugs or alcohol, (18) half of what might have
been expected for a normal cross-section of the workforce! (19)

The ultimate impact of random testing regulations remains to be
seen, as testing is still being phased in within the transportation
industry. Many workers have responded by adjusting their drug use, however
grudgingly. Others persist in risking a urine positive, relying on one or
another evasion techniques to minimize their risks. Relatively few are
actually caught: airlines report fewer than 1% of employees test urine
positive. (20) Included are an unfortunate number of very occasional
users: NORML has heard from more than one flight attendant dismissed for
indulging a rare joint with an old friend.

Many workers report turning to alcohol as a substitute for
marijuana. "I'm drinking a lot more now," says one trucker, echoing a
common complaint of many drug-tested workers who say they use pot to
control alcoholism. Other drug-tested workers report widespread alcohol
abuse among their fellows: "You see guys stumbling in here drunk from the
management on down," says a Customs employee, "There are guys drinking
alcohol first thing in the morning." Another employee told NORML that
workers at his job had started smoking heroin instead of pot. Meanwhile,
in the military, LSD is said to have become the illicit drug of choice due
to its relative undetectability. (21) It is tempting to speculated that
recent reports of a parallel upsurge in alcohol and LSD use among young
persons reflect a broader social trend created by the incentives of drug
urinalysis. (22)

URINALYSIS: "ON-CAUSE" OR NO CAUSE?

In many workplaces, employees are subject to "on-cause" testing
whenever they have an accident. While such testing might seem
unobjectionable, it is often abused so as to inculpate innocent workers.
For instance, a diesel mechanic told NORML that he had been ordered
to take a urine test following a minor workplace accident on a Friday, and
that his drug test was scheduled for Monday, three days after the accident.
The worker was rightly concerned that he might be fired because he had
recently smoked marijuana at home. Ironically, however, three days would
have been ample time to pass the test had he actually been under the
influence of any other drug--cocaine, heroin, alcohol or speed--at the time
of the accident!

In another case, a woman reported that her husband, a print shop
worker with eight years' seniority, had flunked a drug test for marijuana
after receiving a minor finger cut in an accident caused by another worker.
Not only was her husband fired for an accident that wasn't his fault, but
the family also lost health insurance coverage for their son, who had
serious medical problems costing $1200 per month. Like other urine testing
victims, the woman charged that the company had financial motivations to
fire her husband, namely the family's insurance costs.
Urinalysis abuse is a phenomenon that extends beyond the job
market. For instance, some insurance companies require drug urinalysis as
part of their physical exams. Applicants are routinely denied insurance if
they are found to use marijuana, despite the fact that there is not an iota
of actuarial evidence showing marijuana adversely affects life expectancy.

Urinalysis has also come to figure in custody battles between
estranged couples. One husband told California NORML that he had been
directed by a court to submit to urinalysis after his wife had accused him
of being a marijuana smoker, a condition widely presumed to compromise
parental fitness. He complained that he was given no time to prepare for
the test, despite the fact that his wife, who had demanded the test, had
three weeks to prepare a clean sample of her own.

Another arena where urinalysis is widely abused is the
prison system, where it is often imposed indiscriminately as a condition of
probation or parole. As a result, many non-violent offenders face
substantial prison time for simply smoking a joint. For instance, a
California woman with a long history of medical marijuana use for migraines
was sentenced to 8 months in jail on charges of marijuana transportation.
The judge explained that he could not give her a suspended sentence because
in that case she would be subject to drug testing, which she would almost
certainly fail, thereby ending up with a substantial sentence. Drug use
violations have been reported to constitute 45% of all parole violations in
California, which in turn account for nearly half of all prison admissions.
(23) The use of marijuana screening appears especially dubious in light
of the fact that marijuana tends to suppress violence, whereas the nearest
substitute, alcohol, tends to aggravate it.

