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Former head of NIDA and the American Society of Addiction Medicine advocates widespread drug testing

The former head of NIDA and the American Society of Addiction Medicine thinks we should be randomly drug testing just about everybody. Read the details in my commentary below. You can read the entire 107-page ASAM/Dupont white paper online

Random Drug Testing for All? The Chilling Proposal That Could Eradicate Your Privacy

By Paul Armentano
March 11, 2014  |  

The practice of random drug testing has become popularized in both the workplace and in public schools. But according to a recently released paper by the American Society of Addiction Medicine (ASAM), the controversial practice is, at present, “underutilized” and ought to be expanded to include people of all ages in virtually all aspects of daily life.
The white paper, authored by former United States National Institute on Drug Abuse Director (and present-day drug testing consultant and profiteer) Robert Dupont (along with input from staffers at various drug testing labs and corporations) argues: “The major need today is the wider and smarter use of the currently available drug testing technologies and practices. … This White Paper encourages wider and ‘smarter’ use of drug testing within the practice of medicine and, beyond that, broadly within American society. Smarter drug testing means increased use of random testing rather than the more common scheduled testing, and it means testing not only urine but also other matrices such as blood, oral fluid (saliva), hair, nails, sweat and breath.”
ASAM’s paper calls for the expanded use of random drug screening among patients undergoing palliative care as well as those seeking emergency medical treatment, psychiatric treatment or obstetric care. Adolescent patients, as well as geriatric patients – “The geriatric population has been the target of drug dealers, who may even take them to medical appointments and then trade prescriptions for cash,” it alleges – also ought to be targeted for increased drug test monitoring. “Drug testing (in clinical settings) needs to become as common in medical practice as clinical diagnostic testing is in the management of hypertension and diabetes,” Dupont writes. (This outcome seems unlikely since most testing in clinical settings would arguably need to be voluntary. To date, the Supreme Court has only upheld mandatory random drug screening to apply to certain safety-sensitive public employees and/or public school students engaged in athletics or other extra-curricular activities.)
Predictably, the paper argues for expanded drug testing practices in both the workplace and in public schools even though the supposed benefits of such programs have never been established in either forum and have been associated with adverse effects, such as the increased use of so-called ‘hard’ drugs, in school settings. It also calls for greater drug testing of motorists suspected to be under the influence of drugs. (Dupont has previously called for the imposition of zero tolerant per se laws, which mandate that the act of driving with any detectable level of a controlled substance or its inactive metabolite present in one’s body is a criminal act, despite acknowledging that there exists no evidence demonstrating that such laws reduce incidences of drugged driving behavior.) The paper also suggests more parents engage in the random drug testing of their children – a practice that is not recommended by the American Academy of Pediatrics since such home tests have not been demonstrated to be accurate or efficacious, and “may be perceived by adolescents as an unwarranted invasion of privacy.”
Of course, similar criticisms can be (and have been) lobbied at the practice of warrantless drug testing in general. To date, federal guidelines only exist overseeing the practice of urinalysis (and only in cases in which public employees are among those tested), a biological matrix that solely detects the presence of inert drug metabolites (non-psychoactive by-products that linger in the body’s blood and urine well after a substance’s mood-altering effects have subsided), not the actual drugs themselves. (This why the US Department of Justice acknowledges : “A positive test result, even when confirmed, only indicates that a particular substance is present in the test subject’s body tissue. It does not indicate abuse or addiction; recency, frequency, or amount of use; or impairment.”) Other proposed alternative matrices for drug detection – such as breath, saliva, hair, and sweat – are not standardized nor are they subject to any type of federal regulations.
Further, even urine tests – when the results are confirmed and federal guidelines are followed – may be subject to false positive results and human error. According to a 2012 report published by the National Workrights Institute, “[Government] certified drug testing laboratories have significant reliability problems and that the government’s assurances that false positive test results are a thing of the past is untrue.” It adds, federal regulations “allow labs to make mistakes on ten percent of the blind samples used in the certification process.”
Finally, in the case of cannabis detection, both urine and blood testing are especially problematic – and discriminatory – since both THC and its primary metabolite, carboxy-THC, are lipid soluble and may be linger in the body in more regular consumers for days (in the case of THC in blood) or even weeks or months (in the case of carboxy THC in urine) after a person has ceased using pot. This is not the case with most other commonly screened for controlled substances, which are often water soluble and therefore undetectable some 24 hours (or sooner) or so after ingestion.
Nonetheless, ASAM concludes, “(Our) principal goal in drug testing is for today’s impressive drug testing technology to be far more widely used.” If and when that day comes, expect Dupont – whose website brags, “(Our) years of experience can help your organization to implement and maintain a viable drug testing program.” – and many of the other drug testing industry insiders affiliated with the American Society of Addiction Medicine to benefit while the rest of us pay the price.



