Dale Gieringer, Ph.D.,

A paper for the Drug Policy Foundation
Published in "Strategies for Change: New Directions in Drug Policy (1992)

Among the impositions on personal privacy introduced in the
Reagan-Bush era, few are more intrusive but less questioned than drug
urinalysis. Relatively unknown at the start of the eighties, urinalysis
has now become a condition for employment in over half of America's major
companies, as well as for insurance, child custody, security clearance, and
freedom from jail on probation or parole. While urinalysis has been
challenged by civil libertarians, courts have generally upheld it in the
face of strong public support. Opponents have objected that drug testing
is an unwarranted violation of privacy and a search without probable cause,
bu supporters have successfully countered that the supposed hazards of drug
abuse necessitate urine testing.

What is all too rarely challenged in this debate is the scientific
rationale of urinalysis as a means of detecting drug abuse in the first
place. The facts that urinalysis does not detect whether someone is
impaired or under the influence of drugs; rather it detects the presence
of non-psychoactive drug metabolites that may linger in the system days or
weeks after use. In this respect urinalysis differs from the familiar
alcohol breathalyzer and blood tests, which detect whether one is actually
under the influence (as it turns out, alcohol is unique in this regard:
for other drugs, there is no simple relation between impairment and
concentration in bodily fluids). Thus it is not only possible, but
entirely likely that someone whose urine tests positive for drugs is
altogether competent and unimpaired.

As it happens, urinalysis is particularly sensitive to marijuana, a
single use of which can register positive for as long as a week, long after
any effects have vanished; heavy users may register positive for as long as
4-6 weeks. Thus, urinalysis precludes even the most innocent, weekend
smoking of marijuana as "drug abuse." Ironically, urinalysis is
considerably more tolerant of harder drugs such as cocaine and heroin,
which generally wash out in 2-3 days at most. Other commonly used
psychoactive drugs, including nicotine, tranquilizers, and psychedelic
drugs such as LSD are generally not tested for.

Above all, urinalysis doesn't detect America's number one drug of
abuse, alcohol. Thus urinalysis in no way assures a drug-free workplace.
Instead, it encourages substitution of alcohol and other non-tested drugs
for marijuana, cocaine, opiates and amphetamine.

Drug urinalysis is therefore an inherently flawed technology. On
one hand, it arbitrarily treats even the most occasional marijuana users as
"drug abuse," despite the substantial evidence that moderate marijuana
use is harmless. On the other hand, it ignores flagrant alcoholism. The
upshot is that urinalysis disqualifies many productive, competent workers
who enjoy non-traditional drugs in their free time, while completely
ignoring the majority of drug abusers, who are alcoholics. All of this
raises obvious questions about the value of drug urinalylsis.

Morally, urinalysis can be compared to randomly searching workers'
homes and garbage cans and branding them alcohol abusers if empty liquor
bottles are found. Though it might seem that Americans would strenuously
object to such warrantless searches of their homes, polls have shown strong
public support for searching their bladder contents, especially in jobs
deemed safety-critical.

URINALYSIS: AN UNPROVEN TECHNOLOGY

Despite the public support for drug testing, urinalysis is a
remarkably unproven technology. Were urinalysis a life-saving new drug, it
would have had to undergo years of painstaking premarket testing in order
to meet FDA regulations, requiring it to be proven fully "safe and
effective" in rigorous, double-blind studies. Yet the fact is that
urinalysis has been imposed on millions of American workers involuntarily
without so much as a single scientifically controlled study to show that it
is a safe or effective means of promoting workplace safety. Moreover,
unlike drug consumers, urinalysis subjects receive no warning labels
informing them of what they are being tested for, nor of the risks,
accepted usage or implications of the tests.

A close inspection of the evidence for drug testing shows that it
rests largely on exaggerated, distorted and unfounded claims, as shown in
critical reviews in Scientific American and elsewhere. (1) For instance,
testing advocates have cited a Research Triangle Institute survey
purporting to show that the income loss due to marijuana use was some $26
billion; yet the same data showed no difference at all in income between
non-users and current users of marijuana or other drugs. Other,
non-peer-reviewed studies by employers have likewise been misinterpreted to
support urinalysis: for instance, a pair of studies at Utah Power and
Light Co. and Georgia Power Co. purporting to show that drug users pose a
high risk of accidents and absenteeism only looked at users who had
exhibited problem behavior on lthe job. Not surprisingly, this population
had worse than average work records. Nonetheless, Utah Power found thalt
drug users cost $215 less in health insurance benefits, while Georgia Power
found lower rates of absenteeism in workers who tested positive only for
marijuana!

