The Summer Olympics and the “War on Doping”

 
Time for a change in strategy?

The Summer Olympics are fast approaching, and that can only mean one thing: drugs. After more than a decade, you might wonder, how goes the so-called “War on Doping?”

Not so good, but thanks for asking. The World Anti-Doping Agency, established in 1999 and backed by the UNESCO anti-doping convention, will be operating 24/7 during the games, protecting the “purity” of Sport, trying to ferret out everything from cannabis and cocaine to steroids and arcane metabolites unfamiliar to the world at large. Marijuana as a “performance enhancing” drug? Doesn’t sound likely, but cannabis derivatives are on the banned list anyway. As Bengt Kayser and Barbara Broers of the Institute of Movement Sciences and Sports Medicine at the University of Geneva write in the Harm Reduction Journal, marijuana seems to have been included “largely because of pressure from the ‘war on drugs’ movement, even though there are no known proven performance enhancing effects but rather evidence for the contrary.”

No matter. That’s just for starters. As in life, an athlete can be busted for a banned substance taken days earlier, in some other recreational context, and not intended as a sports enhancer, if the metabolites linger too long in the body. The current policy, Kayser and Broers write, “is still essentially based on repression and surveillance from a zero-tolerance viewpoint.”

Did they say “surveillance?” Top athletes are not like you and me. Jocks operate under a “strict liability” rule: It doesn’t matter how it got in your body, or why. If they find proscribed metabolites, you’re busted. It’s entirely possible to get banned from your sport for life. In 2003, British sprinter Dwain Chambers tested positive for a proscribed substance and was subsequently banned from competition for life by the British Olympic Association. (Chambers recently won an appeal, and continues to compete.)

And to make sure that the Olympic Committee can be diligent about the ever-growing list of banned substances, Olympic-level athletes are subject to something called the “whereabouts” rule, say the authors. Elite athletes must “inform the anti-doping authorities where they will be each day of the year, to allow unannounced out-of (and in)-competition testing…” This requirement is clearly impossible for almost anyone to honor, certainly including globetrotting athletes. But Sebastian Coe, chairman of the London Organizing Committee for the Olympic Games, didn’t let even a ray of ambiguity enter the picture, stating: “I don’t think there is room for drugs cheats in sport.”

However inartfully phrased, this sentiment reflects the Olympic Committee’s desire to increase testing, even though the Geneva sports scientists believe that the “probability for false positives rises with the number of tests performed, as well as with a drop in prevalence of actual doping. Furthermore, for some forms of doping practices, there exist no laboratory tests.” The result? “A greater number of tests would lead to a greater number of false positives, wrongly accusing innocent citizens.”

In fact, you can now be busted even though no trace of a banned drug was found in your blood or urine. Here’s how it works:

Longitudinal testing, looking for fluctuations in certain blood parameters compatible with doping, is now also being introduced. This practice, known as the "athlete biological passport" (ABP), has recently led to the first indictments of athletes, based on indirect indices of presumed doping rather than laboratory tests directly showing the presence of the forbidden substance or their metabolites.

This practice is even shakier, write Kayser and Broers, producing even more false positives “due to analytical variability and outlying individual patterns resulting from the effects of behavior (training, altitude exposure) and genetics.

But the purpose of anti-doping—to celebrate the “clean” and upright athlete as exemplar of everything good and fair—is unrealistic, say the authors. “Doping has always been a part of sports…. Performance enhancement is a logical and essential ingredient of competitive sport. Athletes look for ways to get better, by changing their training paradigm, by eating differently, by taking vitamins, by taking licit medication, by taking supplements.” In short: “The line between licit and illicit fluctuates and has dimensions that can be perceived as arbitrary.”

The essay asks us to consider whether anti-doping tests might one day be logically applied to coaches, trainers, and referees as well—not to mention students studying for a final exam.

So what do we do? Just throw the doors open to any and all drug taking at the Olympics? Since the paper was published in the Harm Reduction Journal, the authors have some thoughts on that. “The argument that it would change sports into an arena akin to Formula 1 where the best engineering team wins is only partly correct,” they write. Which is only partly reassuring. But the authors hasten to argue that “such a scenario is already in place anyway; today well-assisted athletes may engage in complex training regimes and strategic doping while remaining undetected.” They advocate shortening the list of forbidden substances, banning only those with “actually proven performance enhancing effects and major health hazards.” In amateur sports, the authors urge the establishment of so-called steroid clinics, where jocks could get syringes, anonymous service, and professional advice from medical staff.

