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Patrick Dixon, author, broadcaster and lecturer on global trends, reviews the drug problem and outlines strategies for prevention and cure.
On current trends within two years it will be almost impossible for recreational drug users to get a job with larger companies. Drug testing at work is probably the single most effective weapon we have against adult substance abuse. It is a proven, low cost strategy which identifies those needing help, reduces demand, cuts accidents and sick leave, improves attendance and increases productivity.
Yet testing is (or rather was) highly controversial: it penalises users with positive tests that can bear little or no relation to work performance, encourages knee-jerk dismissal and discrimination at interview. It costs money, invades privacy and smacks of authoritarianism.
Despite all this, almost overnight it has become fashionable to talk of testing millions of people at work for both alcohol and drugs. Just over twelve months ago the idea seemed so extreme that the government cut it out of their White Paper altogether - with small concessions for prisons and roadside.
In a dramatic policy shift, drugs czar Keith Halliwell and government Ministers have started encouraging drug testing by employers. They are following a quiet revolution, largely unreported because firms have been scared of bad publicity.
The government's own Forensic Science Agency alone carried out over a million workplace tests last year, with a rush of interest from transport, construction, manufacturing and financial services industries. Last year the International Petroleum Exchange joined London Transport and many others in random testing.
This stampede to test follows spectacular success in America when many had declared the mega-war against drugs all but lost. The drugs industry accounts for 8% of all international trade according to the UN. Education, customs, police, crop destruction and prison sentences have failed to deliver so testing has become highly attractive, even at the cost of civil liberties.
By January 1996 80% of all large US companies spent over œ200m a year testing for drugs at work, affecting 40% of the US work force.(1) By 2005 up to 80% of all workers will be covered.
But Britain also has a significant and growing problem with addiction. 8% of men and 2% of women in Britain abuse drugs or alcohol, costing at least £3bn a year in accidents and absence alone.(2)
Every office, factory, train operator, airline, construction company and hospital is affected with serious risks to public health and profitability. Workplace testing in America is being forced on employers for economic and safety reasons. Drug companies that don't test will go bust. Their insurance premiums will go through the roof.
US studies show that substance abusers (including alcohol) are 33% less productive, three times as likely to be late, four times as likely to hurt others at work or themselves, five times as likely to sue for compensation, and ten times as likely to miss work.(3)
When the State of Ohio introduced random testing they found absenteeism dropped 91%, there were 88% less problems with supervisors and 97% decrease in on-the-job injuries.(4) These results are so striking that many companies are now screening job applicants.
One plastics company realised many workers were taking amphetamines to keep awake after they lengthened shifts to twelve hours. Staff found tell-tale powder residues and scratch marks on equipment. They estimated that 20% of the workforce were taking drugs. After random testing was introduced drug-taking fell to negligible levels.(5)
A Wisconsin cardboard factory was contacted recently by their insurers who were worried about high levels of injuries. Random testing was introduced and accidents fell 72% the following year, with an 80% decrease in days lost as a result.(6)
Health and safety will be the driving force at first in the UK. Take doctors: a recent report in The Lancet revealed that 37% of male junior doctors were using cannabis and 14% cocaine, amphetamines, barbiturates, LSD, ecstasy, magic mushrooms or other substances. The figure for women was 12%. And that's just the ones willing to admit it.
The BMA's own figures suggest around 8% of all doctors may abuse either alcohol or illegal drugs, including cocaine, crack and heroin.(7) However that is based on self-reports in surveys and they are hardly likely to overstate the problem. On the contrary, my own view is that the true figure is likely to be around 10%. That's almost 10,000 doctors, treating perhaps 200,000 patients every day. Do you, your relatives or your own patients want to be operated on by a surgeon who is suffering from withdrawal? In an operating theatre with two anaesthetists, a consultant and two junior doctors there is a 50% risk that one of the team is a substance abuser.
I am appalled at the stance of the BMA, who have long been opposed to random testing of doctors. They say we are sensible enough to come forward for help, and those that don't are informed upon. Both these claims are complete fiction, judging by the vast gap between numbers with dependency and the few who have been identified. The BMA's resistance to random testing will be over-ruled soon. We know that it is very difficult in practice for - say - a GP to inform on a senior partner because it is immediately obvious who's done it. Likewise, what chance would a junior doctor have after informing on a consultant, especially without hard proof - which requires a test and, in the case of alcohol, a test at the right time? And very few doctors volunteer for help.
We will never know how many have died under the knife of an intoxicated surgeon or as a result of a physician's drug-clouded mind. Doctors don't like admitting errors, even in court long after the event, by which time evidence of substance abuse has vanished.
If you're too drunk or doped to drive, or drive a train, you shouldn't be operating - nor working a crane or cement mixer for that matter. Nor should you be defending someone in court nor making huge financial decisions on which other people's future will depend.
Testing is cheap. Breathalysers cost £40 with virtually no running costs while £30 urine tests for drugs only have to be carried out on a few to be effective. For example, London Transport tests just 5% of its drivers a year.
That means each worker is checked on average once every twenty years. Hardly a mass invasion of privacy, yet more than enough to be a powerful deterrent. In America positive test rates have fallen from 13.6% to 4.9% in a decade. This is a method that works.
However, random testing is barbaric unless introduced sensitively as part of a comprehensive package of education and access to confidential treatment. The primary aim should not be to sack, but to discourage abuse, to offer help, to treat. The most effective programmes are those where the workforce approves a humane, compassionate and fair anti-drugs policy. However those who place others lives at serious risk must expect to face the consequences.
There are many unresolved problems with testing: for example cannabis tests are almost useless with positive tests weeks after use. What blood levels are acceptable for illegal drugs? Who should be tested? How often and what action should be taken?
