End the Medical School Drug Test

Before the 1980s, drug testing was uncommon. It was widely viewed as an invasion of privacy and an infringement on fourth amendment rights1. Today, a medical student is likely to be drug tested before entering medical school, before clinical rotations, and/or before residency. If preventing drug use among medical students is the goal of these tests, they have failed miserably. Urinalysis drug tests are ineffective. But more importantly, they are immoral.

 

Drug tests are ineffective for two reasons. First, they basically just test for marijuana. A 10 panel urinalysis technically tests for 10 different drugs, but marijuana is one of the only drugs that can be detected for more than 30 days. Cocaine can be detected for 4 days. Amphetamine, methamphetamine, ecstasy, heroin, and codeine all can be detected in urine for only 2 days2. This means that a user of drugs far more dangerous than marijuana needs to abstain for just a couple of days. Psilocybin mushrooms, as well as several other mind-altering drugs, are not tested for at all.

 

For a marijuana user, a drug test might seem like a nightmare. But here we arrive at the second reason why drug tests are ineffective, they are easily beaten. A marijuana user may choose to drink a lot of water before his drug test to dilute his urine. Alternatively, he may choose to use a friend’s urine who he knows does not use marijuana. Either one of these options might work. But fortunately for such a marijuana user, there is another option that is essentially risk free, synthetic urine. There are several companies that make synthetic urine capable of beating drug tests. The word on the internet is that QuickFix is a safe bet. I personally know some people who would agree. At just $30 for a bottle, it looks like the drug test is no match for the free market.

 

Do not just take my word for it though. In 2003, the University of Michigan conducted a study on the effectiveness of drug testing students. From nearly 900 schools, the study found that drug testing, whether routine, random, or based on suspicion, had no measurable effect on drug use among students3. Put simply, drug testing accomplishes nothing.

 

The most important concern I have about drug testing medical students is a moral one. Regardless of their effectiveness, or ineffectiveness, the endgame of drug testing is to prevent drug users from becoming doctors. Users, not addicts; and there is a big difference. A marijuana user might use on weekends or at night to relax, much like an alcohol user. A marijuana addict, although rare, is the type of person who might show up to important occasions intoxicated. The statistics on marijuana addiction vary. They usually show that less than 10% of users become addicts, but they always show that alcohol users have higher rates of addiction4. A urinalysis detects alcohol for no more than 12 hours after use2. This means that medical students who use alcohol are more likely to be addicted, and they face basically no risk of failing a drug test.

Should we be worried about medical students being drunk in clinical settings? Of course. And we should also be worried about medical students being high in clinical settings. Intoxication could be disastrous and it needs to be prevented. The good news is that this is done naturally. It is highly unlikely to find medical students who are addicts of marijuana, alcohol, or any mind-altering drug. I believe it is safe to say that the rigor of medical school itself prevents drug addicts from becoming doctors. There are, however, drug users who will make it into medical school or other rigorous scientific careers. Actually, many of them thrive. Richard Feynman, Kary Mullis, and Francis Crick used marijuana and LSD, Carl Sagan used marijuana5, and Oliver Sacks used several illicit drugs6. When drug tests are required for every medical student, the casual drug user, no matter how much potential he has, is bullied for no reason. The potentially dangerous drug addict has already been weeded out long ago.

 

Medical school is supposed to be based on science. The science shows that drug testing does not work. If it did work, then many great scientists would have been removed from their professions. These facts alone should be enough to settle the issue, but it is important to look at two more moral objections we should all have.

 

First, drug tests are not free. Before entering medical school, I paid about $30 for one. This does not sound like much. But charging students even one penny is unacceptable, for there is not even a fraction of a penny in benefit from these tests. The nearest drug testing facility for me was a 20 minute drive from my house. I could have driven anywhere for 20 minutes and just handed $30 to any random person. Surely, that $30 would bring more value to society than $30 wasted on a drug test. Imagine if a police officer searched a person’s car for drugs against his will, found none, and then charged this person $30. That is the reality of drug testing.