Non-Tokers Just as Likely to be Involved In Workplace Accidents as Marijuana Smokers

Proponents of workplace drug testing policies for pot have long alleged that random testing improves workplace safety. But do they? A newly published case-control study published online ahead of print in the Journal of Addictive Diseases says "no."

The study, authored by the Medical Director of St. Mary’s Occupational Medicine Clinic in Evansville, Indiana assessed whether there exists a statistical association between marijuana use, as defined by the identification of the inert carboxy THC metabolite in urine, and an elevated risk of work-related accidents. The author compared the prevalence of marijuana-positive tests among employees involved in workplace accidents to a random sampling of employees not involved in workplace mishaps. Drug tests were analyzed and compared from employees who worked in variety of industries located throughout Indiana, Kentucky, Missouri, Ohio and Pennsylvania.
The study determined that marijuana-positive test results were not correlated with any greater frequency of workplace accidents.
“This study fell short of finding an association between marijuana use and involvement of workplace accidents.” The author added, although “this study cannot be taken as definitive evidence of absence of an association between marijuana and work related accidents, … the findings are compelling.”
The findings were also predictable. A 2010 review of 20 years of published literature pertaining to cannabis, drug testing, and workplace performance similarly concluded, “[I]t is not clear that heavy cannabis users represent a meaningful job safety risk unless using before work or on the job; urine tests have poor validity and low sensitivity to detect employees who represent a safety risk; … [and] urinalysis has not been shown to have a meaningful impact on job injury/accident rates.”
This is largely because standard workplace drug tests are urine tests. Conventional urinalysis -- even when the results are confirmed -- only detects the presence of inert drug metabolites, non-psychoactive by-products that linger in the body’s blood and urine well after a substance’s mood-altering effects have subsided. That is why the US Department of Justice acknowledges: “A positive test result, even when confirmed, only indicates that a particular substance is present in the test subject’s body tissue. It does not indicate abuse or addiction; recency, frequency, or amount of use; or impairment.”
A positive test result for carboxy THC, marijuana’s primary metabolite, provides little if any substantive information to employers. That is because carboxy THC, unlike most other drug metabolites, is fat-soluble and may remain detectable in urine for days, weeks or, in some rare cases, months after a person has ceased using cannabis. Most other common drug metabolites are water soluble and therefore undetectable some 24 hours or so after ingestion.
In short, a positive test result for carboxy THC does not provide any definitive information regarding an employee’s frequency of cannabis use, when he or she last consumed it, or whether he or she may have been under its influence at the time the drug screening was administered. Further, such tests discriminate against pot consumers -- who are more likely to be detected by the nature of test itself, yet pose no demonstrable workplace safety risk compared to non-tokers. As more states move forward with amending marijuana laws, employers should follow suit by, at a minimum, revisiting their existing workplace drug testing policies for pot or, preferably, repealing them altogether.

Link to full article:

THC Detectable In Breath For Limited Periods Of Time

Baltimore, MD: The psychoactive cannabinoid THC may be present in the breath of subjects who recently inhaled marijuana, according to clinical trial data published online in the journal Clinical Chemistry.

Investigators at the National Institutes of Health in Baltimore, Maryland and the Karolinska University Hospital in Stockholm, Sweden analyzed the exhaled breath of occasional and habitual marijuana consumers shortly after subjects inhaled a standardized cannabis cigarette of 6.8 percent THC. Researchers sought to identify whether THC, its primary metabolite THC-COOH, or cannabinol (CBN), a non-psychoactive cannabinoid, were present in breath at detectable levels following smoking.

Researchers reported identifying the presence of THC in both occasional and in regular consumers for limited periods of time following subjects' inhalation of marijuana. Authors concluded: "Among chronic smokers (n = 13), all breath samples were positive for THC at 0.89 hours, 76.9 percent at 1.38 hours, and 53.8 percent at 2.38 hours, and only one sample was positive at 4.2 hours after smoking. Among occasional smokers (n = 11), 90.9 percent of breath samples were THC-positive at 0.95 hours and 63.6 percent at 1.49 hours. One occasional smoker had no detectable THC."

No samples tested positive for the presence of the carboxy THC metabolite and only one subject tested positive for the presence of CBN.

Authors concluded that breath analysis potentially offers an alternative matrix for identifying subjects who had recently inhaled cannabis. The study did not attempt to correlate the detection of THC in breath with actual behavioral impairment of any kind.

Swedish researchers had previously reported in April that breath analysis is sensitive to the presence of THC in those who have recently consumed cannabis as well as other controlled substances. That study reported that 89 percent of subjects tested positive for THC in breath. Investigators reported that the results "confirmed the potential of exhaled breath as an alternative specimen for toxicological investigations."

Why on Earth Are Almost a Third of High-Schoolers Getting Drug-Tested in America?

Nearly one in three high school students are exposed to student drug-testing programs. Yet, over a decade of scientific scrutiny of the practice has consistently found that these programs do far more harm than good.
The latest finding appears in the January issue of the Journal of Studies on Alcohol and Drugs. Investigators from Israel and the United States assessed whether students' awareness of drug-testing programs in their schools was associated with a reduction in the frequency of their use of alcohol, cigarettes or cannabis. It wasn’t.
Authors wrote, "Consistent with previous research, results of the current study show that perceived SDT (student drug testing) is not associated with a reduction in initiation or escalation of substance use in the general student population." They concluded, "The current research reinforces previous conclusions that SDT is a relatively ineffective drug-prevention policy."
Ineffective is putting it mildly. In fact, no peer-reviewed study has ever praised the program as effectual. By contrast, numerous studies, including those sponsored by the US government, have reported that student drug-testing programs fail to deter adolescent substance use, and in some cases may even encourage it.
A 2011 study in the Journal of Youth and Adolescence assessed the impact of school drug-testing programs in a nationally representative sample of 943 high school students. Researchers discovered that the imposition of random drug-screening programs failed to reduce males' self-reported use of alcohol, tobacco or illicit drugs and that the program was equally ineffective among at risk females. Authors concluded: "The current research expands on previous findings indicating that school drug testing does not in and of itself deter substance use. … [D]rug testing should not be undertaken as a stand-alone substance prevention effort.” 
A 2010 study by the Department of Education—the same agency that spent over $36 million during the second half of the George W. Bush administration to encourage and subsidize random drug-testing programs in public schools—reported similarly poor outcomes. Its assessment of students at 36 separate high schools reported that federally funded mandatory random student drug-screening programs failed to reduce rates of drug use among either the students exposed to testing or the student body at large. Suspicionless drug testing "had no statistically significant impacts" upon participants' substance use, the study found. "For nonparticipants, there was no significant difference in self-reported substance use between the treatment and control schools," the authors added. 
A widely reported 2007 study by researchers at Oregon's Health & Science University found not only that student drug-testing programs don’t reduce self-reported substance abuse, but that the practice may encourage greater risk-taking behaviors among those tested. Researchers reported that students exposed to drug testing were more likely to report an "increase in some risk factors for future substance use" compared to students who attended schools without drug and alcohol testing. 
University of Michigan investigators reaffirmed this latter finding in a 2013 study analyzing the impact of student drug-testing programs in some 250,000 high school and middle-school students over a 14-year period. While investigators reported that random drug-testing programs of the student body, as well as programs specifically targeting student athletes, were associated with "moderately lower marijuana use," they cautioned that the programs in gneral were "associated with increased use of illicit drugs other than marijuana."
The likelihood that students subjected to random drug screenings may be more likely to engage in drug substitution hardly comes as a surprise to anyone familiar with marijuana pharmacology. Urinalysis, the most common form of student drug testing, screens for the presence of inert drug metabolites (breakdown products), not the actual parent drug. Because marijuana's primary metabolite, carboxy-THC, is fat soluble, it may be present in urine for days, weeks, or in some cases even months after past use. By contrast, most other illicit drug metabolites, such as those associated with cocaine, are water-soluble and will exit the body within a matter of hours. The University of Michigan researchers speculated that students subjected to drug screens were switching from cannabis to other illicit drugs that possessed shorter detection times.

"Random SDT (student drug testing) among the general high school student population, as well as middle and high school subgroups targeted for testing, was associated with moderately lower marijuana use; however, most forms of testing were associated with moderately higher use of other illicit drugs, particularly in high school," they concluded. "These findings raise the question of whether SDT is worth this apparent tradeoff."

But this particular question had already been raised publicly years earlier. A 2005 paper published by Britain’s Joseph Rowntree Foundation had previously warned of this trend, stating that student drug testing programs may “encourage some pupils to switch from the use of cannabis and other substances that can be traced a relatively long time after use, to drugs that are cleared from the body much more quickly,” including alcohol and more dangerous drugs like cocaine and heroin.

Nonetheless, despite overwhelming evidence pointing to the potential negative unintended consequences associated with student drug-testing programs, and despite a lack of research in support of the practice’s effectiveness as a deterrent, an estimated 28 percent of high-schoolers are now subject some form of student drug testing. They shouldn't be.