It would require a major change of heart, and a whole different way of viewing competitive sports. Throttling back the anti-doping program would not sit well with many sports parents of young athletes. The authors are aware of this need, and note that “since athletic careers often start very early, the protection of young talents would be mandatory.”

As a former collegiate athlete, I don’t have an answer to this dilemma. Not even a clue, really. Testing is cumbersome and intrusive and puts the innocent under suspicion. On the other hand, performance-enhancing drugs are unfair and unevenly applied—but so are things like good coaching and state-of-the-art equipment. The answer, perhaps, is to begin viewing anti-doping efforts as wholly distinct from drug war efforts—different rationale, logistics, and deployment.

Kayser B, and Broers B (2012). The Olympics and harm reduction? Harm reduction journal, 9 (1) PMID: 22788912

Photo Credit: http://www1.skysports.com/

From NINA to NSNA: No Smokers Need Apply

 Smoke-free workplace or job discrimination?

It started with hospitals and medical businesses. As more and more states adopted strict policies about smoking, state courts began to bump up against a vexing question—the legal system is being called upon to adjudicate the legality of refusing to hire smokers.

The issue has split the anti-smoking world into two camps, and shines light on the fundamental question: Is it legal to discriminate against tobacco consumers, usually known as smokers, for the use of a lawful product? Will courts uphold cases where employees have been fired for “smelling of smoke”?

20% of Americans continue to smoke. As the New York Times puts it, a shift from “smoke-free” to “smoker-free” workplaces reflects the general feeling that “softer efforts—like banning smoking on company grounds, offering cessation programs and increasing health care premiums for smokers—have not been powerful-enough incentives to quit.”

Join Together reports that under new “tobacco-free” hiring policies, “applicants can be turned away for smoking, or if they are caught smoking after hire. Policies differ by company, but some require applicants to take urine tests for nicotine.”

The chief executive of St. Francis Medical center in Cape Girardeau, Missouri, which recently stopped hiring smokers, said that it was “unfair for employees who maintained healthy lifestyles to have to subsidize those who do not. Essentially that’s what happens.”

The American Lung Association, the American Cancer Society, and the World Health Organization (WHO) do not hire smokers. However, the American Legacy Group, an anti-smoking advocacy organization that does hire tobacco users, argues that “smokers are not the enemy.” In the words of Ellen Vargyas, the group’s chief counsel,  “the best thing we can do is help them quit, not condition employment on whether they quit.”

As Dr. Michael Siegel of  the Boston University School of Public Health told the New York Times: “Unemployment is also bad for health.”

The issue has broader implications, as yet imperfectly explored. Will it become legal to discriminate against alcohol and drug users in general? How about junk food? Should a company be forced to saddle itself with the likely health costs associated with a junk food junkie?

And so on. This one bears watching.

No Urine Test for Addiction

Drug wars never work.

The recognition that drug wars create crime is long overdue. More than fifteen years ago, a study of the economics of street drug dealing by the Rand Corporation confirmed that most drug dealers make more money illegally than they could possibly make through any form of legitimate employment. That equation has not changed.  For minors, drug dealing is without a doubt the best-paying job available to them. 

The effort to combat drugs has poisoned our relationships with other countries. Farmers in Latin America, Southeast Asia, and Afghanistan are not the source of the drug problem. The danger of concentrating on the interdiction of foreign shipments is that it breeds the fantasy solution—a belief that the nation’s drug problem can be solved offshore, if the barriers and borders of the United States are vigorously defended.

Drug wars weaken the force of law at home. Minor drug laws are flouted with impunity, while basic civil rights are under attack in the name of national security. Drug wars ask a lot from citizens:  weakened rules of evidence, the erosion of the doctrine of probable cause, and an end to the presumption of innocence, for starters.