 

Second, drug tests are an invasion of privacy. Medical students should not be forced to prove their innocence. This creates a guilty until proven innocent environment. It immediately creates resentment among students, and rightfully so. Furthermore, what about people with paruresis? The International Paruresis Association estimates that 7% of people suffer from this condition, also known as shy bladder. Type “paruresis drug test” into a search engine and spend some time reading through the horror stories that are shared. These people suffer from a medical condition, and of all places, their medical school is completely inconsiderate!

 

Drug testing is a moral and scientific failure. Medical schools should be too embarrassed to take part in such nonsense.

 

References

1. Organization for the Reform of Marijuana Laws. (n.d.). Historical Legal Basis for Drug Testing. NORML. Retrieved February 28, 2014, from http://norml.org/legal/drug-testing/item/historical-legal-basis-for-drug-testing

2. Drug of Abuse Reference Guide. (n.d.). LabCorp. Retrieved March 2, 2014, from https://www.labcorp.com/wps/portal/!ut/p/c1/04_SB8K8xLLM9MSSzPy8xBz9CP0os_hACzO_QCM_IwMLo1ALAyNj1yBnQxNfA4MAI30_j_zcVP2CbEdFAFDtPnI!/dl2/d1/L2dQX3cvSURqQUFBaUlpSWlJaUEhIS80Qms0WXVHYmhoNFplR1BobjRZQkdRUmlFWmhHRVEhIS82X1E4Nk5RMk4yMDgyVTgwMjNFUkMxNE0wMFAyLzZ

3. Yamaguchi, R., Johnston, L., & O’Malley, P. (2003). Drug Testing in Schools: Policies, Practices, and Association With Student Drug Use. Youth, Education, and Society, 2. Retrieved March 2, 2014, from http://www.drugpolicy.org/docUploads/Johnston_sdt_study.pdf

4. National Academy of Sciences, Institute of Medicine. 1999. Marijuana and Medicine: Assessing the Science Base. p. 95, Table 3.4: Prevalence of Drug Use and Dependence in the General Population

5. 10 Scientific and Technological Visionaries Who Experimented With Drugs. (n.d.). io9. Retrieved February 28, 2014, from http://io9.com/5876304/10-scientific-and-technological-visionaries-who-experimented-with-drugs

6. Sacks, O. W. (2012). Hallucinations. New York: Alfred A. Knopf.

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2 thoughts on “End the Medical School Drug Test

