Medical school drug testing is a moral and scientific failure

Before the 1980s, drug testing was uncommon. It was widely viewed as an invasion of privacy and an infringement on fourth amendment rights. 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 days. 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 Quick Fix 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 students. 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 addiction. A urinalysis detects alcohol for no more than 12 hours after use. 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 marijuana, and Oliver Sacks used several illicit drugs. 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.

The author is an anonymous medical student who blogs at unchainedmedical.

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  • Peter Elias

    And in a couple years you will find yourself obligated (by your employer and possibly by state law) to test the urine of your patients if they wish to obtain Schedule II medications from you for chronic pain. I hope you remember then how offensive it feels to you now. Because it is offensive.

  • SteveCaley

    So few people understand the vast chasm in privacy and intrusiveness between current society, and American society 20 years ago.
    George P. Schultz, Reagan’s former Secretary of State, has been a strong opponent of this violation of privacy. During the Reagan years, there was discussion of urine testing of government employees in the Executive Branch. Schultz insisted that any sort of intrusive and dehumanizing mandate such as this should apply to all employees, including the President and the Cabinet; and that under any circumstances, if it was implemented, he would resign.
    Any public statement of firm morality merits approval; good for Schultz! Nowadays, many physicians applying for jobs are expected to do Urine + Credit Check, the same as for casino employees. People would be amazed to see how offensive such things would be taken 20 years ago – the AMA would be up in arms! (There was an organization called the AMA back then…)

  • Eric W Thompson

    I don’t find it that offensive. But I was in the military 28 years. I do know that we test people a lot and find all kinds of drugs; cocain, opiates and others. It does screen out the idiots that can’t wait the time period necessary for the drugs to be out of their systems and for that, I am grateful. I support drug testing for similar reasons to background checks for guns. I guess it matters what part of the political spectrum you occupy.

  • Eric W Thompson

    To spell it out: A guy or girl with a gun. Or flying a jet fighter. On crack or LSD. Sound like fun?

    • ninguem

      Does the military drug test for LSD?

      If there is a mass screening technology for lysergic acid diethylamide, I’m not aware of it. Surely it can be done, but not to my knowledge on a mass screening scale.

      I hear the story “I was in the military ‘X’ years, it was OK there, it should be OK here…..”

      Fair enough. I agree completely about one thing in particular. If the drug screen is announced well in advance. Not random, but “we will drug test everyone in a mass screening in six weeks on the first Tuesday……..”

      If a person, knowing full well there’s a urine drug test coming in six weeks, and that person can’t stay clean long enough for the test, then there’s VERY likely a drug problem with that person. By definition, that person can’t control drug use.

      Do they drug test the generals? The civilian contractors? That’s the sort of area where I personally would have a problem. When some are singled out.

      Drug test Congress. No more Kennedys in office, which might be a good thing. Drug test the judges. Then let’s talk about the physicians.

      • Eric W Thompson

        I am now retired and don’t have access to see just what is tested. I know it was a big deal and yes, the generals had to do it also. Pretty fair. No one liked it. LOTS of people tried to beat it and failed. But like I said, you don’t want a lot of the military career fields on drugs, but they test all equally. I would drink a bunch of coffee and pee.