Drug testing is similar to what some refer to as the "middle child syndrome." Others call it mediation. Something occurs between two parties and a third is called in to go back and forth between the two. The third party can bear the brunt of the tension, and occasionally has to make like a referee in a boxing match. These people are the epitome of the word 'misunderstood', and of the old cliche, "don't shoot the messenger."
Dr. Darryl Lesoski, M.D. and his peers are the middle child of the drug testing controversy. As administrators cry out for more drug testing of workers, and those same workers cry out against an invasion of privacy, clinical drug testers go about their business, trying not to get too much of the mess on them.
Dr. Lesoski is the Medical Review Officer for Munson Medical Center; he describes his job without exaggeration. "I am a physician. The practice that I do is occupational and environmental medicine. Predominantly we deal with workplace injuries, illnesses... I'm certified as a medical review officer (MRO)."
He adds that MROs are physicians who are licensed and have taken a course and passed an exam to become, "basically the local expert on drug screening."
Terry Whalen, the technical director of Munson's laboratories, works closely with Dr. Lesoski. As far as drug screenings go, Whalen has seen more than his fair share.
"We've been into drug testing... for over 20 years," Whalen says. "We get a lot of pre-employment drug screenings."
He notes that the results are sent to Dr. Lesoski who coordinates the program and is on contract with different businesses in the area. The lab also does pre-employment testing for businesses under contract.
"We also do drug testing and alcohol testing for accidents," Whalen adds. "Then if there is an accident on the job site, they'll bring the patient over and we will do alcohol testing and drug testing."
In addition to drug screenings, the lab at Munson also runs many alcohol tests.
"We do the legal (alcohol testing) for Antrim, Kalkaska, Grand Traverse and Leelanau counties," Whalen says. "It really amazes me at the number of alcohol (testings) that we still do. After all the publicity about not driving drunk we still do a ton of them. I think we did 17 last Thursday alone. Frequently our technologist has to go to court to testify. Usually they hold up; they're very solid and our testing holds up in court."
Tape On The Toilet
Lab technicians have a specific procedure to go through in order to be sure they have taken a good sample of urine from each donor. "We have paperwork that (the donor) fills out verifying that it is okay that we take a specimen from them," says Tricia Jankowski, a phlebotomist in the lab at Munson. "If they are under 18 there has to be a parent here and we have to have a photo of them if they don't have an ID. They usually send certain containers with them if they want, but they have to be sterile. We put tape on the toilet so they can't turn that water on and try to put that in there. (After that) it goes straight up to the lab and they are the ones who run it."
As soon as the sample is collected, there are immediate things that the technicians look for in order to determine if the sample has been altered. "Is the temperature correct? Because if it's either too cold or too hot we know it did not come from a human being," Dr. Lesoski says. "So we have to collect again and then we have to do a collection under observation and I have to get involved and watch the person pee in a cup."
Whalen states that the lab uses a five-panel testing method referred to as the Nida-5. Munson performs a colorimetric procedure. Samples are mixed with various types of reactants and to produce a reaction indicating drug use.
"What we're doing with the instrument is measuring the rate of the reaction; how fast the reaction takes place," Whalen says. "Then we can relay that back to the concentration of the drug. So the instruments are very sophisticated and, I believe, very accurate. What we do with the drugs is the federal government recommended cut-off points. And the cut-off point, below it we call it negative and above it we call it positive. It's somewhat of an arbitrary point that's been given to us and we calibrate the instrument to that particular point.
"If you did find a touch of the drug you would have a tendency to call it negative; it probably would not meet this calibration point," Whalen adds.
As far as what drugs are tested for, lab technologist Tom Clute says, "We look for amphetamines, barbiturates, opiates, marijuana or THC and PCP, and we also look for cocaine."
Tests are also run to make sure that the person giving the sample of urine has not attempted to dilute it. "We do a specific gravity test and a creatinine test and those two tests tell us if the patient has attempted to dilute the sample, which is a major consideration," Whalen adds.
If it has been determined that a patient has been using illegal drugs, the laboratory sends the results to Dr. Lesoski who works with the company that initiated testing.
"We refer our test results to him and let him do the interpretation," Whalen says. "Because there is interpretation. He might interview the employee involved to see if the employee is on any type of therapeutic drugs that may alter our results and so he makes that type of determination."
"I go through a routine interview asking about prescription drugs and asking about use of illicit drugs, like marijuana or cocaine," Dr. Lesoski says. "I would say that out of the positives, 95% of the people admit to using. Some will say, 'I have no idea why it's positive,'... I say you've got to look at other ways that you may have ingested this or been exposed to it or used it and how long ago."
Some who test positive become very defensive about their test results, and can make things very difficult for Dr. Lesoski.
"A few people get pretty adamant and say there is no way that it is positive and they want it re-tested and re-tested," he notes. "For those individuals I can offer to have that same sample sent to another lab to be re-tested again for that same drug. Out of that half-dozen or so that were very difficult to deal with, only three of them accepted that offer to pay and have it re-analyzed, and they all came back positive again."
Even with this option, there are still donors who can be unreasonable, but Dr. Lesoski is always assured of the veracity of the lab's results. "The nice thing about drug screens is if you give me a sample of urine, it's a two-part test," he says. "The first part is called a screening test. It's a certain procedure they use and they screen for a panel of drugs. If it shows up positive on that initial test it's sent further on for another test called a GCMS (Gas Chromatograph-Mass Spectrometer) and it's tested for that specific drug. And the goal here is that it's set up so not any amount in the urine is positive; it has to reach a certain cut-off level.
