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Drugs and alcohol - The Truth

Futurist Topics - Health

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Article for Christian Medical Fellowship by Dr Patrick Dixon

	8% of all international trade is illegal drugs
	80% of all large US companies test workers for drugs
	8% of all men dependent on alcohol or drugs, 2% of women (UK)
	14% of 15-16 year old boys took drugs last week, 11% of girls
	10% of older US pupils take drugs every day
	Updates from 100,000 daily publications + many good links

Drug testing takes off in workplace

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 six months ago the idea seemed so extreme that the government cut it out of the White Paper altogether - with small concessions for prisons and roadside.

Huge policy shift

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 month 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.

80% of all large companies already spend over £200m a year testing for drugs at work, affecting 40% of the US work force. 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.

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.

Drug and alcohol abuse cripples society

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.

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. 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.

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.

Doped doctors kill patients

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%. But 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. 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 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.

Drug testing can be barbaric

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, 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.

Drugs crisis in schools

Schools are facing a new drugs epidemic this Autumn - 1.5 million pupils in the UK have already taken drugs - 300,000 will try them this year. Over 700,000 starting High School this week will find ready access to every illegal drug - from friends. More than 10% will have tried them by the Summer.

Every High 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 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.

Christian mission at forefront of tackling addiction

In Britain and many other nations Christians have been at the cutting edge of developing new care services and in 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. However, expect to see a new rationale for abstention, based on the fact that little in absolute health terms can be martialled against cannabis and ecstasy which should not also be made against alcohol. Example is vital: both in non-use of tobacco and moderate or non-use of alcohol.

Christian position on drug abuse

The starting point for a believer is that all things in creation have been made by God and that we are called to "control and subdue" the earth (Gen 1v21). However 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. (I Cor 6v19). We are told that the issue is not so much the letter of the law - for example does the bible ban cannabis? - but the attitude towards life. "Everything is permissible for me - but not everything is beneficial" says Paul (I Cor 6v12). Example should also influence the believer. (2 Tim 3v10-11)

The biggest drug problem in biblical times was alcohol abuse and the bible is very clear on this, and on the relationship between addiction and faith - or lack of it. Paul suggests replacing drunkenness on alcohol with being "drunk" in the Holy Spirit. "Do not get drunk on wine, which leads to debauchery. Instead be filled with the Holy Spirit." (Eph 5v18). What a strange thing to say! He could so easily have stopped at the end of the first command, as most of our sermons do. Don't get drunk. Instead he follows on with a further command. The two in his mind are linked.

He is not talking about an intellectual grasp of faith that delivers someone from addiction. He is describing an experience of God's power and grace that is so powerful and overwhelming that the person is transformed, changing their habits and desires. Indeed that is the experience of many kicking a drug or alcohol habit as they have found faith. "Faith in Jesus is the biggest buzz a man can ever have". Paul's link of two commands reminds us of an event in history that he knew much about but missed: the day of Pentecost. On that occasion, disciples filled with the Holy Spirit were at first indistinguishable in the eyes of observers from those who were drunk (Acts 2v13). Their psychomotor apparatus was beginning to fail. The disciples themselves were struck by the Holy Spirit in an outward, obvious and dramatic way. Though the outward symptoms would soon fade, their lives from that moment would never be the same.

Cannabis - harmless medicine or total ban?

And what of the cannabis debate? 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 it's way around as easily and as legally as packets of cigarettes in the school playground.

But conventional prevention and control methods are failing, and if the drugs war is to succeed we land up back at the door of random testing. That's why a government opposed to legalisation has come to the reluctant conclusion that random tests are needed. Expect them not only at work but also at school, in measures introduced by teachers, parents and governors in conjunction with pupils themselves, the majority of whom, as we have seen are not interested in taking them.

Cannabis on prescription?

Many physicians are beginning to recognise that cannabis seems to help some patients yet the substance is banned. This is illogical. Doctors have used cocaine in the old Brompton Mixture for pain until it fell into disfavour. We give heroin to relieve suffering. Why the hangup about cannabis? My own view is that medicinal use of cannabis or its derivatives is entirely consistent with the Christian position. The best way forward would seem to me to approve cannabis on prescription, but under strict limits, for example in helping relieve symptoms in the dying.

The Truth about Drugs by Dr Patrick Dixon is published by Hodder and has generated wide media coverage - TV / radio / press since launch. For more see Dr Dixon's Web TV site: http://www.globalchange.com - 350,000 hits in 8 weeks.

The Truth about Drugs by Dr Patrick Dixon was published by Hodder September 1998 and deals comprehensively with issues relating to prevention and treatment - price £7-99. The book has generated wide media coverage - TV / radio / press since launch, particularly over drug testing at work. Latest MEDIA and PRESS interviews. Search this site for more on drugs.

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