The Wider Social Context
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 or quantifiable; 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 social problems is both seductive and dangerous. In recent decades there has been a growing tendency to stifle debate on complex issues to reduce discussion to simple binary opposites, such as, ‘you are either for us, or against us’.
In respect of recreational drug use, this resulted in a crude unscientific bifurcation, in which unapproved substances (such as LSD, heroin, cannabis and cocaine) are presented as dangerous, immoral and likely to lead to addiction, whereas approved and promoted substances (such as caffeine, alcohol and tobacco) risks are minimised and use is normalised, indeed rarely are they even considered as ‘drugs’. Despite the mounting evidence concerning the risks posed by these state approved and promoted drugs, alongside the relative safety, by comparison, of some illicit drugs, the over-simplistic misinformed binary approach dominates law, policy and practice.
People who regularly enjoy state approved drugs take offence at being considered a ‘drug user’. If they develop physical, social and psychological problems with legal drugs are never referred to as ‘addicts’, junkies or problem drug users. Despite the fact that more people are killed by tobacco and alcohol than all the other illegal drug deaths combined, it is illicit drugs that will not be tolerated and drug testing is a key weapon to deter and eradicate the use of unapproved drugs.
The Appeal of the Drug Test
Legal and illegal drugs can for a small proportion of people result in serious health and social problems – in rare cases with devastating and fatal consequences. It is understandable that a concern to prevent such tragedies creates an interest in a possible role for drug testing. The technology appears to offer some tempting evidence and insight. There are a growing number of companies selling a wide range of equipment to test saliva, hair, perspiration, blood and urine for a variety of drugs. It’s a burgeoning industry with strong connections with law enforcement, often managed by ex-police officers.
Drug testing has long history of use with the substitute prescribing, initially used for safety reasons to ensure that people issued with a clean legal supply of opioids had actually been using opiates. However, some prescribing regimes continue to use drug testing on its long term patients, as a punitive tool to impose sanctions for any on-going use of illicit street drugs.
More recently drug-testing technology has been incorporated as a central tenet of Drug Courts and positive tests invariably lead to warnings, breach and sometimes short periods of imprisonment. 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-testing 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 certainty of a drug test, in an era dominated by ‘punitive populism’ and simplistic approaches must have appeal, but sadly it can also undermine any attempt to engage effectively with the complexity of the issue, indeed it can do more harm than good.
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 not 100% reliable and can be 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 not usual, 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 it could be 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 severe 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 fairly accurate information. Well let us assume that the test is indeed 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. It is important to be absolutely clear drug use is not indicative of drug misuse, and a positive result will not indicate why or in what circumstances the drug was ingested.
These contextual details are much more important than the apparent ‘factual’ detail of the presence of a drug in your body. At best drug testing technology is only able to provide contested ‘evidence’ that a person is (or is not) free from a particular drug. This crude indicator risks decontextualize and over-simplifying the issue of illicit drug use. Thinking can easily drifts into 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.
Armed with a ‘hard copy’ evidence of a positive drug test 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 deeply flawed, it can also have a number of serious adverse and unintended consequences.
17 Negative Consequences of Drug Testing:
- Drug testing identifies substance ‘use’ rather than any substance disorder/problem. This misguidedly widens the net of concern, which should be directed towards the person with a drug problem not towards the recreational user.
- Most people with a chronic drug problem have endured damaging personal and social circumstances before drugs became an issue and need considerable help and support in life, more generally. Drug testing can lead to a pre-occupation on drug presence, and this narrow focus risks overlooking the real underlying issues, which if not addressed, will almost certainly lead to drug problem relapse.
- Women drug users with child care responsibilities are often forced to undertake regular or even daily drug tests to prove they are ‘drug’ free, this disproportionately focuses attention on drug presence rather than fitness to parent. Regular positive drug tests are then used wrongly as evidence as to why the child should be ‘looked after’ by the state. Any assessment of a mothers parental capability to care for her child should never be reduced to a drug test.
- A pre-occupation with drug testing by key stakeholders can result in a paradigm shift in which abstinence and so-called ‘clean’ drug tests become the desired measure of any successful outcome. Not only does harm reduction get marginalised in the process, but the messy and challenging process of rehabilitation and social reintegration may be forgotten in the satisfaction that the person appears to be drug free.
- Around 30-70% of young people in most western countries have used illicit drugs and the vast majority manage to avoid: a criminal record; a drug problem; harm to themselves or harm to others. Widespread random drug testing in schools, at the roadside, in employment, on benefit claimants etc., will only waste resources and result in capturing mainly non-problematic drug users who then risk being ascribed damaging labels as ‘deviant’ or ‘addicts’ that will pose serious damage to future life opportunities (education, employment, travel, insurance, housing etc) and in relationships.
- Resources for public and voluntary services are limited and money that could be used to deliver much needed harm reduction services is wasted on expensive drug testing for people who don’t use drugs, or those who use drugs in a non-problematic recreational manner.
- Random drug testing of pupils, students and children often accompanied by police and sniffer dogs as a health promotion strategy is misguided. Cultural behavioural change is not achieved through policing, confronting and punishing, but it is facilitating by meaningful, culturally relevant, reliable information exchange, harm reduction education, relationships and peer dialogue.
- The most widely used illicit drug (cannabis) is much less harmful than the promoted legal drugs alcohol and tobacco, it is therefore, untenable or indeed hypocritical to pursue drug testing and punish cannabis use and not drug test and punish alcohol and tobacco use.
- Drug testing regimes with sanctions, such as random drug tests in schools 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; but the losers are honesty, trust and communication.
- Tougher drug testing regimes to stamp out illicit drug use, such as drug testing in employment, have spawn the proliferation of new synthetic designer ‘legal’ highs to avoid detection (such as Spice). However, once these new drugs have been detected and subsequently outlawed the drug testing ‘net’ widens, then new legal highs are further developed and the never ending spiral continues. These ‘legal highs’ may be considerably more dangerous than commonly used illicit drugs.
- Some drugs such as 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) have inadvertently pressurised people to switch from the less harmful cannabis to the more dangerous heroin, spice or cocaine.
- Drug testing concentrates attention towards illegal drug use and unhelpfully firms up the misguided bifurcation between licit and illicit substances. It is not the use of any illicit drug that warrants attention but rather the misuse of any drug legal and illegal that should warrants attention. The legally promoted drugs (alcohol, caffeine, tobacco and sugar) can pose serious risks, sometimes greater than their illegal counterparts.
- A positive drug test may reduce the risk of people who are intoxicated from using machinery, driving a car 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, so a positive drug test could result in misguided concern, and unfair dismissals.
- Some maintenance opioid substitute prescribing regimes rooted in harm reduction engage in regular drug testing, but as a consequence of a positive drug test for illicit drug use some automatically suspend or even terminate prescribing. The use of drug testing in this manner transforms what was a low threshold harm reduction prescribing philosophy into a punitive abstinence only regime.
- A positive drug test indicates drug presence but not necessarily drug impairment, but as in the case of drug driving government campaigns are often conflating drug presence with drug impairment, ascribing much more to drug testing than it is telling us. Association does not mean causation.
- A positive drug test may be incorrect due to a small percentage of ‘false positives’ caused by equipment failure or human error, and conversely ‘false negative’ can occur.
- An accurate positive drug test still maybe misleading. It is assumed that the person has taken illicit drugs when those drugs may have been ingested legally. For example, consuming poppy seeds in bread can lead to a positive drug test for opiates, or if the person took a para-codeine tablet for a headache they’d show positive for opiates.
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 conference paper, the PowerPoint presentation which can be accessed here