The June 17, 2001, Juneau Empire trumpeted “Court Shoots Down Random Drug Tests” as the Alaska Supreme Court ruled that random drug testing constituted an unlawful search and seizure. This decision cheered civil libertarians, union officials and firefighters while chilling media-conscious politicians, administrators and drug testing representatives who seek to simplify a complex issue by subjecting firefighters to random drug tests.

Almost one year later, thousands of miles away, the specter of drug testing and drug use resurfaced in Akron, Ohio, where the revelations of positive drug tests shook the department with two resignations. One member, a district chief, headed the training division, while another handled financial accounts, both critical roles within the department. By all reports both were respected for their job performance and have not been replaced.

Drug testing is born

What sequence of events pierced the bureaucratic waters and plunged the fire service into wholesale drug testing? In 1983 President Ronald Reagan established the President's Commission on Organized Crime. The commission's 1986 report on drug abuse recommended drug testing for public- and private-sector employees. Reagan sanctioned the report and signed into law Executive Order 12564, which mandated drug testing for all federal employees. Reagan insisted that this wouldn't be punitive; employees were not to be fired or otherwise punished. In fact, he promised, offenders would receive help.

However, the Office of Personnel Management's written regulations departed dramatically from the president's assurances and included a dismissal provision. To the employees' dismay they learned that they could be fired for a single incidence of drug use and that a second offense mandated dismissal. The regulations didn't require the agencies to link employees' drug use with deteriorating work performance, absenteeism problems or inappropriate behavior.

Why have fire departments disregarded the spirit and the letter of Reagan's original recommendations? What motivated Reagan to discourage punitive actions and redeem employees? He certainly didn't advocate illicit drug use, but he recognized that people make bad decisions and that a blend of confrontation and counseling, coupled with a change in attitude and behaviors, can redeem those ensnared in the matrix of illicit drug use.

A tool, not a cure

According to Dr. J. Michael Walsh, chief of clinical behavior in the pharmacology branch of the National Institute on Drug Abuse, fire department leaders should realize that many companies jump into drug testing blindly and realize after the fact — after they've collected samples and taken adverse action against employees — that they haven't really thought about the many parameters involved in developing a drug policy. He says drug testing can be a useful tool in identifying people with drug problems within an overall program of treatment, prevention and education. In other words, drug screening must not stand alone; its usefulness depends on other components.

We practice this principle in fighting structure fires. Fire companies respond to working fires in frigid weather, arctic blasts and whiteout conditions while frozen hydrants hinder suppression efforts. Firefighters overcome a Mount Everest of obstacles and manage to extinguish the fire. Do we then just pack up and leave a scorched hulk of a structure unsecured and the freezing residents to fend for themselves? No, and if we did, we'd deserve the forthcoming rebuke.

Suppression provides one aspect of the firefighters' responsibilities to suffering citizens of the community. Firefighters also must provide extinguishment, salvage and overhaul and then connect the family to a service agency who can provide food, lodging and other needs. When all of this is accomplished, then — and only then — has the department provided comprehensive fire protection.

Treatment may vary

According to the National Institute on Drug Abuse's report on drug testing, employers should consider providing an opportunity for employees who test positive to enter a drug treatment program and be eligible for reinstatement in an appropriate position upon successful completion of that program.

This method doesn't always ensure rehabilitation, though. In one instance a large city department's random drug testing screening snared multiple firefighters. They received cursory treatment: attending two classes that lasted two hours and speaking with an employee assistance program representative. The fire department's foremost concern was for each firefighter to produce a negative urine test. Of course, this didn't mean they were rehabilitated.

Ray Isackila, a licensed professional clinical counselor and certified chemical dependency counselor affiliated for 15 years with Southwest General Hospital in Middleburg Heights, Ohio, says that in a typical outpatient treatment program employees participate in group therapy for three hours a day, three to six days a week. The program does offer alternatives, however. For instance, employees have the option of being involved in a program for one month or once a week for 90 minutes for four months. Employees who test positive can be mandated to test five to six times a year for as long as five years. This system uses tough love and provides extensive counseling, treatment and accountability.

Doug Thorburn, author of Drunks, Drugs & Debits: How To Recognize Addicts and Avoid Financial Abuse, also advocates tough love and accountability as the means to extricate the addict. Thorburn says pain is the addict's best friend, along with what he calls credible threats. These include suspension, demotion, and, ultimately, dismissal. Thorburn's rationale is, “You can't reason with chemicals.”

Prevention is key

Firefighters are plucked from mainstream society and find themselves susceptible to the allure of drugs. Even drug education doesn't always work. Studies show that drug use among children who have gone through drug abuse resistance education is virtually identical to the level among kids who have not.

