tag:theconversation.com,2011:/global/topics/drug-testing-7188/articlesDrug testing – The Conversation2023-11-08T19:10:54Ztag:theconversation.com,2011:article/2166282023-11-08T19:10:54Z2023-11-08T19:10:54ZIs drug testing in the workplace effective or necessary?<figure><img src="https://images.theconversation.com/files/558239/original/file-20231108-25-ssnwv6.jpg?ixlib=rb-1.1.0&rect=702%2C257%2C5228%2C3681&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Shutterstock</span> </figcaption></figure><p>Alcohol and other drug use is a major problem in Australian workplaces costing more than <a href="https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/impacts/economic-impacts#">A$4 billion</a> a year. Of this, $3.6 billion is due to absenteeism.</p>
<p>While testing is <a href="https://www.australiadrugtesting.com/when-you-can-drug-alcohol-test-your-employees/">legal</a> to ensure the health and safety of workers, companies must have explicit policies telling employees their objectives and the consequences of being drug affected at work.</p>
<p>Many workplaces, particularly in safety sensitive industries like building and construction, manufacturing, mining, transport and aviation, test regularly for alcohol and other drugs. Workers can be fired for <a href="https://www.fwc.gov.au/documents/decisionssigned/html/2013fwc2017.htm">refusing</a> to take part.</p>
<p>Both the <a href="https://www.parliament.nsw.gov.au/about/Documents/Independent%20Broderick%20Report.pdf">Broderick report</a> into bullying, harassment and sexual misconduct at the parliament of NSW in 2022 and the <a href="https://humanrights.gov.au/set-standard-2021">Jenkins report</a> into Commonwealth parliamentary workplaces in 2021 identified alcohol as a significant psychosocial risk in the workplace.</p>
<h2>How should testing be conducted?</h2>
<p>While workplace health and safety laws are largely uniform across the country, there are no specific provisions regarding how and in what way alcohol and other drug testing should be conducted.</p>
<p>Most workplaces that test do it either at random intervals and with no notice as workers enter high risk worksites if there is a suspicion of use, or if a safety incident occurs.</p>
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Read more:
<a href="https://theconversation.com/helping-drug-users-get-back-to-work-not-random-drug-testing-should-be-our-priority-77468">Helping drug users get back to work, not random drug testing, should be our priority</a>
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<p>Testing usually involves breath tests for alcohol, similar to police roadside testing of drivers, or urine or saliva tests for other drugs. <a href="https://infostore.saiglobal.com/en-au/standards/as-nzs-4760-2019-1144217_saig_as_as_2711498/">Current</a> <a href="https://www.saiglobal.com/PDFTemp/Previews/OSH/AS/AS4000/4300/4308-2008.pdf">standards</a> require positive tests to undergo further testing in a laboratory to confirm the result.</p>
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<a href="https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Certificate signed by workers to say they agree with their workplace's drug and alcohol free policy" src="https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A workplace must inform its employees if has an alcohol and other drugs testing policy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/search/alcohol-workplace?image_type=photo&page=2">Shutterstock</a></span>
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<p>Alcohol testing is an effective way to detect someone who is unfit for work because they are intoxicated. The test involves measuring alcohol in the blood stream and correlating this with impairment.</p>
<h2>Even workplace testing is not foolproof</h2>
<p>The problem with testing for illicit and pharmaceutical drugs is that these tests don’t necessarily indicate intoxication.</p>
<p>Both urine and saliva tests have <a href="https://www.sydneycriminallawyers.com.au/blog/how-long-will-illicit-drugs-remain-detectable-in-my-system/">long detection windows</a>, so drugs can be detected hours, days or even months after the effects have worn off.</p>
<p>THC (Delta-9 tetrahydrocannabinol), the psychoactive component of cannabis, can be detected up to 30 hours after consumption in a saliva test and nearly a month after consumption in a urine test.</p>
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Read more:
<a href="https://theconversation.com/drink-problems-at-work-got-much-worse-during-the-pandemic-heres-how-employers-can-tackle-them-175467">Drink problems at work got much worse during the pandemic – here's how employers can tackle them</a>
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<p>The Victorian parliament is currently holding an <a href="https://new.parliament.vic.gov.au/workplacedrugtestinginquiry">inquiry</a> into the laws governing workplace drug testing, with a particular focus on whether current laws discriminate against medicinal cannabis users.</p>
<p>Under its <a href="https://new.parliament.vic.gov.au/4a5f0e/contentassets/b5cd021c07d040959123f0bc59c77616/terms-of-reference-attachments/terms-of-reference---inquiry-into-workplace-drug-testing.pdf">terms of reference</a>, the inquiry is considering whether testing may be improved to ensure due process and natural justice occurs in workplaces with these users.</p>
<h2>Is there evidence to support workplace drug testing?</h2>
<p>Drug testing is considered quite invasive so it needs strong evidence to justify its use. But there is very <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293184/">limited research</a> of <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2022.1051119/full">good quality</a> available.</p>
<p>The evidence we do have is <a href="https://pubmed.ncbi.nlm.nih.gov/29582489/">mixed</a>. There is some indication testing can <a href="https://psycnet.apa.org/record/2015-28335-001">reduce risk of injury</a> but other research has found <a href="https://www.liebertpub.com/doi/abs/10.1089/jomh.2014.0008">no impact.</a></p>
<p>The highest quality evidence shows testing doesn’t reduce overall alcohol or other drug use. One study found of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293184/">11 evaluations</a> only two showed tests cut alcohol or other drug use rates.</p>
<h2>What makes good alcohol and other drug policy?</h2>
<p>So testing may be helpful for workplace safety in industries where there is a high risk of injury, but it’s not enough on its own to improve the health of the majority of the workforce.</p>
<p>For that to occur, testing needs to be part of a comprehensive workplace strategy. Fatigue, stress, and mental health problems can all impact on health and safety in similar ways to alcohol and other drugs.</p>
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Read more:
<a href="https://theconversation.com/the-jenkins-review-has-28-recommendations-to-fix-parliaments-toxic-culture-will-our-leaders-listen-172858">The Jenkins review has 28 recommendations to fix parliament's toxic culture – will our leaders listen?</a>
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<p>So there needs to be a broader consideration of “fitness for work” than just alcohol and other drug intoxication.</p>
<p>Also, much of the negative impact of alcohol and other drugs in the workplace is not in safety but in productivity and absenteeism rates.</p>
<p>A good alcohol and other drug policy reduces the damaging effect of usage, fatigue, stress and mental health issues by creating a healthy workplace culture where:</p>
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<li><p>wellbeing is valued and supported</p></li>
<li><p>workers receive early education and support</p></li>
<li><p>managers and team leaders are trained to identify workers at risk</p></li>
<li><p>clear referral options such as an identified employee assistance program (EAP) provider are available</p></li>
<li><p>there are return to work options for workers who have been impaired</p></li>
<li><p>there are clear expectations about what is and what is not acceptable to ensure fitness for work.</p></li>
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<p>Workplaces with effective drug and alcohol policies have happier, healthier and more productive staff and reduced absenteeism.</p>
<p><em>If you are worried about your own or someone else’s alcohol or other drug use, contact the National Alcohol and other Drug Hotline on 1800 250 015 for free, confidential advice.</em></p><img src="https://counter.theconversation.com/content/216628/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee is CEO at Hello Sunday Morning and also works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into alcohol and other drug prevention and treatment.</span></em></p><p class="fine-print"><em><span>Jarryd Bartle does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Testing workers for drug and alcohol use can reduce injuries but is less effective than a comprehensive approach to improving staff health.Jarryd Bartle, Associate Lecturer, RMIT UniversityNicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2146222023-10-12T12:31:00Z2023-10-12T12:31:00ZHorseshoe crab blood is vital for testing intravenous drugs, but new synthetic alternatives could mean pharma won’t bleed this unique species dry<figure><img src="https://images.theconversation.com/files/552874/original/file-20231010-19-onfdw4.jpg?ixlib=rb-1.1.0&rect=33%2C8%2C5579%2C3728&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Horseshoe crabs in spawning season at Reeds Beach, N.J., on June 13, 2023.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/HorseshoeCrabHarvest/053d4f924f9c453f808a4d3724a87e73/photo">AP Photo/Matt Rourke</a></span></figcaption></figure><p>If you have ever gotten a vaccine or received an intravenous drug and did not come down with a potentially life-threatening fever, you can thank a horseshoe crab (<em>Limulus polyphemus</em>).</p>
<p>How can animals that are <a href="https://www.britannica.com/animal/horseshoe-crab">often called living fossils</a>, because they have barely changed over millions of years, be so important in modern medicine? Horseshoe crab blood is used to produce a substance called limulus amebocyte lysate, or LAL, which scientists use to test for <a href="https://www.britannica.com/science/endotoxin">toxic substances called endotoxins</a> in intravenous drugs. </p>
<p>These toxins, produced by bacteria, are ubiquitous in the environment and can’t be removed simply through sterilization. They can cause a reaction historically referred to as “<a href="https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/inspection-technical-guides/pyrogens-still-danger">injection fever</a>.” A strong concentration can lead to shock and even death. </p>
<p>Identifying LAL as a highly sensitive detector of endotoxins was a 20th-century medical safety breakthrough. Now, however, critics are raising questions about environmental impacts and the process for reviewing and approving synthetic alternatives to horseshoe crab blood.</p>
<p>We study <a href="https://scholar.google.com/citations?user=Dd_T980AAAAJ&hl=en&authuser=1&oi=ao">science, technology</a> and <a href="https://www.linkedin.com/in/jolie-crunelle/%20student">public policy</a>, and recently published a <a href="https://osf.io/3tm9g/">white paper</a> examining social, political and economic issues associated with using horseshoe crabs to produce LAL. We see this issue as a test case for complicated problems that cut across multiple agencies and require attention to both nature and human health.</p>
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<figcaption><span class="caption">Protecting horseshoe crabs will require persuading the heavily regulated pharmaceutical industry to embrace change.</span></figcaption>
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<h2>An ocean solution</h2>
<p>Doctors began injecting patients with various solutions <a href="https://doi.org/10.1016/j.socscimed.2004.06.044">in the mid-1800s</a>, but it was not until the 1920s that biochemist <a href="https://lemelson.mit.edu/resources/florence-seibert">Florence Seibert</a> discovered that febrile reactions were due to contaminated water in these solutions. She created a method for detecting and removing the substances that caused this reaction, and it became the medical standard in the 1940s.</p>
<p>Known as the <a href="https://www.matresearch.com/pyrogen-testing/">rabbit pyrogen test</a>, it required scientists to inject intravenous drugs into rabbits, then monitor the animals. A feverish rabbit meant that a batch of drugs was contaminated.</p>
<p>The LAL method was discovered by accident. Working with horseshoe crabs at the <a href="https://www.mbl.edu/">Marine Biological Laboratory</a> at Woods Hole, Massachusetts, in the 1950s and ’60s, <a href="https://www.goldengooseaward.org/01awardees/horseshoe-crab-blood">pathobiologist Frederik Bang and medical researcher Jack Levin</a> noticed that the animals’ <a href="https://hub.jhu.edu/magazine/2021/summer/horseshoe-crabs-covid19-medical-uses/">blue blood</a> coagulated in a curious manner. Through a series of experiments, they isolated endotoxin as the coagulant and devised a method for extracting LAL from the blood. This compound would gel or clot nearly instantaneously in the presence of fever-inducing toxins.</p>
<p>Academic researchers, biomedical companies and the U.S. Food and Drug Administration refined LAL production and measured it against the rabbit test. By the 1990s, LAL was the <a href="https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/inspection-technical-guides/bacterial-endotoxinspyrogens">FDA-approved method</a> for testing medicines for endotoxin, largely replacing rabbits.</p>
<p>Producing LAL requires harvesting horseshoe crabs from oceans and beaches, <a href="https://www.theatlantic.com/technology/archive/2014/02/the-blood-harvest/284078/">draining up to 30% of their blood</a> in a laboratory and returning the live crabs to the ocean. There’s dispute about <a href="https://www.scientificamerican.com/article/medical-labs-may-be-killing-horseshoe-crabs/">how many crabs die in the process</a> – estimates range from a few percent to 30% or more – and about possible harmful effects on survivors. </p>
<p>Today there are five FDA-licensed <a href="https://asmfc.org/uploads/file/645bf065HSC_Biomedical_BMPs_2023.pdf">LAL producers</a> along the U.S. East Coast. The amount of LAL they produce, and its sales value, are proprietary. </p>
<h2>Bait versus biotech</h2>
<p>As biomedical LAL production ramped up in the 1990s, so did harvesting horseshoe crabs to use as bait for other species, particularly eel and whelk for foreign seafood markets. Over the past 25 years, hundreds of thousands – and in the early years, millions – of horseshoe crabs have been harvested each year for these purposes. Combined, the two fisheries kill <a href="https://asmfc.org/species/horseshoe-crab">over half a million</a> horseshoe crabs every year.</p>
<p>There’s no agreed total population estimate for <em>Limulus</em>, but the most recent <a href="https://asmfc.org/uploads/file/63d2ed62HSCAssessment_PeerReviewReport_May2019.pdf">federal assessment of horseshoe crab fisheries</a> found the population was neither strongly growing nor declining.</p>
<p>Conservationists are worried, and not just about the crabs. Millions of shorebirds <a href="https://atlanticflywayshorebirds.org/">migrate along the Atlantic coast</a>, and many stop in spring, when horseshoe crabs spawn on mid-Atlantic beaches, to feed on the crabs’ eggs. Particularly for <a href="https://www.allaboutbirds.org/guide/Red_Knot/overview">red knots</a> – a species that can migrate up to 9,000 miles between the tip of South America and the Canadian Arctic – gorging on horseshoe crab eggs provides a critical energy-rich boost on their grueling journey.</p>
<p>Red knots were <a href="https://www.federalregister.gov/documents/2014/12/11/2014-28338/endangered-and-threatened-wildlife-and-plants-threatened-species-status-for-the-rufa-red-knot">listed as threatened</a> under the Endangered Species Act in 2015, largely because horseshoe crab fishing threatened this key food source. As biomedical crab harvests came to equal or <a href="https://asmfc.org/species/horseshoe-crab">surpass bait harvests</a>, conservation groups began calling on the LAL industry to find new sources.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/Ct2Aji4xcPJ/?utm_source=ig_web_copy_link\u0026igshid=MzRlODBiNWFlZA==","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Biomedical alternatives</h2>
<p>Many important medicines are derived from living organisms. Penicillin, the first important antibiotic, was <a href="https://www.sciencemuseum.org.uk/objects-and-stories/how-was-penicillin-developed">originally produced from molds</a>. Other medicines currently in use come from sources including <a href="https://www.goodrx.com/well-being/diet-nutrition/medications-that-contain-animal-byproducts">cows, pigs, chickens and fish</a>. The ocean is a <a href="https://oceanexplorer.noaa.gov/facts/medicinesfromsea.html">promising source</a> for such products.</p>
<p>When possible, synthesizing these substances in laboratories – especially widely used medications like <a href="https://www.cityofhope.org/breakthroughs/art-riggs-tribute">insulin</a> – offers many benefits. It’s typically cheaper and more efficient, and it avoids putting species at risk, as well as addressing <a href="https://www.uspharmacist.com/article/animal-derived-medications-can-be-problematic-for-some-patients">concerns some patients have</a> about using animal-derived medical products.</p>
<p>In the 1990s, researchers at the National University of Singapore <a href="https://patents.google.com/patent/WO1999015676A1/en?inventor=Jeak+Ling+Ding">invented and patented</a> the first process for creating a synthetic, endotoxin-detecting compound using horseshoe crab DNA and <a href="https://www.genome.gov/genetics-glossary/Recombinant-DNA-Technology">recombinant DNA technology</a>. The result, dubbed recombinant Factor C (rFC), mimicked the first step in the three-part cascade reaction that occurs when LAL is exposed to endotoxin. </p>
<p>Later, several biomedical firms <a href="https://www.americanpharmaceuticalreview.com/Featured-Articles/569887-Historical-Milestones-and-Industry-Drivers-in-the-Development-of-Recombinant-Lysate-for-Bacterial-Endotoxin-Testing/">produced their own versions</a> of rFC and compounds called recombinant cascade reagents (rCRs), which reproduce the entire LAL reaction without using horseshoe crab blood. Yet, today, LAL remains the dominant technology for detecting endotoxins in medicine. </p>
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<a href="https://images.theconversation.com/files/552876/original/file-20231010-22-ilv12l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A vial partly filled with pale blue fluid" src="https://images.theconversation.com/files/552876/original/file-20231010-22-ilv12l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552876/original/file-20231010-22-ilv12l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552876/original/file-20231010-22-ilv12l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552876/original/file-20231010-22-ilv12l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552876/original/file-20231010-22-ilv12l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552876/original/file-20231010-22-ilv12l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552876/original/file-20231010-22-ilv12l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A sample of horseshoe crab blood.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/riAZsU">Florida Fish and Wildlife Commission</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
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<p>The main reason is that the <a href="https://www.usp.org/">U.S. Pharmacopeia</a>, a quasi-regulatory organization that sets safety standards for medical products, considers rFC and rCR as “alternative” methods for detecting endotoxins, so they require case-by-case validation for use – a potentially lengthy and expensive process. The FDA generally defers to the U.S. Pharmacopeia.</p>
<p>A few large pharmaceutical companies with deep pockets have committed to <a href="https://www.esg.lilly.com/environmental/biodiversity?redirect-referrer=https%3A%2F%2Fwww.google.com%2F#case-studies">switching from LAL to rFC</a>. But most drug producers are sticking with the tried-and-true method. </p>
<p>Conservation groups want the U.S. Pharmacopeia to <a href="https://www.audubon.org/magazine/summer-2018/inside-biomedical-revolution-save-horseshoe-crabs">fully certify rFC</a> for use in industry with no extra testing or validation. In their view, LAL producers are stalling rFC and rCR approval to protect their <a href="https://www.npr.org/2023/06/10/1180761446/coastal-biomedical-labs-are-bleeding-more-horseshoe-crabs-with-little-accountabi">market in endotoxin detection</a>. The U.S. Pharmacopeia and LAL producers counter that they are doing due diligence to <a href="https://hsc.criver.com/#lal-endo">protect public health</a>.</p>
<h2>Change in the offing</h2>
<p>Change may be coming. All major LAL producers now have their own recombinant products – a tacit acknowledgment that markets and regulations are moving toward <em>Limulus</em>-free ways to test for endotoxins. </p>
<p>Atlantic fisheries regulators are currently considering <a href="https://www.asmfc.org/home/2023-annual-meeting">new harvest limits for horseshoe crabs</a>, and the U.S. Pharmacopeia is <a href="https://www.uspnf.com/notices/86-bet-using-recombinant-tests-gen-annc-20230822">weighing guidance</a> on recombinant alternatives to LAL. Public comments will be solicited over the winter of 2024, followed by U.S. Pharmacopeia and FDA review. </p>
<p>Even if rFC and rCR don’t win immediate approval, we believe that collecting more complete data on horseshoe crab populations and requiring more transparency from the LAL industry on <a href="https://asmfc.org/uploads/file/645bf065HSC_Biomedical_BMPs_2023.pdf">how it handles the crabs</a> would represent progress. So would directing medical companies to use recombinant products for testing during the manufacturing process, while saving LAL solely for final product testing. </p>
<p>Making policy on complex scientific issues across diverse agencies is never easy. But in our view, incremental actions that protect both human health and the environment could be important steps forward.</p><img src="https://counter.theconversation.com/content/214622/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This material is based upon work supported by the National Science Foundation under Award No. 2121146, as well as the Leverhulme Trust through a Leverhulme Trust Research Project Grant. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation or the Leverhulme Trust.</span></em></p><p class="fine-print"><em><span>Jolie Crunelle receives funding from the Aberg Family Fellowship at Rochester Institute of Technology. </span></em></p>Horseshoe crabs play a unique role in medicine, but they’re also ecologically important in their home waters along the Atlantic coast. Can regulators balance the needs of humans and nature?Kristoffer Whitney, Associate Professor of Science, Technology and Society, Rochester Institute of TechnologyJolie Crunelle, Master's Degree Student in Science, Technology, and Public Policy, Rochester Institute of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2063472023-05-25T15:47:46Z2023-05-25T15:47:46ZTranq: first UK death from the flesh-rotting ‘zombie drug’ xylazine<p>The flesh-rotting “zombie drug” xylazine has been <a href="https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine#:%7E:text=United%20States%20Drug%20Enforcement%20Administration,-Search&text=">wreaking havoc</a> in the US. Now it’s in the UK. A <a href="https://www.sciencedirect.com/science/article/pii/S1752928X23000604?via%3Dihub%20%22%22">toxicology report</a> showed that a middle-aged man from Solihull, England, died from the effects of xylazine, heroin, fentanyl and cocaine.</p>
<p>Drug overdoses in the US have been increasing over the last 20 years, with <a href="https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates">over 100,000 overdose deaths</a> reported in 2021, largely driven by <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00043-3/fulltext">opioids</a>. It is one of the worst public health disasters to have ever affected the US and Canada. </p>
<p>To add to this already devastating trend, US heroin supplies are now commonly adulterated with the strong synthetic opioid fentanyl and the animal tranquillizer xylazine to reduce the cost of producing large batches of heroin. In some regions, there are reports that over <a href="https://www.cfsre.org/nps-discovery/drug-checking/drug-checking-q3-2022-philadelphia-pennsylvania-usa?mc_cid=260fcc43dd&mc_eid=b3ed6bf795%5C">90%</a> of heroin contains this combination. </p>
<p>Xylazine – termed “tranq” or “tranq dope” when combined with heroin and fentanyl – is used in veterinary medicine to induce sedation, pain relief and muscle relaxation, but is not approved for human use.</p>
<p>Both xylazine and fentanyl are psychoactive and add to the effects that a user experiences. Fentanyl is a short-acting drug and the addition of xylazine extends the resulting feeling of euphoria to mimic the effects of heroin. </p>
<p>However, many users are unaware that the heroin is adulterated (or “cut”) with these other substances, and this can lead to unintended side-effects and even overdose. </p>
<p>For example, when xylazine is injected it can cause open wounds such as skin ulcers and abscesses to form. With long-term use, these lesions can become widespread across the arms and legs causing tissue death, hence its nickname: the zombie drug.</p>
<p>Although xylazine was first detected in the US illicit drug supply in the early 2000s, the <a href="https://www.sciencedirect.com/science/article/pii/S1752928X23000604?via%3Dihub">first evidence</a> of its use outside of North America was its detection in the drug-related death that occurred in Solihull. My colleagues and I reported on this case in the <a href="https://www.sciencedirect.com/science/article/pii/S1752928X23000604?via%3Dihub%20%22%22">Journal of Forensic and Legal Medicine</a>.</p>
<p>The death involved a 43-year-old man with a history of illicit drug use. No natural disease was identified in any of his main organ systems by the post-mortem examination. But several drugs were detected by post-mortem toxicology: eight in both the blood and urine, and an additional three in the urine. </p>
<p>The man’s death was concluded to have occurred from a combination of heroin, fentanyl, cocaine and xylazine. There was evidence to suggest that this drug combination had been injected.</p>
<p>When Dr Alexander Lawson, a toxicologist at Birmingham Heartlands Hospital and co-author of our report, analysed the blood and urine samples for this case, he noticed an anomalous peak in the original test results, which was subsequently identified as xylazine. </p>
<h2>A shift in heroin supply</h2>
<p>Xylazine is not included in standard toxicology drug screens in the UK, so its identification in this case was due to the vigilance of Dr Lawson and his team. This means that there could be additional deaths with xylazine in the UK that have gone undetected. </p>
<p>Indeed, subsequent submissions to the voluntary drug testing service <a href="https://www.wedinos.org/">Wedinos</a> has found xylazine in drug samples of opioids, benzodiazepines (such as Valium) and THC (the active compound in cannabis).</p>
<p>Most of the heroin in the UK has historically come from Afghanistan, whereas heroin in the US usually originates from central and South America. However, the Taliban appear to be holding firm to their promise to <a href="https://www.npr.org/2022/06/02/1102586941/afghanistan-opium-heroin-taliban-poppy-farmers-ban">eradicate poppy field cultivation in Afghanistan</a>. </p>
<p>While the origin of the heroin used in this death in the UK has not been confirmed, this may represent a resulting shift in the UK heroin supply to central and Southern American origins. </p>
<p>Heroin users should therefore be made aware of the additional risks of using “tranq dope”, especially as the opioid overdose reversal agent naloxone is not effective against the sedative effects of xylazine.</p><img src="https://counter.theconversation.com/content/206347/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Copeland does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The flesh-eating drug Xylazine is causing havoc in the US. Now it’s in the UK.Caroline Copeland, Lecturer in Pharmaceutical Medicine, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2006182023-02-27T13:24:07Z2023-02-27T13:24:07ZCan eating poppy seeds affect drug test results? An addiction and pain medicine specialist explains<figure><img src="https://images.theconversation.com/files/512239/original/file-20230224-1769-g9ij77.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eating culinary poppy seeds won’t get you high, but they could lead to a failed drug test.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/midsection-of-woman-holding-bagels-in-plate-royalty-free-image/691138209">Linda Caldwell/EyeEm via Getty Images</a></span></figcaption></figure><p><em>The U.S. Defense Department <a href="https://media.defense.gov/2023/Feb/21/2003164614/-1/-1/1/POPPY-SEEDS-WARNING-MEMO-SIGNED-CONTACT-REDACTED.PDF">issued a memo</a> on Feb. 17, 2023, warning service members to avoid eating poppy seeds because doing so may result in a positive urine test for the opiate codeine. Addiction and pain medicine specialist <a href="https://psychiatry.ufl.edu/profile/reisfield-gary/">Gary Reisfield</a> explains what affects the opiate content of poppy seeds and how they could influence drug tests.</em></p>
<h2>What are poppy seeds?</h2>
<p>Poppy seeds come from a species of poppy plant called <a href="https://www.britannica.com/plant/opium-poppy"><em>Papaver somniferum</em></a>. “Somniferum” is Latin for “<a href="https://www.mcgill.ca/oss/article/drugs-health-history-quirky-science/what-drug-may-have-been-detected-had-dorothys-and-cowardly-lions-urine-been-tested-they-entered">sleep-bringing</a>,” which hints that it might contain opiates – powerful compounds that depress the central nervous system and can induce drowsiness and sleep.</p>
<p>There are two main uses for the opium poppy. It is a source of the opiates used in painkillers, the most biologically active of which are morphine and codeine. Its seeds are also used for cooking and baking.</p>
<p>Poppy seeds themselves don’t contain opiates. But during harvesting, the seeds can <a href="https://www.deadiversion.usdoj.gov/drug_chem_info/unwashed_poppy_seed.pdf">become contaminated</a> with opiates contained in the milky latex of the seed pod covering them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/512234/original/file-20230224-1815-nrztn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of opium poppy heads with drops of opium milk latex leaking from the pod." src="https://images.theconversation.com/files/512234/original/file-20230224-1815-nrztn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512234/original/file-20230224-1815-nrztn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=473&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512234/original/file-20230224-1815-nrztn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=473&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512234/original/file-20230224-1815-nrztn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=473&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512234/original/file-20230224-1815-nrztn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=594&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512234/original/file-20230224-1815-nrztn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=594&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512234/original/file-20230224-1815-nrztn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=594&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The milky latex of poppy seed pods contains opiates.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/opium-poppy-heads-papaver-somniferum-drops-milk-royalty-free-image/1445043432">Daniel Prudek/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>What affects opiate content in poppy seeds?</h2>
<p>Many factors determine the opiate concentrations and ratios of poppies. As with wine grapes, the opiate profile of the poppy plant – and thus its seeds – is <a href="https://doi.org/10.1042/bj0140618">affected by its terroir</a>: climate, soil, amount of sunshine, topography and time of harvest.</p>
<p>Another factor is the variety or cultivar of the plant. For example, there are genetically engineered opium poppies that produce no <a href="https://www.abc.net.au/science/articles/2004/09/23/1203133.htm">morphine or codeine</a> and others that produce <a href="https://doi.org/10.1111/ppl.12086">no opium latex</a> at all.</p>
<h2>Can you get high from eating poppy seeds?</h2>
<p>Practically speaking, you cannot eat enough poppy seeds to get you high. Furthermore, processing dramatically decreases opiate content – for example, by <a href="https://doi.org/10.1021/acs.jafc.0c01681">washing</a> or <a href="https://doi.org/10.3389/fchem.2020.00737">cooking or baking</a> the seeds.</p>
<h2>Do poppy seeds affect drug tests?</h2>
<p>Poppy seeds don’t have nearly enough opiates to intoxicate you. But because drug tests are exquisitely sensitive, consuming certain poppy seed food products can lead to <a href="https://doi.org/10.1016/j.forsciint.2014.04.042">positive urine drug test results for opiates</a> – specifically for morphine, codeine or both. </p>
<p>Under most circumstances, opiate concentrations in the urine are too low to produce a positive test result. But <a href="https://doi.org/10.1093/jat/bkac079">certain food products</a> – and it’s generally impossible to know which ones, because opiate content does not appear on food labels – contain enough opiates to produce positive test results. Moreover, because of overlap in opiate concentrations and morphine-to-codeine ratios, it can sometimes be <a href="https://doi.org/10.1093/jat/bkac079">challenging to distinguish</a> test results that are due to the consumption of poppy seeds from those that are due to the use of opiate drugs. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/512229/original/file-20230224-1687-j2ktnx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bowl and scoop of poppy seeds" src="https://images.theconversation.com/files/512229/original/file-20230224-1687-j2ktnx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512229/original/file-20230224-1687-j2ktnx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512229/original/file-20230224-1687-j2ktnx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512229/original/file-20230224-1687-j2ktnx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512229/original/file-20230224-1687-j2ktnx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512229/original/file-20230224-1687-j2ktnx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512229/original/file-20230224-1687-j2ktnx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Processing poppy seeds decreases the opiate content that may be on the seed.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/poppy-seeds-royalty-free-image/1257842791">Burcu Atalay Tankut/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>This is not a problem with most <a href="https://www.ecfr.gov/current/title-49/subtitle-A/part-40#40.137">workplace drug testing</a>. Test results are reviewed by a specially trained physician called a medical review officer. Unless the physician finds evidence of unauthorized opiate use, such as needle marks or signs of opiate intoxication or withdrawal, even relatively high concentrations of opiates in the urine that produce positive test results are generally ruled to be negative.</p>
<p>It turns out, though, that <a href="https://www.washingtonpost.com/nation/2023/02/22/poppy-seeds-drug-test-military/">drug testing in the military</a> is different, and poppy seeds pose potential problems. One such problem, as highlighted in recent news reports, concerns service members who test positive for codeine and assert a “poppy seed defense.” They are still regarded as having taken codeine, sometimes with <a href="https://www.defense.gov/News/News-Stories/Article/Article/3306336/service-members-should-avoid-foods-with-poppy-seeds/">serious consequences</a>, such as a disciplinary action or discharge from the service.</p><img src="https://counter.theconversation.com/content/200618/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gary Reisfield does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Poppy seeds can become contaminated with opiates during harvesting. For the US Defense Department, invoking a ‘poppy seed defense’ may not be enough to rule out a positive drug test result.Gary Reisfield, Associate Professor of Psychiatry, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1928552022-10-20T01:32:05Z2022-10-20T01:32:05ZAn entirely new illicit drug has been discovered by Australian chemists. Here’s how they did it<figure><img src="https://images.theconversation.com/files/490583/original/file-20221019-22-c1leoa.jpg?ixlib=rb-1.1.0&rect=42%2C5%2C3282%2C1989&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Malcolm McLeod/ANU</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Imagine, if you will, a small plastic baggy containing a mixture of crystals and powder. </p>
<p>The person presenting it thinks “it might be ketamine?”, but admits the subjective effects are different to what they’re used to. How do we find out if it’s what they think it is? And what are the consequences if it isn’t?</p>
<p>This is a typical scenario for the people working at <a href="https://www.cahma.org.au/services/cantest/">CanTEST</a> – Australia’s first and only fixed-site, face-to-face drug checking service, located in Canberra.</p>
<p>And in this case, it led chemists to discover a drug never before seen in Australia, and with no associated clinical information from anywhere in the world.</p>
<h2>Identifying ‘chemical X’</h2>
<p>The identification of <a href="https://adf.org.au/drug-facts/new-psychoactive-substances/">new psychoactive substances</a> – drugs made to resemble established illicit drugs – presents a major challenge when pill-testing. Testing a chemical provides us with its “fingerprint” that will hopefully match one of the thousands stored in databases available to analysts.</p>
<p>But what happens when a fingerprint doesn’t provide a match and we have come across “chemical X”? </p>
<p>That brings us back to the original baggy of powder. </p>
<p>Patrick Yates, a PhD candidate from the Australian National University’s Research School of Chemistry, ran the sample through the first piece of equipment, the Fourier transform infrared (FTIR) spectrometer – a workhorse of many drug-checking programs around the world.</p>
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<p>FTIR works quickly and reliably – even at a <a href="https://en.wikipedia.org/wiki/Doof">bush doof</a> – as long as an electricity supply is available. It shines a laser on the sample, and the “reflection” (a measure of how the drug shakes and wiggles) is captured and compared to a database of more than 30,000 chemicals.</p>
<p>Patrick’s analysis didn’t confirm a ketamine match, but suggested it might be a relatively new ketamine analogue called <a href="https://www.sciencedirect.com/science/article/pii/S0379073820301894">2-fluorodeschloroketamine</a> (2-FDCK). However, Patrick’s trained intuition left him doubtful.</p>
<p>PhD student Cassidy Whitefield then turned to an instrument known as ultra-high performance liquid chromatography with photodiode array (UPLC-PDA), humming away in the corner at CanTEST. She ran lab-based standards through it, calibrating the machine to the ten most common drugs we see, including ketamine.</p>
<p>Chemical X had to “run a race” against a known sample, comparing it to already known compounds. The UPLC-PDA test takes about four minutes to run.</p>
<figure class="align-center ">
<img alt="A woman in a lab environment wearing blue gloves leans over a small grey machine" src="https://images.theconversation.com/files/490576/original/file-20221019-14-wsieks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490576/original/file-20221019-14-wsieks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490576/original/file-20221019-14-wsieks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490576/original/file-20221019-14-wsieks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490576/original/file-20221019-14-wsieks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=516&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490576/original/file-20221019-14-wsieks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=516&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490576/original/file-20221019-14-wsieks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=516&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cassidy Whitefield tests a sample by FTIR at CanTEST.</span>
<span class="attribution"><span class="source">Tracey Nearmy/ANU</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>While the sample appeared similar to the ketamine standard, Cassie’s trained eye saw something was off. The rate at which chemical X ran its race (known as the retention time) was similar, but its absorption of ultraviolet radiation was off.</p>
<p>Whatever was there was real, quite pure, and neither ketamine nor 2-FDCK.</p>
<h2>When in doubt, run more tests</h2>
<p>Ketamine is both an invaluable agent in the emergency and pre-hospital environment, and part of an emerging group of illicit drugs known as <a href="https://link.springer.com/referenceworkentry/10.1007/978-3-319-20790-2_124-2">arylcyclohexamines</a>. </p>
<p>In consultation with ANU chemistry professor Mal McLeod, the CanTEST team arrived at chemical X being “ketamine-like”.</p>
<p>The person who brought it in was advised the substance was <em>not</em> ketamine, and its identity could not be ascertained – our band of peer workers advised extreme caution in using it.</p>
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<p>But that was not the end of the story for analytical chemists – the full inquisition was just beginning.</p>
<p>Next up, chemical X was subjected to a method called gas chromatography–mass spectrometry (GC-MS), meaning the sample was made to “run another race”, and was then smashed into pieces to further fingerprint it.</p>
<p>The GC-MS data correlated closely with a ketamine derivative known as <a href="https://www.naddi.org/glossary/fluorexetamine/">fluorexetamine</a>, but the presence of an isomer – two compounds with the same molecular formula but arranged differently – could not be ruled out.</p>
<figure class="align-center ">
<img alt="Blue-gloved hands shaving a small amount of white powder off a solid piece" src="https://images.theconversation.com/files/490584/original/file-20221019-15-3d9kv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490584/original/file-20221019-15-3d9kv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490584/original/file-20221019-15-3d9kv3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490584/original/file-20221019-15-3d9kv3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490584/original/file-20221019-15-3d9kv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=469&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490584/original/file-20221019-15-3d9kv3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=469&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490584/original/file-20221019-15-3d9kv3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=469&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Identifying unknown drugs requires running small amounts of the substance through various testing instruments – from simple to incredibly advanced.</span>
<span class="attribution"><span class="source">ANU</span>, <span class="license">Author provided</span></span>
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</figure>
<p>It was time to bring out the big guns: a nuclear magnetic resonance spectrometer is a chemist’s Book of Runes. Answers can be found, but only by those few who can speak the language well.</p>
<p>Eventually, after a series of multi-dimensional tests, the team figured out there were four hydrogens next to each other around the aromatic ring, meaning it could <em>not</em> be fluorexetamine.</p>
<p>Chemical X could <em>only</em> be something called 2’-fluoro-2-oxo-phenylcyclohexylethylamine. And they had never seen this compound before.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/490782/original/file-20221020-21-3k6de3.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Four chemical structures arranged in a simple chart" src="https://images.theconversation.com/files/490782/original/file-20221020-21-3k6de3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490782/original/file-20221020-21-3k6de3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=570&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490782/original/file-20221020-21-3k6de3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=570&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490782/original/file-20221020-21-3k6de3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=570&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490782/original/file-20221020-21-3k6de3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=717&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490782/original/file-20221020-21-3k6de3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=717&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490782/original/file-20221020-21-3k6de3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=717&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The chemical structures of ketamine, 2-fluorodeschloroketamine, fluorexetamine and ‘CanKet’ – 2’fluoro-2-oxo-PCE.</span>
<span class="attribution"><span class="source">Malcolm McLeod</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>From chemical X to ‘CanKet’</h2>
<p>It’s hard to emphasise what a phenomenal piece of work this was. We contacted our offsiders at the UN Office of Drug Control, the European Monitoring Centre for Drugs and Drug Addiction, as well as several well-positioned researchers in this space from around the world. None had seen the compound before.</p>
<p>Our colleagues at the ACT Government Analytical Laboratory wrote to their international peers; a global forum of forensic and analytical chemists reviewed their locally acquired data and provided information that supported our findings. </p>
<p>We have since found a single further report out of China from a forensically obtained analytical sample, where it was described by another name (2F-NENDCK). As 2’-fluoro-2-oxo-phenylcyclohexylethylamine is a bit of a mouthful, our team has taken to calling it CanKet, as in “Canberra ketamine”.</p>
<p>After this feat of chemical analysis, we are now able to identify CanKet with impunity. We still don’t know its full effects, but thanks to understanding its chemical composition, we have a better idea of what we’re dealing with.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/yes-we-can-do-on-the-spot-drug-testing-quickly-and-safely-73343">Yes, we can do on-the-spot drug testing quickly and safely</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/192855/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Caldicott has previously been a recipient of an NH&MRC Partnership Grant.
He is the Clinical Lead for Pill Testing Australia, and CanTEST.</span></em></p><p class="fine-print"><em><span>Malcolm McLeod is chemistry lead for Pill Testing Australia and the CanTEST Health and Drug Checking Service operated by Directions Health Services and supported the ACT Government. He was awarded a 2020 Churchill Fellowship to visit leading international drug checking services to rapidly improve the analytical chemistry capabilities in Australia.</span></em></p>What happens when drug testing experts come across a substance they have never seen before?David Caldicott, Senior lecturer, Australian National UniversityMalcolm McLeod, Associate Professor, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1636192021-07-06T15:54:10Z2021-07-06T15:54:10ZBanned from the Tokyo Olympics for pot? Let the athletes decide what drugs should be allowed<figure><img src="https://images.theconversation.com/files/409767/original/file-20210705-35826-125fa4y.jpg?ixlib=rb-1.1.0&rect=26%2C26%2C4428%2C2851&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sha'Carri Richardson celebrates during the U.S. Olympic Track and Field trials on June 18. Shortly after the trials, Richardson was suspended for a month for testing positive for marijuana – a ban that will keep her from competing at the Tokyo Olympics.
</span> <span class="attribution"><span class="source">(AP Photo/Ashley Landis) </span></span></figcaption></figure><iframe style="width: 100%; height: 250px; border: none; position: relative; z-index: 1;" src="https://narrations.ad-auris.com/widget/the-conversation-canada/banned-from-the-tokyo-olympics-for-pot--let-the-athletes-decide-what-drugs-should-be-allowed" width="100%" height="400"></iframe>
<p>The <a href="https://www.nytimes.com/2021/07/01/sports/olympics/shacarri-richardson-suspended-marijuana.html">recent suspension</a> of American sprinter Sha’Carri Richardson, who was supposed to be heading to the Tokyo Olympic Games, for testing positive for marijuana has once again raised questions about what drugs should be banned from sports.</p>
<p>Richardson’s suspension is seen by many as an absurd case — namely, the idea of marijuana enhancing the performance in the 100-metre sprint. But as <a href="https://www.theguardian.com/sport/2021/jul/04/shacarri-richardsons-suspension-joe-biden-news">President Joe Biden</a> noted: “The rules are the rules.” And <a href="https://www.independent.co.uk/sport/olympics/sha-carri-richardson-ban-marijuana-olympics-tokyo-b1877118.html">Richardson herself has admitted</a> being responsible for her actions.</p>
<p>But why is a recreational drug like marijuana on the banned substances list in the first place? And should we be reviewing this list because they seem like “<a href="https://www.nytimes.com/2021/07/02/opinion/shacarri-richardson-drug-test-marijuana.html">such ridiculous and cruel standards</a>”?</p>
<p>There are some with more extreme views on doping. They take a position that could be called pharmaceutical libertarianism — <a href="https://bjsm.bmj.com/content/38/6/666">just stop this silly testing game</a>, which costs a great deal of money that could be wisely spent elsewhere in the world of sport.</p>
<h2>Some PEDs are minor</h2>
<p>Certainly, <a href="https://www.wada-ama.org/sites/default/files/resources/files/2021list_en.pd">many of the hundreds of banned substances</a> are really minor when it comes to performance enhancement. But there are also some, <a href="https://www.elsevier.com/books/gene-doping-in-sports/schneider/978-0-12-017651-9">like the potential use of gene doping</a>, that make taking steroids look like eating Smarties.</p>
<p>The World Anti-Doping Agency (WADA) came into being in 1999, shortly after the famous <a href="https://www.cbc.ca/sports/1998-tour-de-france-champion-used-banned-blood-booster-1.1327074#:%7E:text=The%201998%20Tour%20de%20France,being%20ejected%20from%20the%20Tour">1998 Tour de France Festina scandal</a> when civil authorities stepped in for the first time to lay charges for doping.</p>
<p>At the time the first banned list was created, I was director for ethics and education at WADA and I attended some of those early meetings of the agency. There was no question the United States was not going to sign on the <a href="https://www.wada-ama.org/en/what-we-do/the-code">World Anti-Doping Code</a> (WADC) unless marijuana was on the banned list. At that time, Gen. Barry McCaffrey, the director of the U.S. Office of National Drug Control Policy, wanted the code to deal with recreational drugs too, which were part of his office’s mandate. </p>
<p>Caffeine was also on the banned list at the time because of pressure from South American representatives, who didn’t have the money to run an educational campaign to combat an abuse problem in the region. They wanted WADA to deal with the issue instead. Caffeine was eventually <a href="https://www.abc.net.au/news/2003-09-24/caffeine-removed-from-banned-drug-list/1483236">taken off the list</a>, but not before some athletes <a href="https://theolympians.co/2016/12/17/the-good-ol-days-of-doping-in-sports-dqed-for-beer-and-caffeine/">lost their medals</a> for its use.</p>
<figure class="align-center ">
<img alt="A sectioned-off room with white walls, a sliding door, and a urinal." src="https://images.theconversation.com/files/409770/original/file-20210705-126293-44y73f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409770/original/file-20210705-126293-44y73f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409770/original/file-20210705-126293-44y73f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409770/original/file-20210705-126293-44y73f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409770/original/file-20210705-126293-44y73f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409770/original/file-20210705-126293-44y73f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409770/original/file-20210705-126293-44y73f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The processing room of the Doping Control Station at the 2020 Tokyo Olympic and Paralympic Village.</span>
<span class="attribution"><span class="source">(AP Photo/Eugene Hoshiko)</span></span>
</figcaption>
</figure>
<p>There have been political interests involved, and also potential conflicts of interest, because the more things there are to test for, the more money the accredited labs can make from those tests (which can <a href="https://pubs.rsna.org/doi/abs/10.1148/radiol.2301021122?journalCode=radiology">cost more than $1,000</a> per test).</p>
<h2>The criteria for banned substances</h2>
<p>The written <a href="https://www.wada-ama.org/en/questions-answers/prohibited-list-qa">criteria for the banned list</a> in the WADC, of which two must be met for a substance to be banned, are: harm, performance enhancement, or violation of the spirit of sport.</p>
<p>Critics argue that the doping control process has become too expensive, unmanageable and the criteria too vague and ambiguous.</p>
<p>But, of course, when the Russians were <a href="https://www.nytimes.com/2019/12/09/sports/russia-doping-ban.html">caught cheating</a> at the Olympic Games, many were outraged, and rightly so. WADA had to go from relying primarily on analytic lab expertise to a kind of covert espionage intelligence gathering to catch this level of national systemic doping. This wasn’t a rogue athlete like Lance Armstrong. This was state-supported cheating. </p>
<p>So what’s the way forward? I think the answer lies, as always, with the athletes themselves.</p>
<p>In intense international competitions like the Olympics, with all kinds of necessary risks, athletes already pay a very high price to compete, and for the additonal high risks of certain kinds of doping (especially <a href="https://www.elsevier.com/books/gene-doping-in-sports/schneider/978-0-12-017651-9">gene doping</a>, which can be far more performance enhancing and deadly than anything else on the banned list) athlete collectives have supported the bans. At the dozens of WADA meetings I attended, athletes wanted it banned.</p>
<p>Pharmaceutical libertarianism is not what athletes want, for very good reasons. But that does not mean that we do not need to review, and significantly reduce, the banned list.</p>
<p>An athlete-driven list is needed. It’s the athletes who take the risks and pay the price. They should decide what is on it.</p><img src="https://counter.theconversation.com/content/163619/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Angela Schneider received funding from WADA at its inception over twenty years ago. </span></em></p>In the wake of debate about cannabis, performance-enhancing drugs and the Olympic Games, athlete-driven doping legislation is the way forward.Angela Schneider, Director, The International Centre for Olympic Studies, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1601042021-05-24T05:52:49Z2021-05-24T05:52:49ZThe Tokyo Olympics are going ahead, but they will be a much compromised and watered-down event<figure><img src="https://images.theconversation.com/files/402290/original/file-20210524-19-4sqphe.jpg?ixlib=rb-1.1.0&rect=623%2C69%2C4795%2C3444&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">KIMIMASA MAYAMA/EPA</span></span></figcaption></figure><p>With just 60 days to go until the start of the Tokyo Olympics, there are more questions than answers about how such a massive event will take place as the COVID-19 pandemic continues to rage in many parts of the world.</p>
<p>Japan itself is struggling to contain a fourth wave, with a seven-day average of new cases briefly topping 6,000 earlier this month. Hospitals are <a href="https://www.theguardian.com/world/2021/may/14/hospitals-overwhelmed-as-covid-cases-surge-in-osaka">overrun</a> in the city of Osaka and a state of emergency <a href="https://english.kyodonews.net/news/2021/05/d35c8e4fadc4-japan-to-expand-extend-covid-19-state-of-emergency.html">has been extended</a> in Tokyo and other areas.</p>
<p>The vaccine rollout, meanwhile, continues to lag behind most other major economies, with just <a href="https://apnews.com/article/japan-sports-olympic-games-coronavirus-pandemic-coronavirus-vaccine-a9c97783c7d341e24a6b7905c910dcd1">4% of the population</a> having received one or two doses.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/402287/original/file-20210524-15-1f24co1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/402287/original/file-20210524-15-1f24co1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/402287/original/file-20210524-15-1f24co1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/402287/original/file-20210524-15-1f24co1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/402287/original/file-20210524-15-1f24co1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/402287/original/file-20210524-15-1f24co1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/402287/original/file-20210524-15-1f24co1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">With the Olympics approaching, Japan is trying to speed up its vaccination rollout.</span>
<span class="attribution"><span class="source">Kyodo News/AP</span></span>
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</figure>
<p>The key Olympic stakeholders are all sporting a brave face, insisting they are receiving the best possible advice from Japanese health authorities and the World Health Organisation and putting in place the proper protective measures. </p>
<p>The games will likely go ahead, but they will be more watered down compared to the spectacles of years past. This is what a very compromised Olympics could look like.</p>
<h2>No sightseeing or sex (though condoms are on offer)</h2>
<p>The second version of the <a href="https://olympics.com/tokyo-2020/en/games/tokyo-2020-playbooks/">Tokyo 2020 Playbook</a> was recently released, with a third draft expected by June. This spells out clearly and in great detail what is expected in terms of COVID testing and restrictions. </p>
<p>For example, although a vaccination <a href="https://theconversation.com/covid-vaccines-wont-be-compulsory-for-the-tokyo-olympics-but-if-offered-heres-what-athletes-need-to-know-155470#:%7E:text=COVID%20vaccines%20won't%20be%20compulsory%20for%20the%20Tokyo%20Olympics.,-But%20if%20offered">will not be compulsory</a>, everyone will be tested extensively both before and during the games. Attendees will only be permitted to eat in designated settings and allowed limited movement and social interaction in Tokyo. Sightseeing and using public transportation is strictly forbidden.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/402292/original/file-20210524-23-1qpapri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/402292/original/file-20210524-23-1qpapri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/402292/original/file-20210524-23-1qpapri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/402292/original/file-20210524-23-1qpapri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/402292/original/file-20210524-23-1qpapri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/402292/original/file-20210524-23-1qpapri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/402292/original/file-20210524-23-1qpapri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The torch relay is continuing across Japan, albeit in front of sparse crowds — and in some places, no crowds at all.</span>
<span class="attribution"><span class="source">KYDPL KYODO/AP</span></span>
</figcaption>
</figure>
<p>Significantly, each delegation will also have a “COVID liaison officer” to <a href="https://www.swissolympicteam.ch/de/dam/jcr:503bd592-afe2-49da-9e65-6ad7f583c96c/COVID-19%20Liaison%20Officer%20-%20Job%20Description.pdf">ensure all the rules</a> are being followed, which includes keeping tabs on athletes seemingly at all times.</p>
<p>Within the Olympic Village, interactions between athletes will also be greatly restricted. The rules say no hugging, high-fives or sex, though confusingly, the organisers still plan to <a href="https://www.insider.com/tokyo-olympics-athletes-condoms-social-distancing-2021-2">distribute 150,000 condoms</a>. (This is at least far less than the Rio Games, when a record number of <a href="https://www.washingtonpost.com/news/early-lead/wp/2016/07/19/rio-olympics-providing-a-record-number-of-condoms-to-athletes/">450,000 condoms</a> were on offer!) </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/olympic-athletes-speak-up-current-covid-plans-arent-enough-to-keep-them-safe-161268">Olympic athletes speak up: current COVID plans aren't enough to keep them safe</a>
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<p>Ensuring compliance of the rules will be a herculean task. The organisers warn that athletes who violate the rules will not be allowed to compete, will have their accreditation cancelled and must depart the Olympic Village. Yet, it’s likely some athletes will try to beat the system, particularly once their event is over. </p>
<p>Another concern is the <a href="https://www.brisbanetimes.com.au/sport/how-can-the-olympics-protect-78-000-volunteers-from-the-coronavirus-20210503-p57ocm.html?ref=rss">78,000 volunteers</a>, the majority of whom will not be vaccinated and will have limited protections in the way of basic cloth masks, hand sanitiser and guidelines on how to socially distance. </p>
<p>It seems a strange oversight there is not a specific “playbook” for volunteers, just a brief <a href="https://gtimg.tokyo2020.org/image/upload/production/rb1s3z89emfrmugjugfx.pdf">pamphlet</a> on prevention measures. </p>
<h2>A sterile atmosphere — and a financial hit for Japan</h2>
<p>International spectators will not be permitted. And there is no certainty Japanese fans will be allowed to attend, either. A final decision is expected in June. </p>
<p>So, what will the atmosphere be like without large flag-waving crowds? And if those able to attend are <a href="https://amp.brisbanetimes.com.au/world/asia/clap-but-don-t-cheer-how-will-the-tokyo-olympics-work-20210414-p57j0o.html">prohibited from cheering, singing or whistling</a>? (Clapping is acceptable.)</p>
<p>The opening and closing ceremonies will no doubt be more subdued affairs, with perhaps no spectators, <a href="https://www.theaustralian.com.au/sport/olympics/tokyo-olympics-2021-aussie-athletes-to-be-left-stranded-in-tokyo-if-they-fail-test/news-story/6aa962945459a36f142f17b4bc5ea139">reduced team sizes</a> and even the possibility of only a flag bearer for each nation marching in the stadium. A decision is expected in June.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-japan-cancel-the-tokyo-olympics-it-may-not-be-able-to-161121">Should Japan cancel the Tokyo Olympics? It may not be able to</a>
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<p>During a normal Olympics, the host city is always abuzz with many non-sporting attractions, as well, such as the popular Olympic hospitality or partner venues set up by various nations and specialised groups. </p>
<p>In 2016, there were 52 of these in Rio, with 24 open to the public. The other 28 were restricted venues for national Olympic committees and their athletes, officials and sponsors, but they were nevertheless an important sideshow. </p>
<p>Most of these have been cancelled in Tokyo, leaving one less avenue for the Japanese public and athletes to interact during the Olympics. </p>
<p>One of the most popular of these venues is Heineken House (affiliated with the Dutch Olympic Committee and its beer sponsor), but this iconic “party house” will not be found in Tokyo. It hosted <a href="https://www.insidethegames.biz/articles/1099280/no-holland-heineken-house-at-tokyo-2020#:%7E:text=The%20Dutch%20Olympic%20Committee*Dutch,due%20to%20the%20coronavirus%20pandemic">4,000 visitors a day</a> in Rio. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"767540869406662656"}"></div></p>
<p>Traditionally, major sponsors and other companies also offer extensive corporate hospitality programs for visitors. Coca-Cola, for instance, brings in thousands of guests – many from overseas – who receive complimentary event tickets, flights, accommodation, and food and beverages. </p>
<p>The absence of all of these crowds and amenities will certainly diminish the Olympic spirit in Tokyo. It will be a money-loser for the hosts, too.</p>
<p>One study <a href="https://www.insidethegames.biz/articles/1103338/tokyo-2020-no-spectators-economic-loss">estimated</a> staging the Olympics without spectators will result in a US$23.1 billion loss for Japan — both in terms of direct spending linked to the games, and indirect economic effects from household consumption and tourism.</p>
<h2>Has drug testing been compromised?</h2>
<p>Another concern is the absence of drug testing in the lead-up to the games, due to the pandemic. Mack Horton, an Australian swimming gold medallist, <a href="https://www.smh.com.au/sport/swimming/gap-in-drug-testing-has-athletes-on-edge-for-tokyo-horton-20210414-p57j4w.html">said he wasn’t drug tested</a> for nine months during the worst of the pandemic last year, though out-of-competition has <a href="https://www.nytimes.com/2021/05/06/sports/olympics/olympic-drug-testing.html">reportedly picked up again</a> at the start of 2021.</p>
<p>Drug testing has been, at best, inconsistent during the pandemic. Well-resourced countries with strong national anti-doping agencies have kept up their rigorous testing procedures, while other countries reliant on regional agencies have not. </p>
<p>However, the International Testing Agency, an independent body that will handle the anti-doping program at an Olympics <a href="https://www.insidethegames.biz/articles/1107227/ita-facing-covid-challenges-tokyo-2020">for the first time</a>, has pledged a robust approach in the weeks leading up to the games. </p>
<p>It has already performed a risk assessment of athletes likely to take part in the games and issued 26,000 testing recommendations to anti-doping organisations around the world. This is 17 times the pre-games testing recommendations issued before the Rio Games. </p>
<p>The World Anti-Doping Agency has also said it will <a href="https://japantoday.com/category/tokyo-2020-olympics/'game-changing'-drug-tests-to-be-trialled-at-olympics-wada">trial a new form</a> of drug-testing at the games themselves using a small amount of blood from a pricked finger.</p>
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<p>Can the Olympic movement survive the setback of the pandemic and the prospect of a diplomatic boycott of the Beijing 2022 Winter Games due to rising concerns about human rights in China? The games are indeed at a crossroads. What happens with the Tokyo Games may well set the direction for the future of this elite competition.</p><img src="https://counter.theconversation.com/content/160104/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Baka does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>No sightseeing, cheering, singing or (at least officially) sex. This is what an Olympic Games during a pandemic could look like.Richard Baka, Adjunct Fellow, Olympic Scholar and Co-Director of the Olympic Research Network, Institute for Health and Sport, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1580492021-03-29T01:09:47Z2021-03-29T01:09:47ZAlcohol testing at parliament house would not solve the broader problem of a sexist workplace culture<p>Revelations of alleged sexual assault, harassment and bullying in Canberra have driven a wider debate about what some female MPs have <a href="https://www.abc.net.au/news/2021-03-29/female-politicians-reveal-toxic-culture-in-parliament-house/13249844">described</a> as a “toxic workplace culture” at parliament house.</p>
<p>Some have now <a href="https://www.abc.net.au/news/2021-03-28/liberal-backbenchers-urge-drug-alcohol-testing-parliament-house/100034140">floated</a> the idea of alcohol testing politicians at work, with one saying:</p>
<blockquote>
<p>We need to have at least responsible drinking. But even ministers have said to me, ‘You know what Katie, I think even a dry environment might not be a bad thing for parliament.’</p>
</blockquote>
<p>Most workplaces don’t allow their workers to be drunk at work. Most don’t even allow drinking during work hours any more. So a ban on drinking while working is good policy.</p>
<p>But an alcohol ban or alcohol testing at parliament house does not solve the broader problem of a sexist or misogynistic workplace culture.</p>
<p>Although most sexual harassment and bullying is <a href="https://healthandsafetyhandbook.com.au/bulletin/qa-alcohol-and-the-workplace/">associated with alcohol use</a>, alcohol is not the reason people harass, bully or intimidate. The fundamental problem behind those behaviours is attitudes to women.</p>
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Read more:
<a href="https://theconversation.com/drug-and-alcohol-testing-at-work-doesnt-deter-anyone-so-why-do-it-51244">Drug and alcohol testing at work doesn't deter anyone, so why do it?</a>
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<h2>Alcohol testing on-site doesn’t fix cultural issues</h2>
<p>Alcohol causes disinhibition and can lead to poor decision making. So it is a risk factor for problems. It makes bad behaviour more likely, but it doesn’t cause those issues on its own. Attitudes that lead to sexual harassment and assault are a much more complex problem to solve.</p>
<p>The question of whether alcohol should be allowed at work is completely separate from whether testing is a good tool to address the problem. Testing on-site doesn’t address those deeper cultural issues.</p>
<p>In our court system, alcohol or other drug use is generally <a href="https://www.sydneycriminallawyers.com.au/blog/should-drug-addiction-lead-to-a-lesser-sentence/">not considered an argument</a> for a reduced sentence. There is an association between alcohol and other drug use and crimes but it is considered a risk factor, not a cause.</p>
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<a href="https://images.theconversation.com/files/392110/original/file-20210329-13-1idm4e3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People clink wine glasses." src="https://images.theconversation.com/files/392110/original/file-20210329-13-1idm4e3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/392110/original/file-20210329-13-1idm4e3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392110/original/file-20210329-13-1idm4e3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392110/original/file-20210329-13-1idm4e3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392110/original/file-20210329-13-1idm4e3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392110/original/file-20210329-13-1idm4e3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392110/original/file-20210329-13-1idm4e3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Alcohol makes bad behaviour more likely, but it doesn’t cause those issues on its own.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>Testing is often the first thing people think of when there’s a problem where alcohol or other drugs are involved. It’s simple and it’s measurable, so it is sometimes seen as an easy solution to a complex problem. However, it’s <a href="https://theconversation.com/drug-and-alcohol-testing-at-work-doesnt-deter-anyone-so-why-do-it-51244">not a very effective</a> mechanism for addressing the problems that arise around workplace alcohol and other drug use.</p>
<p>As colleagues and I argued in a <a href="https://theconversation.com/drug-and-alcohol-testing-at-work-doesnt-deter-anyone-so-why-do-it-51244">previous</a> Conversation article,</p>
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<p>To be effective, a workplace policy needs to be part of a broader healthy workplace solution that considers drug and alcohol use, mental health, fatigue and other impacts on fitness for work. Extensive manager and worker consultation is essential for effective uptake and implementation.</p>
<p>A clear and well-defined policy includes education and training for managers and workers, and identified referral options such as an employee assistance program. </p>
<p>Workplaces with effective drug and alcohol policies have happier, healthier and more productive staff and reduced absenteeism and presenteeism.</p>
</blockquote>
<p>There’s a place for a discussion about alcohol use at parliament house, as in any workplace. But alcohol testing on-site is just one small part of that discussion.</p>
<h2>Alcohol and the Canberra culture</h2>
<p>Alcohol testing at parliament house is not likely to solve the kinds of problems some female MPs have raised, such as having to contend with <a href="https://www.abc.net.au/news/2021-03-29/female-politicians-reveal-toxic-culture-in-parliament-house/13249844">sexist comments</a> and attitudes at work. </p>
<p>Alcohol testing at work also doesn’t stop people from drinking outside work time, where many of these incidents occur. People will still have drinks after work with workmates and attend work functions where alcohol is served.</p>
<p>Many of the recent allegations relate to drinking that largely took place away from parliament house, outside work hours.</p>
<p>And there are plenty of men and women who get drunk with friends or workmates and they aren’t perpetrators or victims of harassment or assault.</p>
<h2>Workplace alcohol-testing is no silver bullet</h2>
<p>There’s a growing body of evidence looking at alcohol-related interventions among people who work in male-dominated industries. </p>
<p>I led a systematic <a href="https://www.researchgate.net/publication/265295119_A_Systematic_Review_of_Alcohol_Interventions_Among_Workers_in_Male-Dominated_Industries">review</a> of the research, published in the Journal of Men’s Health. Men are generally heavier drinkers of alcohol than women, so are at greater risk of a range of health and social problems.</p>
<p>However, workplace alcohol testing policies, which were examined in a number of studies, <a href="https://www.researchgate.net/publication/265295119_A_Systematic_Review_of_Alcohol_Interventions_Among_Workers_in_Male-Dominated_Industries">did not have a measurable impact</a> on overall drinking rates.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/392108/original/file-20210329-13-1335gd5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man does a breath test for alcohol before entering a mine site." src="https://images.theconversation.com/files/392108/original/file-20210329-13-1335gd5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/392108/original/file-20210329-13-1335gd5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392108/original/file-20210329-13-1335gd5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392108/original/file-20210329-13-1335gd5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392108/original/file-20210329-13-1335gd5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392108/original/file-20210329-13-1335gd5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392108/original/file-20210329-13-1335gd5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Most workplaces that have workplace alcohol and drug testing, such as mining sites, do so because people are operating heavy machinery.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>Alcohol and drug testing in the workplace is not as common as many people think. It tends to be concentrated in safety-sensitive industries. Routine alcohol and drug testing is less common in workplaces that are more corporate or administrative.</p>
<p>Most workplaces that have workplace alcohol and drug testing, such as mining sites, do so because people are operating heavy machinery, vehicles or equipment. They’re often doing work where, if alcohol was involved, injury or death is a possibility.</p>
<p>Most workplaces that have testing in place also have a broader policy that ensures people are fit for work. This includes well developed systems for education at induction, clear guidelines about what happens if you test positive, training for staff and managers and counselling and treatment available if needed. Fit-for-work policies means looking carefully at issues such as stress, fatigue and anxiety.</p>
<p>In other words, even where there is workplace alcohol or drug testing, it’s woven into a much broader set of health and safety policies. On its own, it is no silver bullet.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/view-from-the-hill-morrison-should-appoint-stand-alone-minister-for-women-and-boot-andrew-laming-to-crossbench-158031">View from The Hill: Morrison should appoint stand-alone minister for women and boot Andrew Laming to crossbench</a>
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<img src="https://counter.theconversation.com/content/158049/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment, and currently holds grants and tenders from the Australian Government, and several state and territory governments. She is a member of the Australian Government's Australian National Advisory Council on Alcohol and other Drugs, a member of the board of directors of Hello Sunday Morning and volunteers with The Loop Australia.</span></em></p>Alcohol is not the reason people harass, bully or intimidate. The fundamental problem behind those behaviours is attitudes to women. Testing on-site doesn’t address those deeper cultural issues.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1557372021-03-01T00:38:37Z2021-03-01T00:38:37ZA rare and significant win for prisoners — new limits around drug tests and strip searches<figure><img src="https://images.theconversation.com/files/386574/original/file-20210225-17-146vgrz.jpg?ixlib=rb-1.1.0&rect=0%2C276%2C4477%2C2424&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>Australian prisoners are regularly subjected to drug and alcohol testing and strip searches. </p>
<p>Each state and territory has rules that allow for drug testing and strip searching in prisons, driven by a desire to maintain security. But they can be arbitrarily applied and this has implications for the human rights of prisoners.</p>
<p>However, high-profile Victorian prisoner <a href="https://www.theguardian.com/australia-news/2018/aug/26/a-u-turn-on-the-road-to-redemption-craig-minogue-and-the-russell-street-bombing">Craig Minogue</a> recently had a significant legal win in the Victorian Supreme Court. </p>
<p>Justice Melinda Richards <a href="https://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/vic/VSC//2021/56.html">found</a> human rights considerations had not been taken into account when prison officials established rules allowing for the strip searching of prisoners when being drug tested. This will now place some limits around prison officials’ treatment of prisoners.</p>
<p>However, Richards did state strip searching prisoners when they have contact visits is permitted in the context of a high security prison. </p>
<h2>Who is Craig Minogue?</h2>
<p>Minogue is serving a life sentence at Barwon Prison for his role in the 1986 <a href="https://www.theage.com.au/national/victoria/the-day-terror-came-to-melbourne-the-russell-street-bombing-30-years-on-and-the-murder-of-angela-taylor-20160223-gn15xs.html">Russell Street bombing</a>, which killed Constable Angela Taylor, the first policewoman in Australia killed on duty, and injured 21 other people. </p>
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<p>This is not the first time Minogue has sought to <a href="https://www.abc.net.au/news/2018-06-20/craig-minogue-russell-st-bomber-appeal-high-court/9889186">challenge the conditions of imprisonment</a> (he did a PhD in prison and bills himself as “the most prominent jailhouse lawyer” in Melbourne). But it is his most successful litigation yet. </p>
<h2>What was this challenge about?</h2>
<p>Minogue <a href="https://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/vic/VSC//2021/56.html">challenged three occasions</a> where he had to have a random alcohol and drug test and be strip searched.</p>
<p>The first two instances were in September 2019 and February 2020, when Minogue was required to provide a urine sample after being strip searched. When Minogue challenged prison authorities, he was told it was a “random general test”, to which 5% prisoners are required to submit each month.</p>
<p>The third instance was also in February 2020, before Minogue was visited by his lawyer. He was told to submit to a strip search, which is standard procedure when prisoners receive outside visitors. He refused because he objected to the blanket nature of the policy. </p>
<p>The strip searching procedure is humiliating and invasive of dignity and privacy. In Victoria, the prisoner is forced take off all their clothes, and their mouth, ears, arms are inspected. The genital area is searched, and the prisoner is forced to bend over and part their buttock cheeks. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-prospect-of-release-kevin-crump-and-the-human-rights-implications-of-life-imprisonment-51435">No prospect of release: Kevin Crump and the human rights implications of life imprisonment</a>
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<p>If prisoners refuse to provide a urine sample, according to the Victorian procedures tendered in the Minogue case, they are “secured in a sterile, secure area” for three hours. The idea is that the prisoner might decide to comply in order to be released from that area.</p>
<p>Minogue argued his human rights under <a href="https://www.humanrights.vic.gov.au/for-individuals/human-rights/">Victoria’s Charter of Human Rights</a> were not properly considered by prison authorities, when they made the rules and directions allowing for random drug and alcohol testing and strip searching. </p>
<p>In particular, he argued the right to <a href="https://www.humanrights.vic.gov.au/for-individuals/right-to-privacy-and-reputation/">privacy</a> and the <a href="https://www.humanrights.vic.gov.au/for-individuals/right-to-humane-treatment-when-deprived-of-liberty/">right to be treated with dignity</a> while deprived of liberty were not mentioned in the Corrections Victoria documents, which describe the regime for strip searching and drug and alcohol testing.</p>
<h2>What did the judge say?</h2>
<p>Richards <a href="https://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/vic/VSC//2021/56.html">found</a> the corrections officials who had made the rules and guidelines about drug and alcohol testing had not taken into account relevant human rights. </p>
<blockquote>
<p>There was no examination of the nature and extent of the ‘degrading’ impact of urine testing, and no evaluation of the effectiveness of the random testing regime. Nor was there any consideration of less restrictive means available […] </p>
</blockquote>
<p>She added the testing process “is inherently demeaning”. </p>
<p>The arbitrary nature of drug testing was also criticised by Richards, who noted Minogue had no history of drug use. In more than 30 years in prison, he had never returned a positive result. </p>
<p>Richards also observed the Barwon prison authorities had not properly considered the “human rights impacts of strip searching”, and that the rule that every prisoner must be strip searched before a random drug and alcohol test “was not the result of a thorough and well-reasoned human rights analysis”. </p>
<h2>Reasonable grounds for some strip searches</h2>
<p>However, when it comes to strip searching prisoners before contact visits (as opposed to “box visits” where there is glass separating the prisoner from the visitors), Richards found that in the case of a maximum-security prison like Barwon, there are reasonable grounds to</p>
<blockquote>
<p>strip search all prisoners … before and after any contact visit, whether personal or professional.</p>
</blockquote>
<p>This is because there is a much higher potential for violence than in the general community, or in lower security prisons and contraband can be brought in during contact visits. </p>
<p>In other words, human rights such as the right to privacy and the right to be treated with dignity when deprived of liberty are balanced against the security rating of the prison.</p>
<h2>What does this mean?</h2>
<p>Minogue’s case is important because it represents a rare win for prisoners in challenging corrections regimes. </p>
<p>Generally speaking, the courts see prison rules as matters for governments to change. But Minogue’s case shows that human rights principles can be applied to prison practices and rules.</p>
<p>Whether the Victorian government will appeal the decision is not yet known and there has been no public comment from corrections officials.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/over-1-000-australians-with-cognitive-disability-are-detained-indefinitely-each-year-this-shameful-practice-needs-to-stop-153724">Over 1,000 Australians with cognitive disability are detained indefinitely each year. This shameful practice needs to stop</a>
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<p>In the meantime, it creates new opportunities for them to challenge whether corrections authorities are adequately considering domestic and international human rights laws in the running of their prisons. </p>
<p>Certainly, the use of strip searching and administration of drug and alcohol testing regimes are now vulnerable to similar challenges. </p>
<p>Perhaps the most important feature of Richards’ decision, however, is it reminds corrections authorities that human rights considerations must always be taken into account. </p>
<p>Discipline and behaviour management regimes need to make sure human rights are given more than just lip service.</p><img src="https://counter.theconversation.com/content/155737/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Greg Barns is the national criminal justice spokesman for the Australian Lawyers Alliance and chair of Prisoners Legal Service Tasmania. </span></em></p>A court challenge from high-profile prisoner Craig Minogue will see new limits around prison officials’ treatment of prisonersGreg Barns, Sessional Lecturer in Law, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1460612020-09-21T13:38:41Z2020-09-21T13:38:41ZExplainer: How clinical trials test COVID-19 vaccines<figure><img src="https://images.theconversation.com/files/358513/original/file-20200917-14-1p5cq9j.jpg?ixlib=rb-1.1.0&rect=299%2C0%2C4693%2C3502&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A lab technician holds a vial of a COVID-19 vaccine candidate during testing at the Chula Vaccine Research Center, run by Chulalongkorn University in Bangkok, Thailand on May 25, 2020. </span> <span class="attribution"><span class="source">(AP Photo/Sakchai Lalit)</span></span></figcaption></figure><p>On Sept. 4, 2020, <a href="https://www.politico.com/news/2020/09/04/trump-coronavirus-vaccine-october-409248">President Donald Trump announced</a> that we will have a vaccine for COVID-19 “before the end of the year and maybe even before Nov. 1.” As an election looms in the United States, the declaration fuelled worry that a COVID-19 vaccine may be approved before scientific vetting is complete.</p>
<p>In the United States, review and licensure of vaccines is the responsibility of the Food and Drug Administration (FDA). But the agency’s handling of emergency use authorizations for <a href="https://www.statnews.com/2020/06/16/hydroxychloroquine-emergency-use-patients-politicians/">two anti-malaria drugs</a> and <a href="https://www.sciencemag.org/news/2020/08/fda-s-green-light-treating-covid-19-plasma-critics-see-thin-evidence-and-politics">convalescent blood plasma</a> for the treatment of COVID-19 have led to claims it has become <a href="https://www.citizen.org/news/blatant-politicization-of-the-fda-hurts-its-credibility/">politicized</a>.</p>
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<a href="https://images.theconversation.com/files/358514/original/file-20200917-14-33bn21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A purple-gloved hand is selecting one of nine vials of blood in a green stand." src="https://images.theconversation.com/files/358514/original/file-20200917-14-33bn21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358514/original/file-20200917-14-33bn21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358514/original/file-20200917-14-33bn21.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358514/original/file-20200917-14-33bn21.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358514/original/file-20200917-14-33bn21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358514/original/file-20200917-14-33bn21.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358514/original/file-20200917-14-33bn21.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Blood samples from volunteers are handled in the laboratory at Imperial College in London, on July 30, 2020. Imperial College is working on the development of a COVID-19 vaccine.</span>
<span class="attribution"><span class="source">(AP Photo/Kirsty Wigglesworth)</span></span>
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<p>Such is the worry about the impartiality of the FDA that <a href="https://www.statnews.com/pharmalot/2020/09/07/pharma-covid-19-vaccine-drew-a-line/">pharmaceutical companies drew a line in the sand</a> and <a href="https://www.pfizer.com/news/press-release/press-release-detail/biopharma-leaders-unite-stand-science">pledged publicly</a> to “only submit [a vaccine] for approval or emergency use authorization after demonstrating safety and efficacy through a Phase 3 clinical study.”</p>
<p>“Hell has frozen over,” <a href="https://www.statnews.com/2020/09/10/hell-has-frozen-over-pharmaceutical-industry-stands-in-for-politically-impaired-fda/">remarked commentators</a>.</p>
<p>But what is a Phase 3 clinical study? And how does scientific testing provide us with reliable evidence that vaccines not only work but are safe?</p>
<h2>Vaccine development</h2>
<p><a href="https://www.historyofvaccines.org/content/articles/vaccine-development-testing-and-regulation">Vaccine development</a> can be thought of as the process of separating the parts of an infectious agent that make us sick, from those that induce an immune response and protect us from future infection. As this separation can be accomplished in myriad ways, vaccines are diverse. </p>
<p>Vaccine candidates for COVID-19 <a href="https://doi.org/10.1038/d41586-020-01221-y">illustrate these diverse approaches</a>. Some, such as <a href="https://blogs.sciencemag.org/pipeline/archives/2020/08/17/sinopharms-inactivated-coronavirus-vaccine">SinoPharm’s inactivated coronavirus vaccine</a>, use killed whole coronavirus. Others, such as the <a href="https://www.statnews.com/2020/07/20/study-provides-first-glimpse-of-efficacy-of-oxford-astrazeneca-covid-19-vaccine/">Oxford University-AstraZeneca vaccine</a>, modify a different virus (in this case, chimpanzee adenovirus) to express coronavirus proteins. Yet others, such as <a href="https://www.nationalgeographic.com/science/2020/05/moderna-coronavirus-vaccine-how-it-works-cvd/#:%7E:text=The%20surface%20of%20the%20SARS,it%20can%20establish%20an%20infection.">Moderna’s mRNA vaccine</a>, use only small bits of viral genetic material. </p>
<p>In Canada, the <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/activities/fact-sheets/regulation-vaccines-human-canada.html">oversight of vaccines</a> is shared by <a href="https://www.canada.ca/en/health-canada.html">Health Canada</a> and the <a href="https://www.canada.ca/en/public-health.html">Public Health Agency of Canada</a>. The <a href="https://www.cdc.gov/vaccines/basics/test-approve.html">scientific evaluation of vaccines</a> involves animal testing, human clinical trials and post-approval surveillance. In many regards, the evaluation of vaccines is the same as the process for drugs. Because vaccines are given to healthy people, however, there is an even greater emphasis in vaccine testing on safety. </p>
<h2>Animal testing</h2>
<p>The first step in evaluating a vaccine is animal testing. Animals are given differing doses of vaccine to check for adverse events and an immune response. </p>
<p>As the virus that causes COVID-19 is new, there was no animal model for the disease. <a href="https://doi.org/10.1126/science.abc6141">Recent work</a> has demonstrated that ferrets, cats and some non-human primates are prone to infection and can spread it to others. Animal testing provides information about safety (and perhaps efficacy) before a vaccine is tested on humans.</p>
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<figcaption><span class="caption">What is vaccine development, and how can it be done faster during a pandemic?</span></figcaption>
</figure>
<h2>Human clinical trials</h2>
<p><a href="https://dx.doi.org/10.4103%2F0022-3859.173187">Human testing in clinical trials</a> is divided into three phases. Ensuring the safety of a vaccine is the prime concern through all phases of clinical trials. Vaccine efficacy is evaluated in different ways across the trial spectrum. Early-phase trials look for the production of antibodies against the virus, while late-phase trials evaluate whether the vaccine in fact prevents people from getting sick.</p>
<p>Phase 1 trials are the first evaluations of a vaccine in humans. These trials recruit 10 to 100 healthy volunteers who receive different doses of vaccine. Common adverse events to a vaccine include redness or soreness at the injection site, muscle pains, headache and fever. Blood is also drawn from the volunteers to assess the immune response to the vaccine, particularly the rise in antibodies and whether antibody levels are similar to those in people who have had the disease.</p>
