Take This Cup and…

After about 20 years in nursing I’ve learned to take a methodical approach to certain things. Lab tests, for instance– why not test for everything all the time? That way you won’t miss anything?

It doesn’t work that way. My experience with community screening for diseases like diabetes only reinforces the principle that you need a reason to do a test. Targeted screening is good, random sometimes worse than useless. Wasteful, raising anxiety in people at low risk, missing the ones who need it and scaring people with false positives.

Before testing at all, it’s important to ask what will be done with the results. The ‘Women’s Cancer Screening Program’ for instance, swiftly learned that you don’t say to a patient–‘You have a spot on your mammogram. Have a nice day.’ Nope. You have to refer uninsured women to doctors and hospitals that will provide treatment, and that takes more funding. The ‘Women’s Cancer Screening Program’ saves lives and engages many volunteers and providers to carry out their mission. It’s not as simple as free mammograms.

Testing without a good reason and plan for dealing with the results does more harm than good.

I thought of these things when I got this email from my cousin–

THANK you FLORIDA and KENTUCKY!! Florida and Kentucky are the first states that will require drug testing when applying for welfare, effective July 1st. Some people are crying this is unconstitutional. How is this unconstitutional? Its OK to drug test people who work for their money but not those who don’t (and live off the people who do)? Re-post this if you’d like to see this done in all 50 states.
I didn’t verify it but I’m all for it!!!

Well, it doesn’t exactly verify. Kentucky, according to Snopes.com, has this in the legislature, but not passed. Florida just passed a bill this year and is working out implementation

Is the welfare population especially at risk for drug abuse? Who are they, anyway?

I put ‘Rhode Island welfare’ into Google and got the site of the Rhode Island Department of Human Services. Here’s the menu bar…

Families with Children
Children with Special Needs
Adults with Disabilities

I work with the elder population, and I doubt the benefit of testing all the grandmothers in the high rise buildings. I don’t know if the public wants to cut off benefits for veterans if they have a substance abuse problem– this would seem to call for drug treatment instead. Maybe they are thinking of adults on General Public Assistance…


Rhode Island residents who are between 19 and 64 years old can apply for GPA. To be eligible a person must-

have an illness, injury or medical condition that is expected to last 30 days or more and prevents a person from working
have a monthly income of $327 or less
have resources of less than $400
have only one automobile with an value of less than $4,650
cannot be eligible for other Federal assistance programs, although it is okay to receive SNAP benefits (food stamps)
cannot have a child under 18 living with the applicant
cannot be pregnant

Covered Benefits

The GPA program covers primary care doctors’ office visits/ health centers visits and most generic prescription medications.

When I worked in a primary health clinic there were people who went on public assistance to get coverage for drug treatment. SSTAR detox and drug treatment, for example, accepts Medicare and Medicaide. I can understand the frustration that someone who wrecks their health with drugs can get disability while so many pay a huge chunk of their paycheck for insurance. It is better for society to support drug treatment than to build more prisons, but until we have universal health insurance these inequalities will be a flashpoint for public anger.

Drug tests cost money. Florida’s law requires people applying for public assistance to pay out of pocket for drug tests– if they pass they are reimbursed, if they fail they lose benefits. Since mothers with children are a large percentage of people on public assistance Florida law has a procedure. From the Miami Herald…

• Parents who fail drug tests can get benefits for their children by naming a state-approved designee to collect the money. That designee must also pass a drug test.

This looks messy. It’s not that drug-using parents are okay, but this system seems thrown together and probably unfunded. Who’s going to approve the designee? What happens when there is a dispute?

There are many unanswered questions. What happens with a false positive test? What happens when a prescription drug affects the result? Who evaluates a positive in that case? Which labs will be authorized to do the tests and what will they be allowed to charge? Who guarantees the quality and accuracy of the tests? Governor Scott has a financial interest in a chain of clinics that does drug testing. Does this pass the ethics test?

One of hottest topics in Florida politics these days is Gov. Rick Scott’s plan to start randomly drug testing existing state employees. With estimates of as many as 100,000 tests a year, there would be a lot of money in it for the company that gets to do the testing.

Perhaps not surprisingly, that stirred up talk about Scott’s major investments in Solantic, an urgent-care chain that provides drug-testing services. (During the campaign, he cited its worth as $62 million, deciding to transfer the holdings to his wife’s name after he was elected.)

So, it’s okay I guess.

The new law may not pass the Constitution test. Lawsuits are pending.

A final word about mass screening. You have to look at cost vs benefit.

The most deadly addictive drugs in our country are tobacco and alcohol. They are widely used everywhere. Florida might do more public good with a stop-smoking campaign and a crackdown on drunk driving. The welfare drug test doesn’t cover drinking and smoking.

Another cost, less tangible, is the cost to human dignity. The chain email mentions drug testing ‘people who work for their money’. I don’t think we should accept the idea that our privacy is traded for our paycheck. Some jobs should screen–pilots and truck drivers, for instance. But should everyone get handed a cup, even if they sit at a desk? And there is no problem with their work performance? Does an employer have to have a reason, or is this just the new normal?

Is mass-screening people on public assistance intended to fight drug abuse, or is it a way to please the base, and make a few bucks for some clinics? Are there good options for dealing with the people who test positive, or will they drop off the welfare rolls and end up in the prisons, or in the hospitals at greater expense? Should we institute mandatory testing of politicians? They are responsible to the public, they live on our tax dollars and there is some evidence of substance abuse in that population.