California NORML has heard from several medical marijuana patients
with drug testing problems. "Pot makes me feel better," complains a
government worker with psoriatic arthritis, "I can't take alcohol." Other
patients are threatened with drug testing programs following convictions
for marijuana offenses. Although marijuana is not an approved medication,
patients may be able to pass urinalysis by obtaining a prescription for
Marinol, the government-approved synthetic marijuana substitute. Since
Marinol reacts exactly like marijuana, patients could presumably obtain a
medical exemption for a positive urine test. Unfortunately, however,
prescriptions for Marinol are not easy to come by and federal regulations
forbid its use outside of cancer chemotherapy.

One common concern about drug testing is the danger of "false
positives," in which subjects are erroneously accused of drug use.
Contrary to rumor, neither passive smoking nor drug interactions are likely
to cause false marijuana positives. Only in the most unlikely conditions,
such as sitting for hours on end in a closet full of heavy pot smokers, has
passive smoking been shown to produce a level of urine metabolites high
enough to be detected on the standart EMIT test. (24) Likewise, no drug is
known to cause a false positive for marijuana, but certain over-the-counter
medicines can trigger the test for amphetamines and poppy seeds can be
confused with opiates (it used to be that ibuprofen interfered somewhat
with marijuana tests, but this problem has been fixed). (25) Such
problems are supposed to be sorted out by medical review officers, the
reliability of whom can only be speculated on. However, NORML has not
heard any complaints about false positives from drug interactions.

The important question remains whether false positives may be
caused by lab error. Early surveys of drug testing labs reported
remarkably high error rates. However, industry and government have taken
steps to insure against false positives for the sake of public credibility
and liability. By requiring accurate gas chromatograph confirmation tests
of positive samples and regulating the chain of custody, selected labs have
demonstrated false positive rates as low as zero in 10,000 -- 48,000
samples in proficiency tests (false negatives, in which drug use is not
detected, run around 3%) (26) Nonetheless, given the profusion of
unregulated labs, higher error rates may well be common. It should be
noted that even if false positives occur in as few as one in 100,000 tests,
hundreds of Americans per year can expect to be falsely branded as illicit
drug users.

California NORML has heard from three or four persons claiming to
be victims of "false positives" for marijuana. Claims of this kind are by
nature suspicious and difficult to verify. On one occasion, however, I
personally observed what appeared to be a serious lapse of security in a
local clinic that administers drug tests to probationers for local
corrections authorities. I had come there to have some experimental
specimens tested, and was told to place them on a shelf. While I waited
for an attendant to record and label the samples, a nurse came in and
deposited another unlabeled specimen jar on the shelf next to mine. Had I
not brought the situation to the attendant's attention, it would have been
child's play to switch and mislabel the samples by error or mischief.

UROMANCY: AN OBSOLESCENT TECHNOLOGY?

The full toll of drug urine victims has yet to be scientifically
investigated. Nothing is known about the number of false positives, nor
the number of responsible workers disqualified for urine positives, nor the
costs to their families, the economy, and welfare roles, nor the extent to
which drug urinalysis has aggravated abuse of alcohol, tobacco and other
untested drugs.
As for the purported benefits of testing, these too are unclear.
Given the potential for drug substitution, however, it may be doubted
whether they will prove significant. Indeed, a pair of recent studies
suggest that the recent decline in marijuana use has led to an increase in
drug-abuse emergencies and auto fatalities due to alcohol and other drugs.
(27) Meanwhile, the Bureau of Labor Statistics lhas reported a jump in
job-related sickness and injuries to a record 6.8 million in 1990, or 8.8
out of 100 workers, the highest rate since 1979, before drug testing began!
All of this raises obvious questions about the purported benefits of drug
urinalysis. Insofar as the evidence for drug testing rests more on faith
than science, it might aptly be called "uromancy."

The case for drug urinalysis is further undermined by the fact that
there exist alternative means for detecting impairment. Most promising of
these are performance tests, which measure reaction time, alertness, and
agility at various tasks. Computer-based performance tests are now on the
market and have started to be used in some workplaces. (28) Performance
tests have the obvious advantage of measuring actual impairment, regardless
of the cause. Unlike urinalysis, they can detect problems caused by
alcohol and other, untested drugs, as well as stress, fatigue, and
emotional distress. In addition, they have the important advantage of
disregarding private behavior that is irrelevant to job performance.

