Helping drug users get back to work, not random drug testing, should be our priority

May 15, 2017 by Nicholas Lintzeris, The Conversation
Urine samples can pick up some types of illicit drugs but can’t say whether that drug use affects someone’s ability to look for work. Credit:

Drug testing people on welfare, as proposed in this year's federal budget, is a blunt way of tackling problems drug users face when looking for work.

The underlying concept of increasing employability for people with substance use disorders has some merit. However, any drug testing needs to be better targetted, may be open to legal challenges, and needs to have checks and balances built in to ensure fairness and transparency if welfare payments are quarantined.

The federal government has proposed a two-year trial of random drug testing of 5,000 Newstart and Youth Allowance recipients for , as part of wider welfare reforms. Those testing positive for drugs such as ecstasy, marijuana and methamphetamines (including ice) would have their welfare payments quarantined, limiting cash withdrawals. Further positive tests would have a range of consequences, including a medical assessment with possible referral for treatment.

We need better targeting

Unemployed people have higher rates of substance use disorders (defined as harmful or dependent use) than employed people (8.5% vs 5.5%), so we should applaud the government for trying to address the complex issues of substance use and its impact on people's ability to work.

However, the proposed intervention should be better targetted. Alcohol is by far our biggest "drug problem". Some 4.3% of Australians have an alcohol use disorder, compared with 1% for cannabis and 0.7% for stimulants (amphetamines, ecstasy or cocaine). Alcohol causes over twice the productivity lost in the workplace than all illicit drugs combined.

If we are serious about enhancing employment in our under-employed, then addressing alcohol use must be our top priority.

Then there's the nature of who random drug tests actually identify. While they can identify some people who use drugs, they don't necessarily identify people with a significant drug problem.

That's because, despite common media portrayals, only a minority of people who use (including alcohol, cannabis and stimulants) have a . This is defined as clinically and functionally significant impairment caused by the recurrent use of alcohol and/or drugs.

Such a disorder is often estimated in about one in ten users. For example, 10% of Australian adults reported using cannabis in the past 12 months, but only 1% had a cannabis use disorder in the same period.

So randomised drug tests will entangle many people who do not have significant problems from their substance use.

The emphasis on illicit drugs ignores the bigger problem, alcohol. Credit:

We need checks and balances

There may well be a place for financial quarantining for people with severe substance use disorders, namely people experiencing severe harms from dependent substance use. But there are already systems in place to manage this.

For instance, guardianship involves a tribunal appointing a guardian to make decisions about a person's health, accommodation, services or other lifestyle matters. And administration orders can be put in place to manage people's finances if they lack the mental capacity to do it themselves.

But these are restricted to people with severe conditions and there are a number of checks and balances, such as a tribunal process.

A "one strike" approach to welfare quarantining based on a single drug test is not a sufficiently robust approach.

We need specialist (and timely) referral options

The proposal to refer regular users for treatment and support should be encouraged. When targeted appropriately, treatment can have major benefits to the individual, their families and the broader community.

However, this will require a considerable expansion of drug and alcohol treatment services across Australia. In 2015-16, fewer than one in six people with a substance use disorder received specialist treatment (an estimated 133,895 received treatment of the approximately one million Australians with a substance use disorder).

The current proposal risks further lengthening treatment waiting lists for people with severe substance use disorders. Having treatment places filled with clients with less severe problems motivated by their need to retain welfare payments may not be clever use of resources.

We need to avoid stigmatising drug users

The current proposal may also have unintended consequences. The focus on random drug tests with financial consequences heralds a "war on drugs" approach that worsens discrimination and stigma against people who use drugs, which in turn limits their willingness to seek help from services and their community.

Targeting particular drugs such as cannabis increase the likelihood that people turn to more harmful drugs not screened for, such as synthetic cannabinoids or prescription drugs.

There are already waiting lists for drug and alcohol treatment. So, how will referrals from this proposed random drug testing program fit in? Credit:

We must also recognise many people turn to substance use as a way of coping with stress, such as can occur with long-term unemployment. This strategy further risks increasing the stress and sense of futility experienced by many, particularly in an environment of high unemployment and youth unemployment in particular.

We need to keep an eye on costs

The government has not released the cost of this proposed measure, saying it is commercial-in-confidence. But the project is likely to be expensive to implement.

It's not just the random drug tests and the required workforce that are costly, but the likelihood of fighting expensive legal challenges if saliva tests are relied on. So, any positive saliva test will need to be corroborated using urine or blood tests, which increases costs considerably.

Previous attempts at introducing similar drug testing schemes for welfare recipients in the US, UK and New Zealand have either stalled or been halted through legal challenge.

Then there's the cost of medical assessments, and drug and alcohol treatment referrals.

If the experience in the US is anything to go by, it's very unlikely there will be any net savings in welfare payments.

We need to fine-tune the proposal

Despite these limitations, the underlying concept of increasing employability for under-employed people with substance use disorders has some merit. Yet the government needs to refine the proposal before implementing it.

Refinements should focus on people with severe substance use disorders (including alcohol), and ensuring appropriate drug and alcohol treatment and other services are available to address barriers faced when looking for work.

For example, in a US study of a similarly designed scheme, only one in 20 welfare recipients who tested positive for drugs identified no other significant barrier to employment. Most had a range of other legal, education, general and mental health, housing, and child welfare barriers to finding work.

Integrated and coordinated service packages and partnerships with employers are likely to have longer term benefits, and provide better value than spending money on programs. Financial or welfare quarantining for people with severe problems may have a role as part of the overall approach, not be the centrepiece.

Explore further: Daily stress can trigger uptick in illegal drug use for those on parole, probation

Related Stories

Daily stress can trigger uptick in illegal drug use for those on parole, probation

May 3, 2017
A recent study finds that even small, day-to-day stressors can cause an increase in illegal drug use among people on probation or parole who have a history of substance use. The study could inform future treatment efforts ...

Giving up cigarettes linked with recovery from illicit substance use disorders

March 7, 2017
Smokers in recovery from illicit drug use disorders are at greater risk of relapsing three years later compared with those who do not smoke cigarettes. Results of the study by researchers at Columbia University's Mailman ...

Internists issue recommendations for preventing and treating substance use disorders

March 27, 2017
The American College of Physicians (ACP) today released a paper with a comprehensive set of public policy recommendations for the prevention and treatment of substance use disorders involving illicit and prescription drugs. ...

Pot smokers may face five times greater risk of alcohol abuse

March 8, 2016
(HealthDay)—People who smoke pot may be five times more likely to develop a problem with alcohol, such as addiction, a new study says.

Don't punish pregnant women for opioid use, docs say

February 20, 2017
(HealthDay)—Prevention and treatment, not legal action, should be the focus when dealing with pregnant women who use opioids, a leading pediatricians' group says.

One-third of emergency patients need help with drug and alcohol problems

September 30, 2016
More than a third of people presenting to NSW hospital emergency departments have an underlying drug and alcohol problem requiring intervention, a study led by researchers at UNSW's National Drug and Alcohol Research Centre ...

Recommended for you

New research finds drug for alcohol use disorder ineffective

February 26, 2018
A new study, published in the Addiction journal, conducted by researchers from the University of Liverpool highlights the ineffectiveness of a specific drug treatment for alcohol use disorders.

Most PA students tobacco-free, but vaping and cigarette use still a concern

February 26, 2018
Most of Pennsylvania's high school and middle school students are tobacco-free, but the use of cigarettes, and their digital counterpart, e-cigarettes, is still a cause for concern, according to Penn State researchers.

Cannabinoids are easier on the brain than booze, study finds

February 9, 2018
Marijuana may not be as damaging to the brain as previously thought, according to new research from the University of Colorado Boulder and the CU Change Lab.

Marijuana use may not aid patients in opioid addiction treatment

December 4, 2017
Many patients who are being treated for opioid addiction in a medication-assisted treatment clinic use marijuana to help manage their pain and mood symptoms.

For opiate addiction, study finds drug-assisted treatment is more effective than detox

November 23, 2017
Say you're a publicly insured Californian with an addiction to heroin, fentanyl or prescription narcotics, and you want to quit.

Study finds medical cannabis is effective at reducing opioid addiction

November 17, 2017
A new study conducted by researchers at The University of New Mexico, involving medical cannabis and prescription opioid use among chronic pain patients, found a distinct connection between having the legal ability to use ...

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

1 / 5 (1) May 16, 2017
250mg of healthy adult male facial skin surface lipid "face grease" pheromone cures drug addiction without withdrawal symptoms.
Drug detection should trigger pheromone treatment.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.