In 1996, Dr. Dick Clayton, a widely respected drug abuse researcher at the University of Kentucky, published the most rigorous long-term study ever performed on the DARE program in the Journal of Preventive Medicine and later in the book Intervening with Drug-Involved Youth. He states, “Although the results from various studies differ somewhat, all studies are consistent in finding that DARE does not have long-term effects on drug use.”

What type of prevention works best? Dr. Kent Holtorf, author of the book Ur-Ine Trouble writes, “A popular DARE message told to children is ‘Drug use is drug abuse,’ but contrary to that they see otherwise. While children and adolescents may know of someone who had a problem with drugs, they know of many others who have used drugs without a problem, especially marijuana. They also see many people who have problems with alcohol but the thought that ‘alcohol use is alcohol abuse’ seems absurd in our alcohol-swilling society. Subsequently the message that drug use is drug abuse is regarded as further evidence that the entire anti-drug message is a pack of lies.”

This type of message, although well intentioned, does more harm than good. Simplistic, one-sided information rarely works on the complexities of human nature and the human psyche.

Know the enemy

Chief officers must educate themselves by obtaining a working knowledge of drug testing and drug use. Try these questions: What drug remains in the system longest? Can firefighters test positive as the result of second-hand smoke? Does a positive drug test prove the firefighter was impaired? Does your organization use hair testing? Beware, as blacks are up to 50 times more likely than whites to have a positive test, even if all use drugs equally. The American Management Association surveyed 11 large firms and it was found that the overwhelming majority, 78%, of positives were for marijuana.

The drug testing industry now grosses $673 million a year, which means they have a vested interest in perpetuating testing. These companies can be likened to the apparatus salesperson who sells the fire chief on the virtues of a particular truck but reveals no weaknesses. Should a chief just accept the sales rep's claims? No, the information must be investigated and verified by checking with departments that have used the brand of apparatus to determine if customer service vanishes once the sale is consummated.

Bttn. Chief Johnnie Brewington of the Cleveland Fire Department sat on the committee that sent forth recommendations for the development of a drug testing policy for the department's 1,000 uniformed members. A master researcher on fire service issues, he believes education is the best deterrent and says departments must change their stance on drug addiction. “Issues of drug addiction must be addressed as other diseases are,” he says. He also points out that departments provide systematic drug education for members are eligible to receive rebates.

Minefields in drug testing

What about issues of privacy? Does random drug screening equal a search? A search occurs when a reasonable expectation of privacy is infringed. A seizure of property occurs when there is some meaningful interference with an individual's possessory interests in that property. Compelling firefighters to produce urine constitutes a search and seizure. The critical issue is reasonableness.

In the case of Anchorage Police Department Employees Association v. Municipality of Anchorage, 24 P.3d 547 (Alaska 2001), which included firefighters, the court ruled that “In our view … the balance shifts in the case of an indefinite requirement of random testing. The policy's provision for ongoing random urinalysis testing alters the ‘special needs’ balance between individual privacy interests and competing governmental interests in at least three significant ways.

“First, random testing places increased demands on employees' reasonable expectations of privacy. Because the policy's provision for random testing could subject employees to unannounced probing throughout the course of their employment, the tests are peculiarly capable of being viewed as unexpected intrusions on privacy.

“Second, random testing is more intrusive; it subjects employees to a greater degree of subjective intrusion. An unannounced test's added element of fear and surprise and its unsettling show of authority make random testing qualitatively more intrusive than testing that is triggered by predictable, job-related occurrences such as promotion, demotion and transfer.

“Third, a requirement of random testing impacts the balance between individuals and governmental interests by reducing the immediacy of the government's need for the disclosed information. Unlike suspicionless testing occasioned by application, promotion, demotion, transfer or vehicular accident, the policy's random test provision has no nexus to any job-related occurrence.”

Mark Hall, IAFF local president at the time of the ruling, agrees. “The only thing that we were opposed to was the randomness of it,” he says. “I understand that city needs a drug program and we are not opposed to [testing] for cause.”

False cause for suspicion

False or innocent positives occur when a drug or metabolite has been detected but is not present in the urine specimen. Common over-the-counter medications and foods can create false positives, plunging the firefighter into a nightmarish scenario of lost employment, lost income and a tarnished reputation.

Dr. Kent Holtorf has testified in 300 court cases as an expert in drug testing methodology. He entered the fray at the behest of an acquaintance who was a firefighter fired after testing positive for illegal drugs. Subsequent investigation found that a type of skin lotion he used cross-reacted with the test, causing the positive reading. Armed with data culled from Holtorf's research, the firefighter reclaimed his job, albeit at great legal, financial, psychological and emotional expense.

Certain medications and foods have been known to trigger false positive readings. For instance, Robitussin and diet pills can produce a false positive for amphetamines; ibuprofen and various antibiotics can duplicate marijuana; the combination of a kidney infection and diabetes can cause an individual to test positive for cocaine; migraine medications and anti-depressants can mimic LSD; and poppy seed consumption can give a positive reading for opiates.