A different strategy would obviate the need for these enhanced powers of repression and control. Drug wars foster a form of social hypocrisy. Many of the country’s finest doctors, scientists, judges, and legislators have routinely used illegal drugs in their past. Yet their lives were not irreparably damaged, their futures thrown on the trash heap. Millions of productive citizens now in their 40s and 50s know that youthful drug use need not be permanently deleterious. They dare not speak up, of course. The people who have the most experience with these drugs have been systematically excluded from the public debate. The emerging models of addictive disease call into question almost every aspect of drug wars as they have been historically waged.

For many Americans, the use of alcohol, cocaine, or any other addictive drug is a matter of personal recreational choice. None of the strategies employed in the drug wars of the past four decades has been able to override the fact that prohibition can only be effective with the cooperation of the citizenry. Without voluntary compliance, the only recourse is federal coercion; some Orwellian nightmare of detection, control, forced detoxification, and detention.

Only a fraction of the nation’s corporations had drug-testing programs in place in 1990, but the number has climbed dramatically ever since. Inaccuracies and false positives have bedeviled drug-testing programs from the outset. Ibuprofen, available over the counter as Advil or Motrin, registers on some tests as positive for marijuana. Cold remedies such as Nyquil, Allerest, Contac, Dimetapp, and Triaminicin all contain a substance, phenylpropanolamine, which sometimes shows up as positive for amphetamine. The list of potential false positives is a long one.

Many drug testing programs do not test for alcohol, and even if such constitutionally dubious testing programs were unerringly accurate in what they do test for, there would still be valid reasons not to adopt them. Few people would insist that the presence of alcohol metabolites in the bloodstream is incontrovertible proof of incompetence on the job. But we frequently make this assumption in the case of illegal drugs, in part because the drug tests themselves are not refined enough to reliably distinguish between casual use and consistent abuse. There is no urine test for addiction. 

Adapted from The Chemical Carousel: What Science Tells Us About Beating Addiction by Dirk Hanson © 2008.

Fewer People Testing Positive For Meth and Cocaine

Quest Diagnostics releases 2007 figures.

Quest Diagnostics, the nation’s leading provider of employee drug testing services, reported a 22 percent drop in the number of U.S. workers and job applicants testing positive for methamphetamine last year. The percentage of positive tests for cocaine fell 19 percent in the same period—the largest single-year decline since 1997, the company reported.

Overall, drug test positives were at an all-time low (see chart). The company said 3.8 percent of employees had tested positive for drug use in 2007, compared to a high of 13.6 in 1988.

Quest Diagnostics based its conclusions on a summary of results from more than 8 million workplace drug tests the company conducted in 2007. The data include pre-employment, random, and for-cause testing. The primary test population included federally mandated testing of “safety-sensitive” workers such as pilots, truck drivers, and employees at nuclear power plants
It is not immediately clear what conclusions can be drawn from the Quest Drug Testing Index. Do the results indicate a falloff of stimulant use, or are they a reflection of scarcities of supply?

The DEA was quick to jump in and claim the latter: “The fact that America’s workers are using cocaine and methamphetamine at some of the lowest levels in years is further evidence of the tremendous success that law enforcement is having at impacting the nation’s illicit drug supply,” Drug Enforcement Administration (DEA) Acting Administrator Michele Leonhard said in a press release.

In the same press release, Dr. Barry Sample of Quest Diagnostics, citing figures that show a 5 percent increase in the use of all forms of amphetamines last year, said: “Although some may conclude that there is a reduced availability for methamphetamine, the fact that our data show an increase in amphetamines suggests that some workers might be replacing one stimulant drug for another in the larger drug class of amphetamines.”

It is also unclear whether or not the lower numbers reflect greater employee awareness of drug testing, and greater knowledge of methods for finessing the testing system, such as a crash course of abstinence when testing is considered likely.

Moreover, drug testing remains a controversial practice. Critics maintain that the costs of drug testing far exceed the benefits of identifying a very small percentage of workers with testing procedures that are not always and inevitably reliable.

In a review of a report on drug testing by the National Academy of Sciences in 1999, the American Civil Liberties Union (ACLU) concluded: “There is as yet no conclusive evidence from properly controlled studies that employment drug testing programs widely discourage drug use or encourage rehabilitation.” According to the ACLU, the federal government spends more than $77,000 dollars for each positive drug test, when overall costs of the federal government’s drug testing program are taken into consideration.

Graphics Credit: Market Wire