McCunney R J
Cabot Corporation, Waltham, Massachusetts 02254.
Am J Ind Med. 1989;15(5):589-600. doi: 10.1002/ajim.4700150511.
To control the adverse effects of substance abuse, urinary drug testing has become common practice in some occupational settings. Although it is virtually impossible to assess accurately the impact of drug abuse at work, increased accidents and absenteeism as well as impaired productivity have been attributed to drug abuse. The major analytical techniques used to screen for illegal drug use are thin-layer chromatography and enzyme- and radioimmunoassays. Gas chromatography-mass spectrometry is uniformly recommended to confirm any positive screening test. The major technical problem in interpreting screening tests is that the presence of a substance in the urine indicates merely exposure to the drug, not necessarily intoxication, habituation, or addiction. Since no certifying criteria are available to insure quality control among laboratories performing urinary drug testing, results may vary widely. In fact, a study conducted by the Centers for Disease Control suggests that poor performance of some laboratories may adversely affect the treatment of drug abuse. The Federal Rehabilitation Act (1973, section 504) prohibits discrimination against the handicapped, which includes both drug abuse and alcoholism. Legal challenges to urinary drug testing have focused on issues related to the right to privacy and freedom from unreasonable searches. Because of the wide-ranging legal, ethical, and medical ramifications of drug-screening programs, careful review of these issues is recommended before an organization establishes such a program.
为了控制药物滥用的不良影响，尿液药物检测在一些职业环境中已成为常见做法。尽管几乎不可能准确评估工作场所药物滥用的影响，但事故增加、旷工以及生产力受损都被归因于药物滥用。用于筛查非法药物使用的主要分析技术是薄层色谱法以及酶免疫分析法和放射免疫分析法。气相色谱 - 质谱联用仪被一致推荐用于确认任何阳性筛查结果。解读筛查检测结果的主要技术问题在于，尿液中某种物质的存在仅表明接触过该药物，不一定意味着中毒、习惯化或成瘾。由于没有可用于确保进行尿液药物检测的实验室之间质量控制的认证标准，结果可能差异很大。事实上，疾病控制中心进行的一项研究表明，一些实验室的表现不佳可能会对药物滥用的治疗产生不利影响。《联邦康复法案》（1973年，第504条）禁止歧视残疾人，其中包括药物滥用者和酗酒者。对尿液药物检测的法律质疑主要集中在与隐私权以及免受不合理搜查相关的问题上。由于药物筛查项目涉及广泛的法律、伦理和医学影响，建议组织在建立此类项目之前仔细审查这些问题。
