Our sophisticated techy gadgets, gismos and latest ‘apps’ make life easier, simpler and quicker. Our technology driven society monitors, measures and controls almost every aspect of daily life. The Internet tracks our lifestyle, values and interests, bar codes scan our shopping habits, CCTV cameras our movement, GPS/mobile phones track our precise location – this mass of data provides greater surveillance, knowledge and certainty for a world with an insatiable appetite for the measurable, tangible and controllable.
But the real world is not so certain; it is blurred, complex and messy. The apparent ‘evidence’ and ‘facts’ we possess are more contested than we would like to acknowledge. The trend to simplify is both seductive and dangerous. In recent decades there has been a growing tendency to stifle debate on complex issues reducing issues to simple binary opposites such as ‘you are either for us or against us’.
In respect of drug taking this resulted in the bifurcation of drugs in which illicit drugs (such as heroin, cannabis and cocaine) were presented as dangerous, immoral and likely to lead to addiction, whereas licit drugs (such as caffeine, alcohol and tobacco) by comparison were not classed as drugs at all, the risks were minimised and use was normalised. Despite the mounting evidence concerning the dangers of licit drugs and the relative safety by comparison of some illicit drugs the over simplistic binary approach continues to dominate law, policy and practice. People that use licit drugs still take offence at being considered a ‘drug user’, if they develop physical, social and psychological problems with licit drugs are never referred to as ‘addicts’, junkies or problem drug users. More people are killed directly by tobacco and alcohol than all the other illegal drug deaths combined, but it’s illicit drugs that will not be tolerated and drug testing is a key weapon to encourage and enforce (illicit) drug free lives.
The Appeal of the Drug Test
Legal and illegal drugs can for a small proportion of people result in major health and social problems – in extreme cases with devastating and fatal consequences. It is understandable that a concern to prevent such tragedies has resulted in a growing interest in drug testing. The technology appears to offer some tempting evidence and insight. Numerous companies sell a wide range of equipment to test saliva, hair, perspiration, blood and urine for a variety of drugs. Drug testing has long history of use with the substitute prescribing initially to ensure that people issued with a clean legal supply have actually used illicit drugs and some regimes using on-going drug tests for confirmation and confrontation within the ‘treatment’ process.
More recently drug-testing technology has been incorporated in Drug Courts and positive tests invariably lead to warnings, breach and sometimes prison. Drug testing has become popular with some employers – a positive result may lead to suspension or termination from employment. Some countries (like USA and New Zealand) drug test welfare benefit claimants and stop payments if the person continues to test positive for illegal drugs. In some countries like Sweden drug testing is used in schools and colleges, in the USA parent groups advocate randomly drug-test their children – there appears to be an endless range of circumstance when a drug test may ‘apparently’ prove useful.
When faced with a complicated situation of determining and responding appropriately to drug misuse a positive drug test appears to offer conclusive proof – clear evidence upon which straight talking and tough sanctions can be imposed. This measurable and quantifiable certainly appeals at this time of ‘punitive populism’ when binary simplistic approaches dominate, sadly it can also undermine any attempt to engage effectively with the complexity of the issue.
What Does a Positive Drug Test Actually Tell Us?
A positive drug test provides an illusion of clear evidence, fact and truth. The illusion occurs because the results of the test are contested. First, the test could produce a ‘false’ positive, or for that matter a ‘false’ negative. Errors and misreading’s can be caused by human error in the testing process, or by faulty testing equipment. While this is rare, there really should be no room for error given that the outcome could result in loss of liberty, loss of employment, damage to personal relationships and considerable repercussions in later life. Secondly, the result may not be a ‘misreading’ but misleading – the person may accurately show positive for an illicit drug, but it might be a drug which was consumed as a herbal supplement or medication, for example, a person who takes a paracodeine tablet for a headache would test positive for opiates. It would then be misleading to assume the person was ‘back on heroin’ even though they tested positive. Thirdly, relying upon the apparent ‘truth’ of a drug test can be flawed because negative test results may be achieved via kits readily available from the Internet that mask the presence of the illicit drugs. So a positive or negative drug test isn’t necessarily a definitive outcome, it could be a contested and/or misleading outcome.