Another, often ignored alternative to urinalysis is blood testing.
Although blood tests are even more physically invasive than urine tests,
they provide a much better indication of current impairment, since they
detect the active presence of psychoactive drugs in the system rather than
inactive urinemetabolites. Because blood tests are less sensitive to
behaviorally irrelevant, past drug use than urine tests, they are commonly
used in forensic studies of accident victimes to determine whether the
subject was under the influence of drugs. Unfortunately, blood tests are
at best an imperfect indicator of intoxication for drugs other than
alcohol, and it is impossible to determine fixed thresholds for impairment.
In the case of marijuana, THC blood levels decline quite rapidly to
negligible levels in as little as two hours for occasional lusers, although
chronic users can manifest detectable levels for a couple of days. Blood
tests may therefore offer a useful way for occasional drug users to
establish their innocence of being under the influence. The case can be
made that any worker accused of on-the-job drug abuse should have the
option of taking a blood or impairment test to prove his or her competence
(in California, motorists accused of driving under the influence of drugs
have the option of blood or urine tests; unfortunately, few if any drivers
understand the dramatic differences in sensitivit;y between the two).

Another, more sinister alternative to urinalysis is hair testing,
which is even more sensitive to past drug use than urinalysis. Promoters
claim to detect drug use for months and even years, far longer than any
pharmacological impact on health. Despite the fact that hair testing has
unresolved technical problems and is considered to be an unproven
technology by the scientific community, (29) it is already being marketed
and used by some private employers and has been boosted by federal
officials like Drug Czars William Bennett and Bob Martinez. The one
advantage of hair testing is that is is less invasive of bodily privacy
than blood or urine testing, although some persons, such as those of the
Sikh religion, object to having their hair disturbed. However, because
hair testing is also much more indiscriminate than other technologies in
distinguishing harmless drug use from abuse, it poses enen greater
potential costs to society, the economy, and civil liberties.

The choice betwee hair testing and performance testing marks a
crucial crossroads for the nation's drug policy. While the outcome remains
to be seen, there are good reasons to think that urine and hair testing
will eventually be rejected for all but forensic purposes, given their
basic inability to measure competence.
Drug urine testing is perhaps best understood as a tool for
imposing social conformity that has aptly been described as "chemical
McCarthyism." (30) Like the loyalty oath of the fifties, urinalysis seeks
to impose "politically correct" attitudes in the workforce. As drugs have
replaced Communism as domestic enemy number one, so the question, "Are you
now or have you ever been a member of the Communist party?" has been
replaced by, "Are you now or have you been the user of a controlled
substance?" When the current anti-drug hysteria subsides, the absurdity of
this question will become apparent.

Technologically, drug urine testing can best be compared to that
other tool of McCarthyism, the polygraph. Like the polygraph, drug testing
rests on the spurious premise that the human mind can be read via crude
physiological measures. Like the polygraph, drug testing is inherently
misleading and endangers innocent parties. Time has revealed the polygraph
to be an essentially flawed technology, and it has now been outlawed for
most purposes (ironically, by the very same Congress that eagerly embraced
random urinalysis). In the fullness of time, it can be expected that the
same will happen to drug urinalysis. As the costs of drug testing are
examined more closely, it is apt to be seen that human beings are best
judged by their perormance, not the chemicals in their urine.


FOOTNOTES

1 John Horgan, "Test Negative: A look at the 'evidence'justifying
illicit-drug tests," Scientific American, March 1990, pp. 18-22; John
Horgan, "Postal Mortem," Scientific American, February 1991, pp. 22-3;
Dr. John Morgan, "Impaired Statistics and the Unimpaired Worker," The Drug
Policy Letter 1 (2): May/June 1989.

2 Dr. David Charles Parish, "Relation of the Pre-employment Drug Testing
Result to Employment Status: A One-year Follow-up," Journal of General
Internal Medicine 4: 44-7 (1989).

