THE BODY DETECTIVES: 20 YEARS OF DRUG TESTING HAS DEFUSED A
ONCE-CONTROVERSIAL PRACTICE

Drug testing is similar to what some refer to as the "middle child
syndrome." Others call it mediation. Something occurs between two parties
and a third is called in to go back and forth between the two. The third
party can bear the brunt of the tension, and occasionally has to make like a
referee in a boxing match. These people are the epitome of the word
`misunderstood', and of the old cliche, "don't shoot the messenger."

Dr. Darryl Lesoski, M.D. and his peers are the middle child of the drug
testing controversy. As administrators cry out for more drug testing of
workers, and those same workers cry out against an invasion of privacy,
clinical drug testers go about their business, trying not to get too much of
the mess on them.

Dr. Lesoski is the Medical Review Officer for Munson Medical Center; he
describes his job without exaggeration. "I am a physician. The practice that
I do is occupational and environmental medicine. Predominantly we deal with
workplace injuries, illnesses... I'm certified as a medical review officer
(MRO)."

He adds that MROs are physicians who are licensed and have taken a course
and passed an exam to become, "basically the local expert on drug
screening."

20 YEARS

Terry Whalen, the technical director of Munson's laboratories, works closely
with Dr. Lesoski. As far as drug screenings go, Whalen has seen more than
his fair share.

"We've been into drug testing... for over 20 years," Whalen says. "We get a
lot of pre-employment drug screenings."

He notes that the results are sent to Dr. Lesoski who coordinates the
program and is on contract with different businesses in the area. The lab
also does pre-employment testing for businesses under contract.

"We also do drug testing and alcohol testing for accidents," Whalen adds.
"Then if there is an accident on the job site, they'll bring the patient
over and we will do alcohol testing and drug testing."

In addition to drug screenings, the lab at Munson also runs many alcohol
tests.

"We do the legal (alcohol testing) for Antrim, Kalkaska, Grand Traverse and
Leelanau counties," Whalen says. "It really amazes me at the number of
alcohol (testings) that we still do. After all the publicity about not
driving drunk we still do a ton of them. I think we did 17 last Thursday
alone. Frequently our technologist has to go to court to testify. Usually
they hold up; they're very solid and our testing holds up in court."

TAPE ON THE TOILET

Lab technicians have a specific procedure to go through in order to be sure
they have taken a good sample of urine from each donor. "We have paperwork
that (the donor) fills out verifying that it is okay that we take a specimen
from them," says Tricia Jankowski, a phlebotomist in the lab at Munson. "If
they are under 18 there has to be a parent here and we have to have a photo
of them if they don't have an ID. They usually send certain containers with
them if they want, but they have to be sterile. We put tape on the toilet so
they can't turn that water on and try to put that in there. (After that) it
goes straight up to the lab and they are the ones who run it."

As soon as the sample is collected, there are immediate things that the
technicians look for in order to determine if the sample has been altered.
"Is the temperature correct? Because if it's either too cold or too hot we
know it did not come from a human being," Dr. Lesoski says. "So we have to
collect again and then we have to do a collection under observation and I
have to get involved and watch the person pee in a cup."

Whalen states that the lab uses a five-panel testing method referred to as
the Nida-5. Munson performs a colorimetric procedure. Samples are mixed with
various types of reactants and to produce a reaction indicating drug use.

"What we're doing with the instrument is measuring the rate of the reaction;
how fast the reaction takes place," Whalen says. "Then we can relay that
back to the concentration of the drug. So the instruments are very
sophisticated and, I believe, very accurate. What we do with the drugs is
the federal government recommended cut-off points. And the cut-off point,
below it we call it negative and above it we call it positive. It's somewhat
of an arbitrary point that's been given to us and we calibrate the
instrument to that particular point.

"If you did find a touch of the drug you would have a tendency to call it
negative; it probably would not meet this calibration point," Whalen adds.

SHOPPING EXCURSION

As far as what drugs are tested for, lab technologist Tom Clute says, "We
look for amphetamines, barbiturates, opiates, marijuana or THC and PCP, and
we also look for cocaine."