However, it could be argued that in most cases they provide useful and accurate information. Well let us assume that the test is accurate – what does it actually tell the parent, teacher, employer, court or drug worker? Imagine you had a drink problem and at a later date you test positive for the drug alcohol, what does it indicate – it doesn’t tell us how you took the drug (it could have been a sherry trifle), where you took the drug, why you took the drug, when you took the drug or who you took the drug with. Most important, a positive drug test would give no real insight as to whether or not you have an alcohol problem. Drug use is not indicative of drug misuse.
These contextual details are much more important than the apparent ‘factual’ detail of the presence of a drug in your body. The drug testing technology is only able to provide scientific (but contested) ‘evidence’ that a person is (or is not) drug free. This information risks decontextualize and over-simplifying the issue of illicit drugs to a binary measure of: you are either drug free or a drug addict; you are either telling the truth or you are lying; you are either co-operating or being deviant, you either want help or you don’t want help. It gives those in power and authority confidence to impose sanctions and punishments upon the ‘outsider’ or ‘deviant’ based upon what masquerades as indisputable evidence. This approach is not only flawed, it has a number of adverse and unintended consequences.
Adverse and Unintended Consequences of Drug Testing:
- Drug testing draws attention to the substance use rather the person’s context, needs and circumstances. Most people with a drug problem have suffered damaging personal and social circumstances before drugs became an issue, and need considerable help. A pre-occupation with the presence of the drug, risks side-stepping the real underlying issues, which if not addressed, will almost certainly lead to relapse.
- An elevated importance to drug testing from key stakeholders can result in a paradigm shift in which abstinence becomes the measure for success. Harm reduction may get lost in the process, and the messy and difficult business of rehabilitation and reintegration is reduced to a simple celebration that the person is drug free.
- Currently around 30-70% of young people in most countries have used illicit drugs and most manage to avoid: a criminal record; a drug problem; harm to themselves or others. Widespread random drug testing risks net widening and capturing non-problematic drug users who then risk attracting labels as deviant or addicts which would pose serious damage to future life opportunities and relationships.
- Resources for public services are limited and money that could be used to tackle problematic drug use is wasted on expensive drug testing for people who don’t use drugs, or those who use drugs in a non-problematic manner.
- Random drug testing of pupils, students and children is misguided, cultural behaviour change is not achieved through policing, confronting and punishing, but through through reliable information, education and dialogue.
- The most widely used illicit drug – cannabis – is less harmful than the permissible legal drugs alcohol and tobacco, it is therefore ethically problematic, irrational and hypocritical to drug test for cannabis and not for alcohol and tobacco.
- Drug testing regimes with sanctions, such as random drug tests in colleges to exclude students who test positive), create a ‘cat and mouse’ game in which an adversarial relationship is established, both sides then seek to out-smart the other with new technology or deceptive techniques. The winners in this game are the drug testing businesses and underground laboratories; the losers are honesty, trust and communication.
- Tougher and more pervasive drug testing regimes to stamp out illicit drug use help spawn the proliferation of new synthetic designer ‘legal’ highs which avoid detection. Once the new drugs have been detected and outlawed the drug testing ‘net’ widens, new legal highs are developed and the spiral continues. These legal highs may be considerably more dangerous than commonly used illicit drugs.
- Some drugs like cannabis can stay in the body for over four weeks whereas drugs like cocaine can be out of the body within 48 hours. Random drug testing regimes (such as those in prisons) may inadvertently pressurise some people to switch from the less harmful cannabis to the more dangerous heroin or cocaine.
- Drug testing concentrates attention towards illegal drugs and unhelpfully firms up the misguided bifurcation between licit and illicit substances. It is not the use of all illicit drugs that warrants serious attention but it is the misuse of all drugs that warrants specific attention.
- A drug test may reduce the risk of people who are intoxicated from using machinery or flying a plane, however, testing positive for a drug doesn’t necessarily mean that the person is intoxicated or impaired – for example cannabis can be detected a month after not using.
While drug testing seems to offers seductive simplicity, the shortfalls, ambiguities and misuse of drug testing technology has arguably greater potential to mislead and distort rather than to inform. The future of drug prevention and drug treatment lie not with monitoring, coercion and punishments, but with listening, engaging and caring – drug testing sits firmly with the former and not with the latter. Drug checking by contrast is an important harm reduction strategy to check the contents of unknown substances to protect people from overdose or poisoning. Testing pills is quite different to drug testing people, one is vital and the other is a counter productive waste of money.
- This blog is based on a PowerPoint presentation which can be accessed here