3. Zwerling, Ryan and Orav, "The Efficacy of Preemployment Drug Screening
for Marijuana and Cocaine in Predicting Employment Outcome," JAMA 264
(20): 2639-43 (1990).

4. Normand, Salyards and Mahoney,, "An Evaluation of Preemployment Drug
Testing," Journal of Applied Psychology, 75 (6): 629-39 (1990).

5. Zwerling, Ryan and Orav, "Costs and Benefits of Preemployment Drug
Screening," JAMA 267 (1): 91-3 (1992).

6. Klonoff, "Acute Water Intoxication as a complication of urine drug
testing," JAMA 265: 84-5 (1991).

7. One in four current marijuana users say they are daily users, while one
in seven report smoking at least two joints a day, according to NIDA's 1982
National Survey of Drug Abuse.

8. Dr. John Morgan, cited in Horgan, "Test Negative," loc. cit.

9. "Lab Experiments: How to Piss and Pass," The Urine Nation News #7,
Jan. 1992 (available from Digit Press, PO Box 920066, Norcross GA 30092);
Robert Freeman, "How to Beat A Urine Test," High Times, August 1988.

10 John Morgan, "Marijuana Metabolism in the Context of Urine Testing for
Cannabinoid Metabolite," Journal of Psychoactive Drugs 20 (1): 107-15
(Jan-Mar 1988).

11 UrinAid, available from Byrd Labs: PO Box 1441, Topanga CA 90290.

12 Urine Nation News, loc. cit.; "Urine Trouble," Austin Chronicle, June
21, 1991.

13 A. Hoffman, Steal This Urine Test, Penguin Books, 1987.

14 Washington Post, "Signs of Drug Use in Fatal Air Crash," printed in
San Francisco Chronicle, March 12 1988.; R.B. Stone, testimony in Hearings
on lthe Airline and Rail Service Protection Act of 1987, Senate Committee
on Commerce, Science and Transportation, 100th Congress, Feb. 20 1987.

15. Associated Press, "Cocaine Called a Factor in Colorado Air Crash,"
San Francisco Chronicle, Feb. 2, 1989.

16. D. Gieringer, "Marijuana, Driving, and Accident Safety," Jopurnal of
Psychoactive Drugs 20 (1): 93-101 (Jan-Mar, 1988).

17 "Drug-Test Rules for Rail Workers Proposed by U.S.," Wall Street
Journal, May 6, 1988.

18 Federal Register Vol. 53 #224, Nov. 21, 1988, p. 47104.

19 A roadside survey of truckers found 14% urine positive on the job;
A.K. Lund et al, "Drug use by tractor-trailer drivers," Washington DC,
Insurance Institute for Highway Safety, 1987.

20 "Airlines Seek Cutback in Drug Testing," Wall Street Journal, May 12,
1992.

21 "By the Way," Reason, August/Sept. 1989, p. 14.

22 "The New Age Of Aquarius," Newsweek, Feb. 3, 1992"; "Binge Drinking
More Common On Campus," San Francisco Chronicle, June 5, 1992.

23 "California Prisoners and Parolees," California Department of
Corrections, 1989.

24 E. Cone and R. Johnson, "Contact highs and urinary cannabinoid
excretion after passive exposure to marijuana smoke," Clinical
Pharmacology and Therapeutics 40 (3): 247-56 (Sept. 1986).

25 David W. Fretthold, "Drug Testing Methods and Reliability," Journal
of Psychoactive Drugs, 22: 419-28 (Oct-Dec 1990).

26 ibid.

27 Peter Passell, "Less Marijuana, More Alcohol?" New York Times, June
17, 1992

28 Manufactured by Performance Factors, 980 Atlantic Ave #104, Alameda, CA
94501.

29 "Hairy Problems for New Drug Testing Method," Science, Sept. 7, 1990
p. 1099f.; The Forensic Drug Abuse Advisor, Vol. 2 # 10, Nov/Dec 1990

30 Dr. George Lundberg, "The Rush to Test Urine," Washington Post
Health, Dec 9, 1986; see also JAMA Dec. 5, 1986 p. 3003.

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