I hope this idea won’t fly in Rhode Island. The best way to solve our social problems is to get our unemployment rate down, and I hope our politicians are keeping their heads clear and working on job creation.

Drug abuse is not limited to the poor, but poor people have not got much opportunity to get help. They can’t just check into the Betty Ford Center. The way to help people beat addiction is to engage them in services, not cut off aid. Too bad Florida did not first build a network of addiction treatment centers, then start a public health outreach. But that would cost money and would not be politically popular.

AND ANOTHER THING: Shockingly, there are people with mental illness and emotional distress who use drugs. Who would have imagined such a thing was possible? It’s called dual diagnosis. Some of the people I’ve worked with who had this problem were military veterans with physical and emotional wounds from war. We are just starting to recognize the damage of traumatic brain injury– the signature wound of the Iraq War. It’s not going to get easier, as long as we damage people faster than we heal them.

THE ICKY PART: Friend Kathryn suggested that our political leaders be the ones who handle the pee cups. That gave me flashbacks to a bathroom with the sink and toilets sealed off, and having to get closer to some grouchy guys than I would prefer. I did a few drug tests when I worked for a walk-in. It’s time-consuming, paperwork-intensive and stressful, because some truck driver’s job depends on the results. I handled the cups, at least I didn’t have to observe the source, as I believe some nurses are required to do. Hey, Florida nurses, thank your governor when the waiting room fills up with sick people while you maintain chain of custody on yellow cups.

4 thoughts on “Take This Cup and…

  1. Nancy-veterans’ benefits are not rescinded or denied because a veteran is drug addicted.Some addiction can be traced to PTSD which is a compensable disability.This is a red herring in the argument.
    I can tell you one thing-my son and daughter both worked security in the public housing high rise unites,originally designated for elderly and disabled residents.
    They both noticed that quite a few “disabled”were drug and alcohol abusers and some others were seriously mentally disturbed.
    Those individuals were a bad mix with the elderly and those who were otherwise physically disabled.
    Both my son and daughter experienced some really bad incidents that occured,including a homicide.They felt that the elderly and physically were placed at unjustified risk in what was supposed to be affordable,safe haven housing.
    The question of why we drug test working people and not people on GPA is interesting.
    My job was subject to involuntary drug testing-it was random and weird.Weird because an agent in my office was tested three times-the guy barely drank,let alone use drugs.
    I was assigned to narcotics enforcement for nine years and never got tested,not like I had any concerns about it-I had my last joint in the 70’s.:))
    I’m not sure about the whole thing-recently my primary care provider asked me to take an HIV test at the VA-I was kind ofoffended,since I don’t engage in high risk sexual activity and I don’t shoot up drugs,and my exposure to contaminated blood products was more than 15 years ago on my job.
    I think it’d have shown up with some symptoms by now,don’t you?
    Anyway ,I took it and surprise,surprise-it was negative.
    This same primary care doc would repeatedly ask me if anything I experienced in Vietnam bothered me so much,it interfered with my life.
    He must have done this four times at least.
    I told him ,finally-“Hey,you’re asking me now?Over 40 years
    later?Very timely”.And the answer was “no”-it was just another year in my life.I’ve really had worse since then.
    Everyone is different.In my case my early childhood was a series of one disease after another-I’d sooner have done a second tour in Nam than repeat those years.Perversely,maybe I built up resistance that has helped me deal with serious disease as an adult.
    I guess my experience could be summarized as”shot at and missed-sh*t at and hit”.
    A last thought-if effective treatment isn’t going to be offered,why test?Treatment is WAY cheaper than incarceration.

  2. I agree about elderly and people with behavior problems not belonging in the same housing. When I worked for Providence Housing they were aware and trying to deal with the problem. I think that people with drug offenses are not eligible for public housing, but there may be exceptions.
    I had a lot of trouble in a nursing home that admitted two disruptive men with a history of violence on a unit that was full of elderly and sick people. I had to play security guard.
    Drug testing won’t do anything about fraud and abuse of the system, I think Florida has enough fraud to pursue, starting with doctors who pad their bills. You’d think Gov. Scott, with his expertise, would be right on that.

    1. I am unfamiliar with the Governor of Florida,so I don’t quuite get your last remark.
      I can’t stand Florida,even to visit.
      I was detailed there twice,which was two times too many.
      I don’t know who is barred from public housing high rises,but there sure were drug users there when my son and daughter were employed.This was in the mid-90’s.
      The VA Hospital has some very irascible patients,so if you’re courteous to the staff(why wouldn’t you be?)you get a nice attitude in return.
      Once,two nurses who knew me from previous stays backed me up against a young surgical resident who wanted to do something that was unecessary and potentially infectious,and they called the senior Nurse Practitioner,who let me get a second opinion from an attending surgeon who had treated me previously-if she wanted me to go along,I was OK with it.
      She actually agreed with me and the problem resolved with merely a minimal treatment.
      Point being,I didn’t get all angry and red faced,I just stood my ground based on logic.

      1. I like working with the VA. The nursing home patient I’m thinking of– without violating confidentiality– was an example of the kind of patient who should not be on a general medical unit. Unfortunately he was shuffled to another nursing home but I think he would have been sent to a higher security place that can handle violence. In that case it was verbal,but the kind of credible threats that even the management had to acknowledge.
        And congratulations on your success in getting good care, more people should speak up when the treatment plan is something they don’t agree
        with. It’s your body and your life.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s