Tests are also run to make sure that the person giving the sample of urine
has not attempted to dilute it. "We do a specific gravity test and a
creatinine test and those two tests tell us if the patient has attempted to
dilute the sample, which is a major consideration," Whalen adds.

If it has been determined that a patient has been using illegal drugs, the
laboratory sends the results to Dr. Lesoski who works with the company that
initiated testing.

"We refer our test results to him and let him do the interpretation," Whalen
says. "Because there is interpretation. He might interview the employee
involved to see if the employee is on any type of therapeutic drugs that may
alter our results and so he makes that type of determination."

"I go through a routine interview asking about prescription drugs and asking
about use of illicit drugs, like marijuana or cocaine," Dr. Lesoski says. "I
would say that out of the positives, 95% of the people admit to using. Some
will say, `I have no idea why it's positive,'... I say you've got to look at
other ways that you may have ingested this or been exposed to it or used it
and how long ago."

GETTING DEFENSIVE

Some who test positive become very defensive about their test results, and
can make things very difficult for Dr. Lesoski.

"A few people get pretty adamant and say there is no way that it is positive
and they want it re-tested and re-tested," he notes. "For those individuals
I can offer to have that same sample sent to another lab to be re-tested
again for that same drug. Out of that half-dozen or so that were very
difficult to deal with, only three of them accepted that offer to pay and
have it re-analyzed, and they all came back positive again."

Even with this option, there are still donors who can be unreasonable, but
Dr. Lesoski is always assured of the veracity of the lab's results. "The
nice thing about drug screens is if you give me a sample of urine, it's a
two-part test," he says. "The first part is called a screening test. It's a
certain procedure they use and they screen for a panel of drugs. If it shows
up positive on that initial test it's sent further on for another test
called a GCMS (Gas Chromatograph-Mass Spectrometer) and it's tested for that
specific drug. And the goal here is that it's set up so not any amount in
the urine is positive; it has to reach a certain cut-off level.

"The reason it's done is because we don't want to have any false positives,"
he adds. "I don't want to have somebody's drug screen come back as positive
and then (have it) be for some other reason. When the federal government set
these regulations, set the standards, they actually, believe it or not, set
the limits to benefit the donors. Most people don't believe that."

SUBSTITUTE URINE

On top of these fail-safes, the lab is required to keep all positive samples
even longer in case it needs to be re-tested. "Then you have to keep that
sample for up to a year afterwards if it was positive if we ever want to
have it re-tested. So I'm comfortable with the procedure of the technical
component. The labs are very regulated. If a federal lab has a
false-positive test, they get investigated by the federal government and
have a chance of getting shut down. Just on one false positive. So if at any
time we have a false positive or think of one, we have to report it
immediately to the government. It's a proven science. It makes my job easier
in that aspect because I don't have to argue about chain of custody, I don't
have to argue, `well was it really my sample, was it not my sample,' or if
the lab screwed up on it. Well, they don't screw up on it. In the times that
people believe it did (screw up) it still came back as positive," Dr.
Lesoski comments.

Although it is a rare occurrence, Dr. Lesoski says that there are times when
people have brought in substitute urine for their screenings, and
occasionally this comes back to bite them. These people will be caught
bringing in outside specimens and will have to give a second sample of their
own, done while the doctor is watching.

But since these donors sign forms stating that all samples they give are
their own, the lab has to test both samples. This is where the weirdness can
start.

"Mostly the first sample (that was brought in from someone else) is negative
and the second (that is really the donor's) is positive," Dr. Lesoski says.
"There are times when the first one has been positive and the second one has
been negative. Their friend or whoever they got the urine from screwed 'em
because they'd have been better off giving their own sample. That's happened
probably three to five times."

THE WHIZZINATOR

According to studies conducted by the federal government, laboratories all
over the country have shown a decline in the number of positives since drug
testing started. But Lesoski says the war on drugs is not being won, even
with those numbers as evidence.

"There are drugs that we are not testing for," he notes. "There are new
drugs out there... and there are always new ways of trying to foil the
system."

