What underlies the broad acceptance of a practice that conservative
Supreme Court Justice Antonin Scalia has called a "needless
indignity"? One factor may be the alarming statistics cited
by testing advocates to demonstrate the high costs of drug
abuse. Examination of some of these claims suggests they do
not always accurately reflect the research on which they are
based. In fact, some of the data could be used to "prove"
that drug use has negligible or even beneficial effects. Consider
these examples.
Last year President George Bush declared that "drug abuse
among American workers costs businesses anywhere from $60
billion to $100 billion a year in lost productivity, absenteeism,
drug-related accidents, medical claims and theft." Variants
of this statistic abound in discussions about drug abuse and
are commonly repeated without qualification by the media.
Yet all such claims derive from a single study, one that "was
based upon assumptions which need additional validation,"
according to an assessment last year by NIDA, the chief federal
agency sponsoring research on substance abuse.
The study grew out of a survey of some 3,700 households by
the Research Triangle Institute (RTI) in 1982. The RTI group
found that the average reported income of households with
at least one person who admitted to having ever used marijuana
daily (20 days or more in a 30-day period) was 28 percent
lower than the average reported income of otherwise similar
households. The RTI researchers defined that difference in
income as "loss due to marijuana use"; the total loss, when
extrapolated to the general population, came to $26 billion.
The researchers then added on the estimated costs of drug-related
crime, health problems and accidents to arrive at a grand
total of $47 billion for "costs to society of drug abuse."
This figure - "adjusted" to account for inflation and population
increase - represents the basis of Bush's statement, according
to Henrick J. Harwood, who headed the RTI study and is now
in the White House drug-policy office.
The RTI survey included questions on current drug use (at
least once within the past month). Yet according to Harwood
there was no significant difference between the income of
households with current users of any illegal drug - including
marijuana, cocaine and heroin - and the income of otherwise
similar households. Does this mean that current use of even
hard drugs - as opposed to perhaps a single marijuana binge
in the distant past - does not lead to any "loss"? "You would
be on safe ground saying that," Harwood replies.
Officials of the U.S. Chamber of Commerce have testified before
Congress and at national conferences on drug abuse that employees
who use drugs are "3.6 times more likely to injure themselves
or another person in a workplace accident ... [and] five times
more likely to file a workers' compensation claim." The pharmaceutical
giant Hoffmann-La Roche, which is leading an anti-drug campaign
among businesses (and has a big share of the drug-testing
market), also promulgates this claim in "educational" literature.
In fact, the study on which the claim is based has "nothing
to do with [illegal] drug users," according to a 1988 article
in the University of Kansas Law Review by John P. Morgan of
the City University of New York Medical School. Morgan, an
authority on drug testing, has traced the Chamber of Commerce
claim to an informal study by the Firestone Tire and Rubber
Company of employees undergoing treatment for alcoholism.
In an interview with SCIENTIFIC AMERICAN, J. Michael Walsh,
who heads NIDA's applied research division and is a strong
supporter of workplace testing, singled out two studies that
he said showed drug users are more likely to cause accidents,
miss work and use health benefits. The studies were done at
two utilities: the Utah Power and Light Company and the Georgia
Power Company. The 12 workers in Utah and the 116 in Georgia
who served as the primary research subjects were tested "for
cause": they had either been involved in accidents, exhibited
other "problem" behavior (commonly, high absenteeism) or submitted
to treatment for alcoholism or drug abuse. Critics point out
that it should not be terribly surprising if these subjects
exhibited the cited traits at a higher-than-average rate.
What may be surprising is that, according to a report published
by NIDA last year, Utah Power and Light actually "spent $215
per employee per year less on the drug abusers in health insurance
benefits than on the control group." Those who tested positive
at Georgia Power had a higher promotion rate than the company
average. Moreover, Georgia workers testing positive only for
marijuana (about 35 percent of all positives) exhibited absenteeism
some 30 percent lower than average. Nationwide, Morgan says,
marijuana accounts for up to 90 percent of all positive findings,
both because it is by far the most widely used illegal drug
and because it persists in urine for up to a month (compared
with two days for most other drugs).
Perhaps the study most publicized of late by testing proponents
involves employees of the U.S. Postal Service. The service
tested 4,396 new hirees in 1987 and 1988 and - keeping the
test results confidential - tracked the performance of positives
(9 percent of the total) and negatives. By last September,
the service reported, 15.4 percent of the positives and 10.5
percent of the negatives had been fired; the positives had
also taken an average of six more sick days a year.
This study may be distorted by more subtle biases - related
to race, age or gender - than those displayed by the utility
studies, according to Theodore H. Rosen, a psychologist and
a consultant on drug testing. Indeed, Jacques L. Normand,
who headed the study, acknowledges that minority postal workers
tested positive at a much higher rate than nonminority workers
and that previous studies have shown minorities to have higher
absenteeism.
Morgan points out, moreover, that the Postal Service study
(like all those cited above) has not been published in a peer-reviewed
journal. In fact, he says, only one study comparing the work
of drug-test positives and negatives has passed peer review.
Last year, in the Journal of General Internal Medicine, David
C. Parish of the Mercer University School of Medicine in Georgia
reported on a study of 180 hospital employees, 22 of whom
had tested positive after being hired. Parish examined supervisor
evaluations and other indexes and found "no difference between
drug-positive and drug-negative employees" at the end of one
year. He noted, however, that 11 of the negatives had been
fired during that period and none of the positives.
Proponents of testing often imply that drug use among workers
is growing. A Hoffman-La Roche brochure, for example, quotes
Walsh pronouncing that "the problem of drug abuse has become
so widespread in America that every company must assume that
its employees will eventually be faced with a substance abuse
problem." Yet in 1989 NIDA reported that illegal drug use
has been decreasing for 10 years and that the decline has
accelerated over the last five years. From 1985 to 1988 the
number of current users (at least once in the last month)
of marijuana and cocaine dropped by 33 and 50 percent, respectively.
To be sure, a subset of this group of current users is increasing:
NIDA estimated that from 1985 to 1988 the number of people
using cocaine at least once a week rose from 647,000 to 862,000
and daily users increased from 246,000 to 292,000. NIDA found
that addiction to cocaine (including "crack") is particularly
severe among the unemployed - who are beyond the reach of
workplace testing.
Clearly, the U.S. has a drug-abuse problem. Could it be that
neither indiscriminate testing of workers - which could cost
upward of $500 million this year - nor the dissemination of
alarmist information by testing advocates is helping to resolve
that problem?