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.
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.