One of these new methods Dr. Lesoski mentions is the Whizzinator. The
Whizzinator is proof of how far some will go to produce negative drug screen
results: it is a realistic, prosthetic penis that is worn under the clothes
and drains urine out of the end, so even if a doctor watched the donor give
a sample, there is little chance of being noticed. Extra packages of
dehydrated urine can also be purchased for $12 to ensure that your sample
will be clean. Whizzinators run around $150 plus shipping.

But Lesoski insists that people trying to scam the drug testing system are
in the minority, and states that the controversy over drug testing has died
down and most people are beginning to accept it. "I think it has become more
accepted because of the federal regulations and because of time. Just like
the raising of the drinking age or the close attention to the smoking age.
With time it becomes more acceptable. With time it has proven to be the norm
because more and more employers are doing it, so it's becoming more
acceptable," he says.

PRESCRIPTION DRUGS

As far as what types of drugs people are taking, Dr. Lesoski says that
illegal use of prescription drugs is not being detected as much as people
would think.

"Right now we do not see a lot of positives relating to abuse of
prescription medications," he says. "The reason is different drug screens
only screen for certain drugs... So there is probably some narcotic misuse
that we are not picking up."

He adds that in Northern Michigan there are some old-reliables that seem to
be the most prevalent. "Predominantly though it's marijuana and cocaine.
When I first came up here in `97 I rarely saw cocaine. It seems to be more
and more. It's still not as prevalent as the marijuana, but you see a few
more or you see the double positives, both for marijuana and cocaine. They
are getting more sophisticated in being able to test for the Ecstacy, the
designer drugs, so we'll have that available. I'm not sure how that will
change things. I don't see a lot of abuse of narcotic drugs."

Interestingly, Lesoski is not required to report anyone to the police when
they come back with a positive result on their drug screen. "No I'm not
required. Two states have that; it's Washington and Oregon. Very liberal
states, but at the same time they are the only ones right now. There is a
push right now to have a national reporting database .because if you go
somewhere else no one is going to know that you had a positive drug screen.
Some states are looking at a state database, Michigan does not have that...
for federal mandated drug screens I may see it in the next 10-15 years but
at a state level. I don't think there is a push for it. There will probably
be more of a push for those drivers at a federal level."

MR. & MS. AVERAGE

As far as the average person who comes in for screenings, both Whalen and
Dr. Lesoski agree that there is no average.

"Is there an average type of person? No. It ranges from all different types
and ages," Whalen says. "I would bet the majority are first-time offenders.
We get the repeats in too, but there are a lot of first-time offenders that
are out partying down and kind of forget what they are doing and then they
get caught."

Dr. Lesoski says, "There are people that have come in and I have done
physicals on them and talked to them and have asked questions and they seem
like the everyday person and they come back positive. Some of those people
are recreational users, some are pretty regular users. As a stereotype it is
not the long-haired, tie-dyed, 1970s `hippie type' of person anymore. I
think it's ages from 16-51 for marijuana." "There is no socio-economic
status that is more prevalent," Dr. Lesoski adds. "As an individual it is
not the 25-year-old caucasian male. For the everyday drug screens there
really is no stereotype. Some people ,you look at them and say, `he's gonna
come back positive,' and he doesn't. Then there is 38-year-old who has got
two kids, wife, got a good job and he'll come back positive. But I'm not
surprised anymore because I have seen it all."

When asked the million dollar question as to whether he believes drug
testing is an invasion of privacy, Dr. Lesoski is not hesitant. "I don't,"
he says. "I have to say that if you look at the studies on what drug abusers
cost us as society, it is great."

Drug testing is necessary for the greater good, he says.

"People think, `I use drugs. I get high. It's over.' It's shown that even
with marijuana, up to 24 or 48 hours (after use) there is an effect on our
cognitive or reaction time. It may be an invasion of privacy because it is
your bodily fluids, but at the same time it's done for the greater good of
our public. I don't want my kids in my wife's car next to a big rig who is
illegally using drugs. It's for public safety... or for yourself or for your
coworkers."