Only a handful of published studies have compared the performance
of drug-positive workers with others, with similar, mixed results. A
one-year follow-up study of 180 new employeees at a Georgia hospital found
no relationship between drug screen results and subsequent job performance.
It concluded, "The data presently available do not support the thesis
that positive drug screening predicts poor job performance." (2)
Nonetheless, the U.S. government has recently ordered random testing of its
VA hospital employees.
The most extensive and widely cited research on workplace drug
testing comes from the U.S. Postal Service, which tracked the job
performance of new employees according to prior drug screen results. Test
results were not used in hiring decisions, but were evaluated to determine
their relation to job performance one year later. The first study, which
tracked the performance of 2533 postal workers in Boston, reported that
drug-positive workers had a statistically 50% higher rate of dismissals,
reprimands, injuries, accidents and absenteeism. (3) However, the authors
noted that this difference was "much less than previously estimated."
Looked at another way, the Boston data actually showed that the great
majority of drug-positive users were reliable: fully 86% of
marijuana-positive workers were discipline-free after one year, versus 91%
for non-users; 74% were accident-free, versus 81% for non-users; and 71%
were still on the job, versus 81% for non-users. Thus, on the average,
marijuana-positive workers were 90% as reliable as clean-urine ones.
Surprisingly, cocaine-positive workers fared even better, being over 95% as
reliable in most categories.

The Boston findings regarding accidents and injuries were
subsequently contradicted by a second, larger, study of 4,396 postal
workers nationwide, which found no relation at all between drug test
results and injuries or accidents. (4) The Boston accident findings had
previously been criticized on methodological grounds. The second Postal
Service study did find that those who tested positive for illicit drugs had
a 50% higher rate of absenteeism and dismissals. Yet once again, they
showed that drug-using workers were largely reliable: drug users had a
93.4% attendance record, versus 95.8% for others, and 85% of users kept
their jobs, versus 89.5% of non-users.

The Boston data were later analyzed in a cost-benefit study, which
found that drug screening would be marginally economical, to the tune of
about $162 per drug-positive worker rejected. (5) However, the authors
cautioned that these results were highly sensitive to variations in the
extent of drug use and cost of urine testing, and that there were likely to
be many situations where drug testing was not cost-effective. They
concluded that companies "should carefully weigh the costs and benefits"
in their particular industry. Had the authors examined the second Post
Service study, they would presumably have found even slimmer benefits from
urine testing, since there would have been no savings from accidents or
injuries. Furthermore, their analysis undoubtedly overstated the potential
value of drug urine testing, since they assumed that all drug-positive
workers would be screened out. In practice, however, drug-using workers
are apt to avoid detection, either by discontinuing use temporarily
beforehand or by other evasion techniques described below.

VICTIMS OF URINALYSIS

While the benefits of drug testing to employers appear dubious and
unproven, the costs to the workforce have scarcely been examined at all.
Nonetheless, it is clear that urinalysis imposes significant costs on
workers. To begin with, it forces millions of innocent employees to submit
to scrutiny of intimate bodily fluids in a way that many regard as
degrading and obnoxious. This is especially trying for the unfortunate
minority sufering "blushing kidneys," who are unable to produce urine on
demand. At least one urinalysis victim has even been hospitalized for
water poisoning after being required to drink three liters of water in
order to make her give urine. (6)

Urinalysis is especially burdensome and offensive to those
otherwise responsible, productive workers who do not abuse drugs on the job
but enjoy indulging them in their free time at home. Principal among these
are the nation's 20 or 30 million marijuana users, the great majority of
whom are occasional users. (7) Due to the oversensitivity of urine tests
to marijuana, pot smokers constitute the great majority of urinalysis
victims: up to 90% of drug-positive test results are for marijuana. (8)
Urinalysis forces these workers either to give up a valued pleasure, or to
risk losing employment, insurance, or other benefits and rights.

California NORML (National Organization for the Reform of Marijuana
Laws) is one of several organizations offering drug testing advice via a
telephone hotline, over which we have received scores of complaints from
victims of drug testing abuse. Included are truck drivers, airline
attendants, office workers, mechanics, nurses and other employees with
impeccable work records, who have lost long-held jobs on account of their
urine chemistry, often against the wishes of their own supervisors and
co-workers.