Mike Bonventre, co-owner of Rapid Test Drug Screening, a nationally certified company, has been conducting drug screenings for three years. “Everything comes back to the integrity of testing,” says Bonventre. He says an employee armed with a vial of another person's urine and $50 could say to a collector, “This is my urine, isn't it?” and proceed to get a negative screening. When he first started his company he encountered difficulty finding competent collectors, so he decided to certify and train his own.

Bonventre says the GC-MS, a more accurate form of confirming positive tests, has been ruled comparable to DNA by the Supreme Court. Holtorf disagrees: “It's the accepted method, the gold standard.” He says most organizations don't use the test to maximum effectiveness because full spectrum testing is too expensive so most companies opt for the cheaper, but less accurate, test.

The high cost of testing

Does drug testing justify the expense? During a six-year period in the 1990s, the federal government conducted 257,576 random drug tests and turned up 1,345 people who tested positive for drugs, meaning that 0.5% tested positive, according to Health and Human Services Department data from fiscal 1993 to 1998. The six years of random drug testing cost $31,791,811 excluding administrative costs, or $23,637 for each positive test result.

Beverly Potter, Ph.D., co-author of Drug Testing at Work — A Guide for Employers, specializes in management psychology and has provided training for Hewlett-Packard, GTE, SUN, IRS, Stanford Medical School and Stanford University. She says departments can enhance safety by using performance tests because they're more accurate. Performance tests assess motor function; for instance, can the firefighter drive apparatus and operate equipment in a competent and safe manner? Conducting formal roll calls also allows company officers to inspect their firefighters.

Retired Fire Department of New York Capt. Hugh J. Caufield writes in Winning the Fire Service Leadership Game, “Your rulebook probably requires that such a roll call include a prescribed number of military functions, such as about face, right face, etc. Even firefighters under the influence of alcohol or another drug who can stand may not be able perform such functions without giving away their true condition. A roll call can serve to alert you to deviance in the line-up.” When a company officer or other officer obtains evidence of impairment, the firefighter must be relieved from duty.

Government influence during the Reagan administration jump-started drug testing by declaring war on drugs in the workplace with patriotic zeal and fervor. Holtorf sees the issue in a more sinister light. “Drug testing is government-driven propaganda; the government gave tax breaks to companies that tested.”

Lines were drawn in the drug war, you were either for or against it, and no options existed. This quote by Reagan expressed the prevailing view of the day, “I have heard critics say employers have no business looking for drug abuse in the workplace, but when you pin the critics down, too often they seem to be among the handful who still believe that drug abuse is a victimless crime.” Statements like these place fire departments in an untenable position: test for drugs or be perceived as soft on drug use.

The role of alcohol

Do you want firefighters under your command zooming on cocaine, nodding on morphine or gassed on whiskey? Each of these firefighters imperils other firefighters, citizens and the mission of the fire service. Caufield writes, “Simply stated, alcohol is a drug. Alcohol can be as debilitating as the so-called straight drugs, in terms of impairing mental and physical function, and leading to addiction — the craving for ever larger quantities and dependence on the drug for daily function.”

One large city department's drug policy included this statement: Although rehabilitation is one of the principal mechanisms relied upon to reach the goal of this program, it's considered only secondary to the primary goal of ensuring safety. Considering the emphasis on safety, it's illogical that departments limit testing to illicit drugs.

Alcohol is by far the most common drug of abuse, followed by prescription drugs. In a recent study of workplace fatalities, Workplace Drug Testing: A Case Study in the Misapplication of Technology at www.doctordeluca.com, 173 autopsies were conducted revealing that 23 workers had detectable blood alcohol contents and 11 workers had detectable traces of prescription drugs, but only one worker had detectable traces of marijuana.

Drug tests don't detect impairment or frequency of use, and they're useless in determining addiction. They can only reveal that a drug has been used sometime in the past, making them a poor tool for determining recent use. A urine drug test administered to firefighters at the beginning of the shift would more likely show positive for an individual who smoked marijuana three days ago than for a firefighter who snorted cocaine in the parking lot.

Drug screening can reveal prescribed medications a firefighter takes for a variety of conditions including hypertension, asthma, bronchitis, depression and pregnancy. These are sensitive issues and reveal conditions firefighters would prefer to keep between themselves and their physicians.

Substance abuse remains a major issue within the fire service. Knee-jerk reactions and simplistic solutions won't correct the problem. Treatment, prevention and education are the foundations of a comprehensive program. We ignore these methods at our own peril.

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A 22-year veteran of the Akron (Ohio) Fire Department, Lt. Marc D. Greenwood, EMT — P, also has worked with American Medical Response for 16 years. He has been published in several fire service journals and EMS/healthcare magazines. Greenwood can be e-mailed at mgreenwood@ci.akron.oh.us.