"The reason it's done is because we don't want to have any false positives," he adds. "I don't want to have somebody's drug screen come back as positive and then (have it) be for some other reason. When the federal government set these regulations, set the standards, they actually, believe it or not, set the limits to benefit the donors. Most people don't believe that."
On top of these fail-safes, the lab is required to keep all positive samples even longer in case it needs to be re-tested. "Then you have to keep that sample for up to a year afterwards if it was positive if we ever want to have it re-tested. So I'm comfortable with the procedure of the technical component. The labs are very regulated. If a federal lab has a false-positive test, they get investigated by the federal government and have a chance of getting shut down. Just on one false positive. So if at any time we have a false positive or think of one, we have to report it immediately to the government. It's a proven science. It makes my job easier in that aspect because I don't have to argue about chain of custody, I don't have to argue, 'well was it really my sample, was it not my sample,' or if the lab screwed up on it. Well, they don't screw up on it. In the times that people believe it did (screw up) it still came back as positive," Dr. Lesoski comments.
Although it is a rare occurrence, Dr. Lesoski says that there are times when people have brought in substitute urine for their screenings, and occasionally this comes back to bite them. These people will be caught bringing in outside specimens and will have to give a second sample of their own, done while the doctor is watching.
But since these donors sign forms stating that all samples they give are their own, the lab has to test both samples. This is where the weirdness can start.
"Mostly the first sample (that was brought in from someone else) is negative and the second (that is really the donor's) is positive," Dr. Lesoski says. "There are times when the first one has been positive and the second one has been negative. Their friend or whoever they got the urine from screwed 'em because they'd have been better off giving their own sample. That's happened probably three to five times."
According to studies conducted by the federal government, laboratories all over the country have shown a decline in the number of positives since drug testing started. But Lesoski says the war on drugs is not being won, even with those numbers as evidence.
"There are drugs that we are not testing for," he notes. "There are new drugs out there... and there are always new ways of trying to foil the system."
One of these new methods Dr. Lesoski mentions is the Whizzinator. The Whizzinator is proof of how far some will go to produce negative drug screen results: it is a realistic, prosthetic penis that is worn under the clothes and drains urine out of the end, so even if a doctor watched the donor give a sample, there is little chance of being noticed. Extra packages of dehydrated urine can also be purchased for $12 to ensure that your sample will be clean. Whizzinators run around $150 plus shipping.
But Lesoski insists that people trying to scam the drug testing system are in the minority, and states that the controversy over drug testing has died down and most people are beginning to accept it. "I think it has become more accepted because of the federal regulations and because of time. Just like the raising of the drinking age or the close attention to the smoking age. With time it becomes more acceptable. With time it has proven to be the norm because more and more employers are doing it, so it's becoming more acceptable," he says.
As far as what types of drugs people are taking, Dr. Lesoski says that illegal use of prescription drugs is not being detected as much as people would think.
"Right now we do not see a lot of positives relating to abuse of prescription medications," he says. "The reason is different drug screens only screen for certain drugs... So there is probably some narcotic misuse that we are not picking up."
He adds that in Northern Michigan there are some old-reliables that seem to be the most prevalent. "Predominantly though it's marijuana and cocaine. When I first came up here in '97 I rarely saw cocaine. It seems to be more and more. It's still not as prevalent as the marijuana, but you see a few more or you see the double positives, both for marijuana and cocaine. They are getting more sophisticated in being able to test for the Ecstacy, the designer drugs, so we'll have that available. I'm not sure how that will change things. I don't see a lot of abuse of narcotic drugs."
Interestingly, Lesoski is not required to report anyone to the police when they come back with a positive result on their drug screen. "No I'm not required. Two states have that; it's Washington and Oregon. Very liberal states, but at the same time they are the only ones right now. There is a push right now to have a national reporting database .because if you go somewhere else no one is going to know that you had a positive drug screen. Some states are looking at a state database, Michigan does not have that... for federal mandated drug screens I may see it in the next 10-15 years but at a state level. I don't think there is a push for it. There will probably be more of a push for those drivers at a federal level."
Mr. & Ms. Average
As far as the average person who comes in for screenings, both Whalen and Dr. Lesoski agree that there is no average.
"Is there an average type of person? No. It ranges from all different types and ages," Whalen says. "I would bet the majority are first-time offenders. We get the repeats in too, but there are a lot of first-time offenders that are out partying down and kind of forget what they are doing and then they get caught."
Dr. Lesoski says, "There are people that have come in and I have done physicals on them and talked to them and have asked questions and they seem like the everyday person and they come back positive. Some of those people are recreational users, some are pretty regular users. As a stereotype it is not the long-haired, tie-dyed, 1970s 'hippie type' of person anymore. I think it's ages from 16-51 for marijuana." "There is no socio-economic status that is more prevalent," Dr. Lesoski adds. "As an individual it is not the 25-year-old caucasian male. For the everyday drug screens there really is no stereotype. Some people ,you look at them and say, 'he's gonna come back positive,' and he doesn't. Then there is 38-year-old who has got two kids, wife, got a good job and he'll come back positive. But I'm not surprised anymore because I have seen it all."
When asked the million dollar question as to whether he believes drug testing is an invasion of privacy, Dr. Lesoski is not hesitant. "I don't," he says. "I have to say that if you look at the studies on what drug abusers cost us as society, it is great."
Drug testing is necessary for the greater good, he says.
"People think, 'I use drugs. I get high. It's over.' It's shown that even with marijuana, up to 24 or 48 hours (after use) there is an effect on our cognitive or reaction time. It may be an invasion of privacy because it is your bodily fluids, but at the same time it's done for the greater good of our public. I don't want my kids in my wife's car next to a big rig who is illegally using drugs. It's for public safety... or for yourself or for your coworkers."
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