  1. This is a topic that deserves more attention by each and every doctor and medical student because before long it is going to get a lot worse. Although drug testing in and of itself is a questionable practice the more urgent question is who will be in charge of such drug testing, what safeguards will be put in place for quality assurance, and what will be the consequences of a positive test? (Cutoff-levels, MRO review, what drugs will be tested for, lab certification, split-specimen, and what type of treatment and followup will be approved). There is a wide spectrum regarding quality control and it is primarily a function of the power differential between those ordering the testing and the person being tested. Those with unions or other organizations who have the best interests of the group being tested have strict guidelines and most follow the SAMHSA/DOT protocol while probationers, the criminal justice system, and monitoring programs associated with regulatory agencies have essentially no guidelines and follow their own rules. Unfortunately certain groups who have gained sway in addiction medicine are claiming that the system they are using called contingency management with frequent drug and alcohol testing using biomarkers they introduced that have very poor specificity with a large amount of innocent positives, and leverage management with “swift and certain consequences” for a single positive test (which includes a referral to one of the facilities they run (no exceptions) for “assessment” is the new paradigm, gold standard, and a replicable model of addiction management. This group is not recognized by the ABMS but they are currently working on it. In addition they have taken over the professional health programs in 46 States and removed dissenters who disagreed with the groupthink. This group has introduced a number of tests as “Laboratory Developed Tests” that bypass FDA approval. The LDT route was introduced so that labs could develop tests that would be utilized in that lab and interpreted by a physician. (i.e. they were designed for the greater good so tests could be used without going through the expensive FDA approval process. There is no regulation other than CAP and it is basically an honor system concerning internal standards. In vivo testing is not required and you do not even have to show that the test is even testing for what it is purported to test! This loophole was noticed by certain unscrupulous individuals who introduced several alcohol biomarkers as forensic tests, then testing them on the group they were monitoring (without informed consent), publishing poorly designed non-randomized non-blinded “studies” in front-group biased journals, and claiming these opinion puff pieces supported the validity of the tests.. The first one was introduced with the only evidence base being 14 psychiatric patients in Europe. As the FDA is not involved the lab can claim anything it wants regarding specificity and sensitivity and that is just what they did. Regulatory Agencies tend to take expert opinion at face value. By using propaganda and misinformation to create “moral panic,” presenting themselves as “experts” and then resourcing regulatory agencies, EAPs, and other organizations that accredit/license or otherwise empower a group of people and have the ability to remove that power. Outreach propaganda campaigns have been set up targeting various regulatory agencies, law enforcement organizations, school administrators, etc. designed to get them to see addiction through their lens and convincing these agencies that there is a huge hidden cadre of addicted employees, students, etc that is causing harm and that this model will help them in identifying and getting the addict help while saving money or improving service. They are then forced into a contract of frequent drug and alcohol testing. The person is essentially coerced into a contract with indoctrination into the groupthink, complete abstinence including alcohol, and frequent testing followed by “swift and certain consequences.” The regulatory bodies are used as “leverage” to enable them to coerce and control the monitored into doing anything and everything they say under threat of loss of licensure. This same group has convinced a the national organization that oversees one profession to accept the proposition that evaluations must be done by “approved facilities” that are all under their purview and out of state, not to question their diagnosis as it “undermines professionalism,” and that there are 3 levels of “relapse” including “relapse without use” and “potential impairment” enabling them to send someone for an assessment based on anything including complaining or even questioning their practices. As a result, few people monitored by this group speak up for fear of consequences. And this is what allows them to brandish the model as a new paradigm as those within remain silent while those without are unaware or in disbelief and this same group is behind the move to drug test all doctors and this will include the long term biomarkers for alcohol. Probable cause or incident based drug testing is one thing but using long-term biomarkers and other drug tests (such as hair or nail testing) to look for substances that may have been used months or even years before would remove a substantial number of bright and talented individuals from our profession. And if they are in charge of drug testing physicians should that come to fruition it will be a dark age for medicine. This is a group that represents profit and prohibition, coercion and control, and irrational and illegitimate power. A self-certification group brandishing themselves as experts in the field of addiction with no accountability, transparency, or regulation are poised to damage all fields of medicine.

  2. See comments section of Dr. Boyd’s blog for an eye opening glimpse into the PHP dystopia. This is who is behind the moral panic of a hidden cadre of drug addled doctors and medical students necessitating frequent testing and the push of this model to other EAPs. http://www.jwesleyboyd.com/?p=280
    Take a look at the Physician Impairment model guidelines at the FSMB. It is incomprehensible that they were bamboozled into accepting “potentially impairing illness” and “relapse without use” as a medically acceptable diagnosis and give the PHPs both autonomy and approval rights for assessment centers. It is a sham.

    This model has been applied in 46 States. They just regrouped and gained more opacity and power while avoiding regulation and accountability.http://medicalwhistleblowernetwork.jigsy.com/george-talbott-s-abuse-of-leon-masters
    This is part of the propaganda campaign
    http://www.usatoday.com/story/news/nation/2014/04/15/doctors-addicted-drugs-health-care-diversion/7588401/
    This is who is behind it
    http://www.likemindeddocs.com/members.html

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