The warrantless drug testing of students is an ineffective, humiliating, invasive practice that undermines the relationships between pupils and staff and runs contrary to the principles of due process. It compels teens to potentially submit evidence against themselves and forfeit their privacy rights as necessary requirements for participating in public school-related programs like sports or other non-athletic extracurricular activities.

Rather than presuming our schoolchildren innocent of illicit activity, drug testing without suspicion presumes them guilty until they prove otherwise. This is neither a healthy nor a worthwhile message to be sending to our children. It’s time for educators to just say no to this costly, ineffective, invasive, and potentially dangerous practice.

Paul Armentano is the deputy director of NORML (National Organization for the Reform of Marijuana Laws) and the co-author of Marijuana Is Safer: So Why Are We Driving People to Drink (Chelsea Green, 2009).




The Truth About Zinc and Drug Tests

The internet is teeming with claims regarding the use of zinc supplements as a strategy for thwarting drug tests. But is there any hard science to support these anecdotes? The answer is "yes" -- and "no."
The most high-profile study substantiating these claims comes from the July/August 2011 edition of the Journal of Analytical Toxicology. The paper, entitled "Zinc Reduces the Detection of Cocaine, Methamphetamine, and THC By ELISA Urine Testing," assessed subjects’ use of zinc sulfate and zinc supplements as methods to trigger false-negative test results. During phase I of the study, participants adulterated positive urine samples with a zinc sulfate additive. During phase II, participants self-administered 200 mg doses of oral zinc supplements shortly after engaging in marijuana smoking. Investigators at the City University of New York concluded that zinc was effective as both an adulterant and as an oral supplement at masking the presence of carboxy THC on conventional urine tests.
“These results argue that the consumption of zinc supplements taken orally after light marijuana use can interfere with the detection of THC [metabolites] in urine samples for a 12- to 18-hour period,” authors determined. “We [also] conclude that zinc ion is a potential adulterant in urine samples tested for drugs. … Its effect in causing potential false-negative results in drug testing is robust and reproducible.” They concluded, “[W]e are aware of no suitable test to determine zinc adulteration in urine and conclude that zinc supplements are effective at subverting routine drug testing and undetectable by standards means.”
Sounds like a silver bullet, right? Not so fast says a newer paper published in the same journal this past July. In that study, researchers at the University of Utah School of Medicine reported that although zinc worked as an adulterant, it was only effective at doses “5,000 times higher” than what would be typically found in a non-adulterated sample. They reported: “We investigated the potential interference of zinc used as a direct adulterant. … Our data indicate that the total zinc concentrations required to directly interfere with EMIT-based testing are easily distinguishable from routine random urine total concentrations.”
The University of Utah study also cast doubt on the notion that the consumption of oral zinc supplements can successfully trigger false-negative results for the presence of THC metabolites, stating “[O]ral ingestion of zinc does not produce total zinc concentrations [in urine] capable of direct interference.” This latter conclusion, however, appears to be somewhat theoretical. Unlike in the 2011 study, no participants in this trial engaged in any actual marijuana smoking. Rather, researchers based this determination on the premise that zinc self-administration failed to produce the supplement’s presence in urine at the quantities they believed to be necessary to interfere with a positive drug test result.
Finally, a to-be-published paper in the October 2013 issue of the American Journal of Clinical Pathology raises further questions regarding whether zinc additives are truly undetectable. Like the previous studies, it reaffirms that zinc adulterants can effectively invalidate a positive drug test result. But, unlike the studies before it, the trial’s authors acknowledge that two newly developed spot tests can rapidly identify the substance’s presence in urine.
Nonetheless, the internet rumors claiming that zinc may be an effective and clandestine tool for compromising drug detection ought not to be dismissed outright. First, most labs do not engage in spot testing for zinc, despite the development of newer technology allowing them to do so. Further, negative immunoassay samples are typically not analyzed further for the presence of less common adulterants or additives. In other words, even if zinc adulterated samples are “easily distinguishable” from non-adulterated samples, as claimed in the Utah study, lab testers would still have to engage in the time an effort to distinguish them -- something that most technicians are unlikely to do on specimens that initially test negative for the presence of illicit substances. Finally, there still remains little evidence disputing the notion that self-administration of zinc supplements interferes with carboxy-THC detection since, to date, no study seeking replicating the methods employed by SUNY research team has been conducted. That said, however, the only proven method for passing a drug test remains abstinence and, ultimately, the best strategy for thwarting drug testing is legalizing marijuana so that its off-the-job consumption is no longer of concern for authorities or employers.

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