One urinalysis victim, Mike Beatty, says he lost $500,000 in Air
Force retirement benefits after discharged for using marijuana solely on
the evidence of one bad urine test. Beatty says that he used to smoke pot
regularly, but like most fellow servicemen gave it up when urine testing
was instituted. Nonetheless, he relates, he continued to socialize with
pot smokers, and had the misfortune of accidentally consuming a marijuana
brownie at a party shortly before a drug test. Beatty says that before his
discharge he was "humiliated" by Air Force personnel with sexual aspersions
and investigations into his wife's private sex life.

Another urinalysis victim named Don was fired from an ARCO truck
driving job after 19 years on the job. "It didn't even occur to me that I
had a problem." he said. "I thought they were looking for coke." Don,
who had an excellent work record and seniority, complains that ARCO never
explained the implications of its drug testing policy. After losing his
job and pension benefits, he was forced to sell his house and settlle for a
much lower-paying job. "You can count me as a victim of drug testing," he
says.

"Jim is outstanding at what he does," reads the employee
evaluation file of another urinalysis victim, a tractor trailer driver who
was fired under Department of Transportation drug testing regulations.
"Excellent safe driving awareness," "great initiative," "demonstrated
dedication and consistency," read other testimonials in Jim's file. Jim,
who admits t being a weekend marijuana smoker, was fired after five lyears
on the job despite having the highest possible job safety rating with his
company.
"My employer couldn't believe it," says another woman who was
fired from a job with a major retail store after failing a surprise drug
test. Like many other drug testing victims, the woman was tested after
being "promoted" to a higher position.

"Drug testing has destroyed my attitude towards my job and my
government," says another utility worker, who was forced into an "employee
assistance program" for a positive urine test. "They treat me like a drug
addict," he says, echoing the complaint of many pot smokers, "and they go
home and get drunk every night."

DEALING WITH DRUG TESTS

The most common question received on the California NORML hotline
is how to deal with a urine test for marijuana. The most obvious advice is
to abstain from suspect substances before the test. Many callers are
surprised to learn that occasional, weekend use typically washes out in as
few as 2-5 days. Most regular smokers commonly pass within a couple of
weeks, though very heavy use can be detected for as long as six weeks.
However, exceptions can occur. NORML has heard from callers who have
reported flunking as long as 10 days after a single, isolated use, while
other, regular smokers have been known to pass within hours of last use.
Such reports only emphasize the essential capriciousness and unreliability
of drug urinalysis.

For pot smokers facing drug tests on short notice, the simplest and
most effective advice is to drink large volumes of liquids immediately
before the test. The purpose of this is to dilute the concentration of
drug metabolites in the urine below the threshold of detection (usually 100
nanograms per milliliter for the commonly used EMIT test). Test subjects
are also advised to avoid giving urine that has accumulated in the bladder
overnight, since this tends to be high in metabolites.

Although reliable information on urinalysis evasion is hard to come
by, reports from underground investigators agree that urine dilution can be
quite effective. Most regular smokers are able to pass within a week or
two, and sometimes much sooner, though exceptions occur. (9) Dilution can
be boosted by taking diuretics, which stimulate urination; however, the
most effective of these are available only on prescription. A number of
diets and wash-out regimes have been proposed for persons who have several
days to prepare; however, none of these have been scientifically validated.
It is possible for laboratories to detect dilute urine by special tests
for specific gravity, creatanin content, etc.; however, such tests are
expensive and rarely used. On rare occasion, subjects are asked to take a
second test after submitting a sample that has been found to be too watery.
Of course, this gives them more time to clear up.

Becuase urine dilution is far from 100% reliable, especially for
regular users caught unawares, there is a natural demand for surer methods.
Many users experiment with oral "drug screens" that are rumored to avert
positive urine tests. Included are certain vitamins, vinegar, zinc
sulfate, and goldenseal root, as well as some overpriced special formulas
and herb teas sold on the underground market. Despite glowing testimonials
from some lucky users, these nostrums have no good scientific foundation
and have been found to be unreliable in underground investigations.