Some argue for tests only where performance is poor. But by then a fellow worker may have lost an arm, a leg, an eye or a hand - a patient her own life. The aim of testing is to prevent mistakes, not to allocate blame after the event.
One thing is clear: drug and alcohol testing will continue to spread fast regardless of government support, as the most practical and cost effective way to strengthen existing drugs and alcohol policies at work. It will be introduced well or very badly. Either we take hold of the issue now or the issue will take hold of us.
Schools are facing a new drugs epidemic - 1.5 million pupils in the UK have already taken drugs - 300,000 will try them this year. This autumn over 700,000 new high school entrants will find ready access to every illegal drug - from friends. More than 10% will have tried them by next summer.(8)
Every secondary school has a drugs problem. Every classroom is affected whether teachers realise it or not. Some pupils are suffering after effects of drug-taking almost every day. Drug-dealing leads to violence: pupils are scared to inform teachers, afraid of being beaten up, knifed or killed. The 'pusher at the gate' is a myth. Pupils usually get drugs from friends.
The good news is that most pupils are non-users; however drug-users make them feel minority freaks for abstaining. That's a terrible thing: it means the drug-using minority are making everyone else feel that they are just about the only abstainers in the world - and media overkill doesn't help. Non-users need urgent help to create their own, powerful anti-drugs culture at school, so they feel good about saying 'no'. Too many schools lessons on drugs actually encourage use because they give facts in a moral vacuum.
In Britain and many other nations Christians have been at the cutting edge of developing new care services and of prevention. It is well known that strong faith is linked to lower addiction levels and that a profound conversion experience is often followed by successful rehabilitation. Centres like Yeldall Manor have set a national standard for professionalism in a non-judgmental environment, with Christian values shaping the organisation but not rammed down people's throats. There is a grave shortage of decent rehab facilities in Britain today. Rehab works. There is life after heroin and crack.
The trouble is that until the church sorts out its position on tobacco, it has little to say to the cannabis user. When did you last hear a sermon on smoking? Yet nicotine is probably more addictive than heroin, and certainly a greater killer. Nicotine is also a gateway drug for younger teenagers. An excellent predictor of future use of cannabis and other drugs is whether or not the teenager already smokes.
The church has moved away from abstention as an option, with the death of the temperance movement over the last sixty years. We live in a generation of Christians which is far more lenient than the generations which have passed. This may have advantages, making us less legalistic, but it does mean that we are much less offended by drunkenness and smoking than before. In many ways this alters our attitudes toward the danger of not controlling our minds and desires in general, and more specifically the dangers of drugs. Expect a re-evaluation of this position as Christians begin to wake up to the dangers of smoking and the fact that nicotine, for many, is the route in to harder drugs.
The starting point for a believer is that all things in creation have been made by God and that we are called to subdue the earth (Gn 1:28). This is not a licence to exploit, but rather to care for the earth as God himself would, being accountable and in submission to him. Components of creation are not to control and subdue us. We are made in the image of God and our bodies are temples of the Holy Spirit. As fallen human beings we were bought with a price and should use our bodies in ways that bring glory and honour to God (1 Cor 6:19-20). Our bodies are to be presented as living sacrifices to him forever for his service (Rom 12:1-2) as we await Christ's return and the new heaven and new earth (2 Pet 3:13).
The Bible does not mention drugs explicitly, with the exception of alcohol. While there is no absolute prohibition on its use (Jesus drank wine and produced it miraculously), there are nonetheless warnings of the dangers of misuse. Christians are not to be filled with wine, but rather to be filled with the Holy Spirit (Eph 5:18). In God's mind the two commands are inextricably linked. Being filled with God's Spirit results in joyful thanks to God and transforms all our relationships in marriage, family and at work (Eph 5:18-6:1).
Alcohol if handled correctly can be thankfully received as a blessing from God (Ps 104:15), but its misuse can lead to inappropriate behaviour (Gn 9:21), anger (Is 5:11), mental confusion (Is 28:7) and the hallucinations, bruises and memory loss of intoxication (Pr 23:29-35). Drunkenness leads to sexual immorality (Eph 5:18), to weaker Christians being harmed (Rom 14:21) and makes us unfit for our godly calling (1 Tim 3:8; Tit 2:3). As doctors we should not allow drugs to cloud our judgement or impair our performance in caring for our patients.
Wine was used for medicinal purposes in biblical times as we see in the use of wine by the good Samaritan (Lk 10:34) and in Paul's recommendation to Timothy (1 Tim 5:23) to take wine for his stomach upsets. This reminds us that drugs can be used to heal as well as to harm.
Cannabis and other minor drugs are often portrayed as natural, relatively harmless things. However new evidence shows long term damage to brain function in both cannabis and ecstasy users. Most people accept that legalisation would bring prices down and lead to increased consumption, which would be a costly price to pay for the benefit of hitting the illegal drugs industry. I don't want to live in a world where cannabis finds its way around as easily and as legally as packets of cigarettes in the school playground.
But many physicians are beginning to recognise that even cannabis can be used for good purposes. Doctors used cocaine in the old Brompton Mixture for pain until it fell into disfavour and we give heroin to relieve suffering. Why the hang-up about cannabis? My own view is that appropriate medicinal use of cannabis or its derivatives (cannabinoids) is entirely consistent with the Christian position.
Those who misuse drugs often do so to deal with pain in their souls; resulting from deep questions about the nature of reality, humanity and morals. Many struggle with guilt or low self-esteem and their real need (like that of all of us) is to know that there is a God who loves them, has dealt with their sin on the cross and who calls them into a new life where there is a future and a hope and power to change. While social support, legal reform and advice play an important part in managing the drug problem, it is God's grace in saving and transforming our lives that is ultimately most important.
Christian doctors and medical students need to be at the forefront in the war against drugs. Specifically we need to: