Clueless psychiatrist, or what? Drug test dilemma.
February 12, 2014 8:32 AM   Subscribe

My adult son mentioned to his psychiatrist that he had to take a drug test for a job he'd applied for. He was not sent to an outside lab, but peed in a cup at the workplace. Son wasn't asked by the tester what meds he's taking and he didn't offer the information. His psychiatrist said that the drug test will reveal all his current medications and that it is possible that the employer will now discriminate against him. What???!

This is counter to everything I've heard about drug testing: that they are looking for particular substances and that even if they are found, the applicant will be contacted first and the employer will not be notified if the drugs were legally prescribed. None of my son's medications are opiates or stimulants, but he does take an antipsychotic and an antiepileptic for a condition that is well-controlled. This sounds so goofy that it makes me question the psychiatrist's professionalism in all things. Is he correct? I assume that this kind of discrimination is illegal in the U.S. Is it commonly practiced anyway?
posted by anonymous to Health & Fitness (11 answers total) 2 users marked this as a favorite
I assume that this kind of discrimination is illegal in the U.S.

That's a difficult question to answer. In general, the Americans with Disabilities Act would make discrimination against your son based on a medical issue that does not affect his work performance in any way illegal.

Is it commonly practiced anyway?

Of course. "He isn't a great fit for the company" makes it very hard to do anything about such discrimination at the time of hiring.

There really isn't anything you can do here. He hasn't been damaged in any way yet (he hasn't been denied employment) and even if he is denied employment, he'd have to work pretty darn hard to prove that the medications he took resulted in being denied employment. If you did find a way to prove that, he'd likely have to sue the employer, which doesn't make him look like a very attractive applicant in the future.
posted by saeculorum at 8:53 AM on February 12, 2014

Most if not all of that information is available via urine testing, if they choose to do so. The employer will do whatever they choose with that information, which may include discrimination. I don't know that it is illegal, I don't know if that sort of thing falls under the umbrella of disability discrimination but it would be incredibly difficult to prove. There is certainly no protection regarding what cannot be tested for in a work-related urine test.

A quick google suggests that you or I could buy test strips for all kinds of drugs online right now. With the employer collecting urine at work, without knowing if there was a lab there to pick it up, there's no telling a) how they're testing, b) what they're testing for, c) if they're doing it right.

Many employers love to discriminate, because it makes them more (real or perceived) money. I'm surprised you're surprised.

But it's not free to test for additional substances, and there's probably a point where so much of the population is on psychotropic medications that positive results are kind of meaningless.

Here's some references:
Detection of common anti-psychotic drugs...

PCP false positive [on quick-read urinalysis] induced by lamotrigine (Lamictal).

I don't know the point of the psychiatrist saying anything, though, unless he was worried about liability. I'm assuming your son's choice was take the test or not have the job, so what was he supposed to do?
posted by Lyn Never at 8:54 AM on February 12, 2014

I highly doubt that the drug testing lab will test for anti-psychotics or anti-epileptics[1], if they did I can't imagine that they would disclose their presence to the employer. The employer's contract with the testing lab might actually preclude the lab from disclosing this sort of thing to the employer at all to protect them from discrimination lawsuits.

I am surprised that they didn't ask him about medications he was taking, isn't that a standard question?

[1] on preview though, there might be cross-reactivity as in Lyn Never's link.
posted by atrazine at 8:56 AM on February 12, 2014 [2 favorites]

Testing is more expensive the more things you're looking for. It's unlikely the company is engaging in a large-scale universal testing regime to weed out applicants on legitimate medications.

The real problem here is the psychiatrist telling a client something that the client can't do anything about and will cause anxiety. Your son should probably ask what therapeutic value that discussion was supposed to have.
posted by Etrigan at 9:00 AM on February 12, 2014 [10 favorites]

If they had him pee in a cup at work, my guess is they are trying to save on high-fee 'professional' testing labs.

Which makes me think they probably just bought test strips for heroin/meth/coke/ (maybe marijuana?) off

If this were done by a small-medium sized blue-collar firm, I wouldn't be too surprised. Low margins combined with (relatively very high) drug use among some types of blue-collar workers might mean they want to make sure he's not taking meth.

If this were done by a white-collar firm... Then that is weird. But I still suspect they are trying to save money by just using small test kits themselves. Using a few test strips at work with his pee would cost like $15. The same thing through a proper drug testing firm $150++
posted by jjmoney at 9:04 AM on February 12, 2014 [4 favorites]

Oh, I meant to mention that the two (in-lab) drug employment tests (once in the late 90s and once in the mid-2000s) I've taken were not interested in my medical history at all beyond "are you able to urinate to this line in the cup right now or do you need some water and a few minutes?"
posted by Lyn Never at 9:13 AM on February 12, 2014

It really depends on the place you're doing it. I have grown to loathe temp agencies that insist on doing the testing themselves on-site, and the fact that they're allowed to, because it means you have to tell them directly when you're on medications that they're testing for. Which in my case meant disclosing both Ativan and Adderall, even though I provided valid prescriptions for both, and while I did get the initial job from that place, once that ended I never got another phone call from them. When they contract with someone else, I think they're just getting a pass/fail and I'm more okay with that.

That said, there was a very defined and relatively limited list of things that the test in question was looking for, and benzos and amphetamines were on that list for a reason. The workplace kits are not that complex; they generally sort of have a series of test strips in the jar, each one for a different substance. They could, yes, theoretically send the sample away or something, but I can't imagine them possibly doing so. I think his psychiatrist is right to be wary, but s/he is probably so because of problems in the past with other patients on particular meds, not because they're actually testing for antipsychotics. The ones I've had in the past have not actually had PCP on the list, but they vary a lot, so even if that one might have resulted in a false positive there's a pretty good chance it didn't come up, if not 100%.
posted by Sequence at 9:43 AM on February 12, 2014

There can be false positives. Better to disclose before the test; tester should have asked. He should be prepared to provide information about his prescription medications (and explain that he wasn't asked) in the event there is an issue. Under ADA they should not withdraw job offer with stated fact pattern. Nothing to do now but wait and see.
posted by ClaudiaCenter at 10:46 AM on February 12, 2014

I worked at a drug-testing lab in the early aughts. FWIW I wouldn't expect a psychiatrist to have any particular insight into the process; this one clearly doesn't. Sequence pretty much has it, but I'll add that if they do send it away to a drug testing lab, your chances of a false positive go way down - they do secondary quantitative tests to confirm any original positives from the immunoassay screening. And no, they wouldn't bother trying to figure out what other stuff might be in the sample besides what they were looking for. Even if there were something so similar to what they were testing for that they could see it, the result would still be reported as negative. I remember having tested a few samples that clearly had some new benzodiazepine in them that we could see in our results - but we weren't testing samples to figure out what many crazy things they might have in them, we were testing them to see if they had the specific things in them we were being asked to look for. As far as our reporting went, those samples were reported as negative, full stop.

Oh, but I should add that any results we obtained were reported to whatever client hired us to test the samples. We did not track people down (assuming we were even given the identifying information to do so, which was not typically the case) to give them a chance to show us their prescriptions before reporting back. That was not within our purview.
posted by solotoro at 12:15 PM on February 12, 2014 [1 favorite]

In a cup on site is likely a 5 panel urinalysis. These typically screen for opioids, cocaine, marijuana, meth and PCP.
posted by glaucon at 12:17 PM on February 12, 2014 [1 favorite]

And yes, the tester should have asked about prescriptions prior to administering the test.
posted by glaucon at 12:19 PM on February 12, 2014

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