A more reliable, if ethically dubious, way to foil urine tests is
to furtively tamper with the sample. One popular trick is to adulterate
the sample with one of a number of household products that are known to
interfere with the common EMIT test so as to produce a false negative for
marijuana. (10) Popular adulterants include detergent, salt, bleach and
Drano crystals, which can be concealed under the fingernails. However,
such substances may be detectable by sight or smell by diligent lab
technicians. A more sophisticated, less easily detected adulterant is
currently sold on lthe underground market. (11) and has been proven to be
quite reliable at producing false negatives for marijuana (the manufacturer
was compelled to move operations when the Texas legislature passed a bill
outlawing sale of urine adulterants) (12)

Another, more cumbersome trick is to substitute clean urine for
one's own when delivering the sample. A surprising number of American
workers appear to have rigged themselves up with substitute urine samples
by methods elaborated in Abby Hoffman's book, "Steal This Urine Test."
(13) In order to discourage such cheating, many labs now measure the
temperature of each sample.

Another, surer safeguard against tampering is to require that
subjects be carefully observed during urination. However, aside from the
armed forces and criminal justice system, few testers resort to such
extreme measures. Most tests accordingly provide leeway for evasive
sleights of hand. One regrettable side-effect of drug testing is thus to
favor those more unscrupulous drug users who are willing to resort to
tampering and similar evasion techniques, whereas honest users must either
give up or face the risk of being fired. In a similar way, dishonesty is
favored on questionnaires asking about illicit drug use: those drug users
who are honest about their use are routinely turned down, with the result
that only dishonest users are hired.

PRE-EMPLOYMENT TESTS

In general, the common pre-employment urine screen is by far the
easiest kind of test to deal with, insofar as prospective employees need
only avoid incriminating substances for the time they are on the job
market. However, a surprising number of ignorant job applicants are
unaware that they should be prepared for urine tests in the first place.
Most pot smokers appear to have little problem abstaining for job tests,
given the low addictiveness of marijuana. Only rarely has California NORML
encountered long-term heavy users who complain of difficulty in giving up
pot for a while.

Nonetheless, pre-employment tests can still be a problem even for
moderate users if they happen to encounter a surprise job opportunity. In
addition, many companies require drug screens of employees when they are
promoted. As a result, many workers whose efforts have won them a
promotion end up being fired instead on account of bad urine chemistry.
Employees may also face urine tests unexpectedly when their company is sold
to new management. In such cases, the new owners may demand a sudden spot
urine check of the entire workforce, effectively purging it of anyone who
has had the bad luck to indulge a suspect substance too recently. Victims
of such abuses generally have no legal recourse against dismissal, and can
also expect to lose unemployment benefits.

NORML has heard from many otherwise blameless pot smokers who have
lost jobs thanks to drug testing. Few cases better illustrate the absurd
lengths to which urinalysis is carried than that of a newly "promoted"
radio programmer who found himself fired for a positive marijuana test.
The employee, who admitted to being a weekend pot smoker, had been working
for a San Francisco "60's golden oldies" FM station!

Many NORML callers complain of having been coerced into drug
testing programs they don't understand or approve of, with little
explanation of how the policy will be administered. "It was very
manipulative," recounts one woman concerning her employer's efforts to make
her sign a form consenting to urinalysis. "They told us of course we
wouldn't be randomly tested; we would only be tested on cause," she
relates, "But the form specifically stated we would agree to random
testing." Many employees receive no disclosure statements at all, leaving
them vulnerable to arbitrary decisions. Some workers complain of being
fired for a single bad test, after being given the impression that they
would be eligible for a rehabilitation program instead. Many employees
complain about being "singled out" for drug tests because they are
unpopular with their supervisor or manager. Others report being told by
their managers that they will be protected from urine tests because they
are valued employees. Some employees receive advance warning about
impending tests, giving them time to prepare; others are taken by surprise.

Because blood and urine samples are used for many other medical
tests, subjects do not necessarily know when they are being drug tested. A
Nevada mother told the NORML hotline that she had been unwittingly
blood-tested for marijuana in a maternity ward, in what she had been told
was a blood test for AIDS. She said her family was subsequently visited by
plainclothes police demanding that they refer their newborn to a hospital
ward for drug-addicted babies, or else give up custody. Another woman
relates giving a urine specimen for what she was told was a pre-employment
drug test, and losing the job when the employer inspected it to find out
that whe was pregnant instead!

(Continued)

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