Back to work drug screenings
by Glen Pietrandoni, R.Ph.
Well, you think you
feel good enough to go back to work. That’s great! Your
health is good, you have managed the HIV drug regimen and
side effects and you are raring to go! Here is something that
you probably have not thought about—pre-employment
drug screening. As a pharmacist, I get a lot of questions
from HIV positive people regarding drug tests and how to prepare
for them. It is important to understand how the test works,
what employers are looking for, and what to do when it’s
time for your test.
Pre-employment drug screenings
can be given to any prospective job applicant only after an
offer of employment has been made. You do have a right to
refuse to take the test, but you will probably not get the
job. Please be aware that this differs from a random drug
screening that is given after you are hired. An employer has
the right to give a drug test that is not announced on a routine
basis, or if there is suspicion of drug or alcohol abuse on
the job. If you refuse to take these tests, you may be terminated
from the job. Most employers use independent laboratories
to conduct a drug screen. They will in turn give the results
of the test to your employer.
The most common type of pre-employment
drug test is a urine test. It is the easiest and least expensive
test to give, and is used by most companies to screen employees
for use of illegal drugs. It usually can detect use of drugs
for the past few days to a week. Chronic users can expect
their urine to detect drugs even 30 days after the last dose.
Don’t assume you are in the clear if you take a few days
off from your recreational drugs. Many variables affect the
presence of drugs in the urine, including metabolism, frequency
of use, potency of the drug in question, and hydration of
the individual. Depending on the employer and the type of
position you are applying for, a blood or hair test can also
be given. These tests are expensive, but can detect a larger
variety of chemicals and for a longer time period.
Drug screens do not measure
how much drug is in the urine, simply if a drug is present
or not. Only these drugs are tested for in a standard drug
screen:
• Marijuana
(cannabis, hash)
• Cocaine
(crack, benzoylecognine)
• Opiates
(heroin, opium, morphine)
• PCPs (phencyclidine)
• Amphetamines
(speed, methamphetamines)
Tests are not given
to determine the presence of any other compounds. The test
will not know if you are taking anti-retroviral medication
so do not stop taking anti-retroviral medication because of
an upcoming drug screen!!!
Expanded tests can look for
barbiturates, benzodiazepines, methadone, and propoxyphene.
Sometimes, alcohol is tested for, but usually during tests
given after you are hired, or if there is a question of your
sobriety, not for pre-employment. Few companies test for LSD,
MDA, mescaline, or inhalants.
Your future employer wants
to know if you are using illicit drugs, not if you are taking
medication prescribed by a doctor. If you test positive for
any of these drugs you will be asked by a Medical Review Officer
(MRO) who performs the test to show proof of a legal prescription.
This will be reported to the employer as a negative result.
You must be honest with the Medical Review Officer, but you
do not have to disclose your HIV status or HIV medications.
If you take Sustiva, certain urine tests will show a positive
result for marijuana in error. If this occurs, ask the MRO
to confirm the test with another brand of urine test. (False
positive tests occur only with the CEDIA DAU Multi-level THC
assay.)
Examples of prescription
drugs that can cause a positive test are drugs for pain, sleeplessness,
anxiety, neuropathy, and others. Acetaminophen (Tylenol) with
codeine, alprazolam (Xanax), diazepam (Valium), lorazepam
(Ativan), Marinol, tincture of opium, hydrocodone (Anexsia
or Hydrocet) and methadone all will cause positive test results.
Again, be honest with the MRO. It is your responsibility to
clear up any positive results of the drug test. Positive results
resulting from a prescribed drug are reported as negative
to the employer. Copies of prescription receipts or medical
records will be very helpful to the MRO. A pharmacist can
easily give you copies of prescription receipts if you need
them.
If you think you have a foolproof
way to “trick” the tests into giving false negative
results, you might be fooled yourself. I am certain the MROs
have heard and seen everything. The McDonald’s poppy-seed
bun trick is not going to work! There are products on the
market in health food stores and on the internet sold for
this purpose. It is possible to dilute the urine with herbs
and teas. Results of tampered urine will almost always come
back as inconclusive rather than positive or negative.
This is a red flag to the MRO, who will have to repeat the
test. After a similar result on a subsequent test, the MRO
will have no choice but to report this to the employer, and
the job may not be yours after all. There are websites devoted
to this topic that may assist you in your search for information
(www.cleartest.com).
Some doctors may be sympathetic
to the common use of marijuana to alleviate nausea and increase
appetite in their patients living with HIV/AIDS. If you have
a good, open relationship with your physician, it may be possible
for your physician to assist you in explaining a positive
test result for marijuana. Speak to your physician before
you go to have the test performed about their willingness
to help.
When it’s your turn
for the drug screen, be honest with the MROs and do not stop
taking your anti-retroviral medication. Be prepared with proof
of prescription drug records and remember it is your responsibility
to clear up any positive results before they are sent to the
new employer.
Glen Pietrandoni is director
of Clinical Pharmacy Services for the Walgreen Specialty Pharmacy,
focusing on HIV, located in the Howard Brown Health Center
of Chicago.
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