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Back to Work Drug Screenings

By Glen Pietrandoni, R.Ph.

September/October 2000

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:

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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