Preemployment drug screening

Article Abstract:

While in 1977 drug users were distinguished from drug abusers, the social climate has changed to the point where any drug use can label a person as a drug abuser. Calls for preemployment screening of job applicants' urine ignore the fact that a positive result can occur in a person who used the drug once, as well as in a habitual abuser. An article in the November 28, 1990 issue of The Journal of the American Medical Association reports the results of a survey of postal workers whose urine tested positive for cocaine or marijuana when they were hired. Although negative outcomes (accidents, injuries, absenteeism) were more frequent for these employees than for those who were drug-negative, they were not as frequent as many reports have implied. The increases in rates of these outcomes ranged from 55 percent to 137 percent, not from three- to four-fold, or even more, as some authors have reported. The study was not able to evaluate job performance in true drug abusers, however, which would presumably be worse than that of casual users. Other criticisms of the research methodology, including aspects of subject selection, are made. Two other studies have found significantly greater consequences of drug use for job performance; they are discussed briefly, but also suffer from methodological problems. Preemployment drug test results should be interpreted in their proper context. Federal job applicants must discuss results with a physician trained in substance abuse before they are reported to the employer; this interview can rule out possible confounding factors (diet, other medications). Such rules are not applicable in the private sector. In addition, the number of job applicants who test positive for drugs (usually marijuana) is minuscule compared with the number of people arrested for any reason who test positive for cocaine (50 to 60 percent of all arrestees). Society might well focus its efforts on the greater concentrations of impaired persons who are involved in crimes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Mandatory drug testing, Drug testing, Employee drug abuse, editorial

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Drug and neurotransmitter receptors: new perspectives with clinical relevance

Article Abstract:

Receptors are highly specific recognition sites at which most drugs and neurotransmitters act via initially binding techniques. Two multiple-receptor subtypes, calcium antagonist and benzodiazepine receptors, are described. Several drugs use calcium channels to exert therapeutic and untoward effects. In the case of hypertrophic cardiomyopathy, a heart disease characterized by overgrowth of the heart, the pathology of the disease could be related to high levels of calcium antagonist receptors. In the case of benzodiazepines, a group of mild tranquilizers, discrete central and peripheral receptors are employed to act. Central benzodiazepine receptors assist the neurotransmitter gamma-aminobutyric acid to deliver inhibitory effects. Peripheral benzodiazepine receptors exist in greatest quantities in several endocrine glands and are affected by therapeutic blood levels of such benzodiazepines as diazepam.

Research, Physiological aspects, Cell receptors, Structure-activity relationships (Pharmacology), Benzodiazepines, Neurotransmitter receptors, GABA, Calcium channel blockers, Drug receptors, GABA receptors

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Quality End-of-Life Care: Patients' Perspectives

Article Abstract:

Many patients have definite opinions about end-of-life care. Researchers in Ontario interviewed 48 dialysis patients, 40 HIV-infected people and 38 people in a long-term care facility. Most of the patients wanted to receive adequate treatment for pain and other symptoms. They did not want to prolong the dying process and wanted to have some control over their situation. They did not want to be a burden on their families but at the same time wanted to strengthen their relationships with loved ones.

Terminal care, Beliefs, opinions and attitudes, Quality of life, Public opinion, Patients

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