- A positive drug test indicates drug presence, but not necessarily drug impairment, so campaigns such as drug testing drivers, tend to conflate drug presence with drug impairment by ascribing much more to a positive drug test result than it is telling us. Association does not mean causation, while presence doesn’t necessarily mean under the influence or impairment.
- 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 paracodeine tablet for a headache they’d show positive for opiates.
- 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 through 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 spawned 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 warrant 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.