<p>Phase 2 vaccine trials are similar to Phase 1 trials in terms of their focus on adverse events and immune response. Phase 2 trials, however, include hundreds of healthy volunteers who are more diverse to give a better indication of the safety and immune response in people likely to receive the vaccine in the future. </p>
<figure class="align-center ">
<img alt="A woman with her back to the camera sits on the examination table in an examination room as a man in a white coat and purple gloves gives her an injection in her upper left arm." src="https://images.theconversation.com/files/358515/original/file-20200917-18-1dkygf9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358515/original/file-20200917-18-1dkygf9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358515/original/file-20200917-18-1dkygf9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358515/original/file-20200917-18-1dkygf9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358515/original/file-20200917-18-1dkygf9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358515/original/file-20200917-18-1dkygf9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358515/original/file-20200917-18-1dkygf9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pharmacist Michael Witte, left, gives Rebecca Sirull, right, a shot in the first-stage safety study clinical trial of a potential vaccine for COVID-19 on March 16, 2020, at the Kaiser Permanente Washington Health Research Institute in Seattle. Sirull was the third patient to receive the shot in the study.</span>
<span class="attribution"><span class="source">(AP Photo/Ted S. Warren)</span></span>
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<p>As Phase 1 and 2 trials involve relatively small numbers of people, they only give us information on vaccine side-effects that are very common (affecting more than 10 per cent of people) and common (affecting more than one per cent of people). Vaccine efficacy is only evaluated indirectly through measuring antibody levels.</p>
<p>It is only the Phase 3 trials that can provide a pivotal demonstration that a vaccine both works and is safe. Phase 3 vaccine trials are large randomized controlled trials conducted in the community. In these trials people either receive the vaccine or a placebo. If fewer people who received the vaccine become sick compared to those who received placebo, we have direct evidence that the vaccine prevents disease.</p>
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Read more:
<a href="https://theconversation.com/ethics-must-not-be-ignored-when-testing-covid-19-vaccines-141736">Ethics must not be ignored when testing COVID-19 vaccines</a>
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<p>A Phase 3 trial may involve tens of thousands of volunteers who receive the vaccine, further providing reliable information on adverse events, including those that are uncommon (affecting fewer than one per cent of people) or rare (affecting fewer than 0.1 per cent of people).</p>
<p>A vaccine may be licensed for use after a successful Phase 3 trial.</p>
<p>Of the 321 <a href="https://cepi.net/news_cepi/321-vaccine-candidates-against-covid-19-now-in-development/">vaccines for COVID-19 in development</a>, 27 are in Phase 1 or 2 trials and six are being evaluated in Phase 3 trials. In total, these trials seek to enrol 280,000 people from 34 countries. No COVID-19 vaccine has been licensed in Canada or the United States. </p>
<h2>Post-approval surveillance</h2>
<p>Once a vaccine is licensed, continued monitoring for safety is critical. Reliable detection of very rare (affecting fewer than 0.01 per cent of people) vaccine adverse events requires information on hundreds of thousands of people. The <a href="https://www.canada.ca/en/public-health/services/immunization/canadian-adverse-events-following-immunization-surveillance-system-caefiss.html">Canadian Adverse Events Following Immunization Surveillance System</a> monitors the safety of marketed vaccines, publishes reports regularly and identifies the need for further study should a safety issue be identified.</p>
<p>Provided that a COVID-19 vaccine successfully navigates human clinical trials and is subjected to continuing safety monitoring after it is licensed, we have good grounds to believe that the vaccine both works and is safe.</p><img src="https://counter.theconversation.com/content/146061/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charles Weijer consults with Cardialen, Eli Lilly & Company, and Research Triangle Institute (RTI) International.</span></em></p>Will a vaccine for COVID-19 be safe? Animal testing, human clinical trials and post-approval surveillance give us good grounds to believe that a future approved vaccine will work and be safe.Charles Weijer, Professor of medicine, epidemiology & biostatistics, and philosophy, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1230982019-09-11T20:07:13Z2019-09-11T20:07:13ZHow philosophy 101 could help break the deadlock over drug testing job seekers<figure><img src="https://images.theconversation.com/files/291875/original/file-20190911-190012-10y0t3c.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C672&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Proponents and critics of drug testing welfare recipients are repeating the same arguments. Here's how to break the deadlock.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/thumbs-down-yes-no-concept-477959560?src=hEcJtdyt3i4lVuN29VAxTg-1-3">from www.shutterstock.com</a></span></figcaption></figure><p>The proposal to drug test welfare recipients keeps on bouncing back. The most recent attempt, <a href="https://www.anneruston.com.au/media_release_drug_testing_trials_to_help_welfare_recipients_become_job_ready">announced last week</a>, is now the third proposal since 2017. </p>
<p>But the tenacity with which the government is pursuing this agenda reflects, not necessarily a fixed policy position, but rather a moral stance. And this moral stance conflicts with that of the proposals’ critics.</p>
<p>Are we doomed to countless repeats of the same policy proposal? Or, as the <a href="https://www.aspc.unsw.edu.au/">Australian Social Policy Conference</a> heard in Sydney this week, can we use philosophical arguments to help break the deadlock?</p>
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<figcaption><span class="caption">Why are we seeing a similar policy proposal again, the third in recent years?.</span></figcaption>
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<h2>What’s proposed?</h2>
<p>These proposals are examples of <a href="https://www.crcpress.com/Welfare-Conditionality/Watts-Fitzpatrick/p/book/9781138119918">welfare conditionality</a>. In other words, welfare participants need to meet certain conditions or behave in certain ways to receive their payments.</p>
<p>Drug testing welfare recipients was originally <a href="https://www.aph.gov.au/Parliamentary_Business/Bills_LEGislation/Bills_Search_Results/Result?bId=r5927">proposed in 2017</a>, failed to get support, then proposed again in 2018 and stalled in the Senate.</p>
<p>This third attempt <a href="https://www.theguardian.com/australia-news/2019/sep/09/scott-morrison-says-he-is-puzzled-by-opposition-to-welfare-drug-testing">has only very minor changes</a> from the original two versions: additional testing for heroin and cocaine, and the removal of the requirement for welfare recipients to pay for positive test results.</p>
<p>These changes are part of the proposal to randomly drug test 5,000 new recipients of Newstart and Youth Allowance at three sites in NSW, Qld and WA. A positive drug test would lead to 24 months of income management. </p>
<p>Another positive test would lead to a medical assessment, and where indicated, rehabilitation, counselling or ongoing drug tests.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/income-management-doesnt-work-so-lets-look-at-what-does-34792">Income management doesn't work, so let's look at what does</a>
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<h2>The ‘pro testing’ philosophy</h2>
<p>Three moral positions sit behind the proposal to drug test welfare recipients: contractualism, paternalism and communitarianism.</p>
<p><a href="https://plato.stanford.edu/entries/contractualism/">Contractualism</a> says the relationship between citizens and the state should be based on reciprocal agreement, with mutual obligations. In other words, people who receive income support should be subject to conditions.</p>
<p><a href="https://plato.stanford.edu/entries/paternalism/">Paternalism</a> enables those conditions to be ones where someone is protected from the consequences of their own poor decision-making (such as taking an illicit drug).</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-dont-need-no-moral-education-five-things-you-should-learn-about-ethics-30793">We don’t need no (moral) education? Five things you should learn about ethics</a>
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<p>And this is morally justifiable in the <a href="https://plato.stanford.edu/entries/communitarianism/">communitarian</a> sense of the importance of community solidarity and social cohesion. In other words, the collective good — however this may be defined but in this particular case the integrity of the social security system — is greater than any individual freedoms or rights to privacy, such as drug-taking. This communitarianism position does seem at odds with the government’s approach to individualism and freedoms in other areas. </p>
<p>This <a href="https://www.aph.gov.au/Parliamentary_Business/Hansard/Hansard_Display?bid=chamber/hansardr/ca60e75d-8c6e-44a5-9c6a-b48e89bff4f1/&sid=0209">typical example</a>, from the National Party’s Mark Coulton in 2018, reflects policy debate using paternalism, mutual obligation and communitarianism:</p>
<blockquote>
<p>The community has the right to expect that taxpayer funded welfare payments are not being used to fund drug addiction.</p>
</blockquote>
<p>Combining these three positions appears to give the proposal to drug test welfare recipients an unassailable moral foundation.</p>
<h2>What do the critics say?</h2>
<p>Critics of the proposals have outlined their concerns about drug testing welfare recipients <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/DrugTestingTrial/Submissions">in Senate submissions</a>, and <a href="https://www.smh.com.au/politics/federal/cashless-welfare-card-trial-not-working-drug-and-alcohol-centre-says-20190910-p52pv5.html">in the media</a>.</p>
<p>Concerns have included the <a href="https://theconversation.com/drugs-dont-affect-job-seeking-so-lets-offer-users-help-rather-than-take-away-their-payments-123096">lack of evidence</a> supporting a relationship between drug use and employment, <a href="https://www.jsad.com/doi/full/10.15288/jsads.2019.s18.42">not enough</a> drug treatment programs, <a href="https://www.theaustralian.com.au/nation/politics/minister-under-pressure-to-reveal-drug-test-costs/news-story/27d52249c0eac5b4ecd0b6142ef56450">the costs</a> associated with the proposal, and the view that it is <a href="https://www1.racgp.org.au/newsgp/clinical/drug-testing-will-stigmatise-welfare-recipients,-s">punitive and discriminatory</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drugs-dont-affect-job-seeking-so-lets-offer-users-help-rather-than-take-away-their-payments-123096">Drugs don't affect job seeking, so let's offer users help rather than take away their payments</a>
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<h2>The critics’ philosophy</h2>
<p>While proponents of drug testing welfare recipients argue from the moral positions of contractualism, paternalism and communitarianism, critics come from a different philosophical standpoint. </p>
<p>Their arguments are largely focused on <a href="https://theconversation.com/is-evidence-for-or-against-drug-testing-welfare-recipients-it-depends-on-the-result-were-after-83641">using evidence</a> to argue the potential harms to testing outweigh the benefits. Philosophically speaking, this would be a <a href="https://plato.stanford.edu/entries/consequentialism/">consequentialist</a>, <a href="https://www.iep.utm.edu/util-a-r/">utilitarian</a> moral position. </p>
<p>Opponents <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/DrugTestingTrial/Submissions">also argue</a> (for example, see submission 28) the proposal infringes human rights, which all Australians have a right to receive. This includes the right to social security, privacy, an adequate standard of living, and the right to equality and non-discrimination.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/drug-testing-welfare-recipients-raises-questions-about-data-profiling-and-discrimination-77471">Drug testing welfare recipients raises questions about data profiling and discrimination</a>
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<p>This can be seen in comments such as <a href="https://www.aph.gov.au/Parliamentary_Business/Hansard/Hansard_Display?bid=chamber/hansardr/ca60e75d-8c6e-44a5-9c6a-b48e89bff4f1/&sid=0209">the following</a> from the Greens’ Adam Bandt, also from 2018: </p>
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<p>You don’t lift people out of poverty by taking away their rights.</p>
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<p>And the following from <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/DrugTestingTrial/Submissions">Senate submissions</a>:</p>
<blockquote>
<p>There is no evidence drug testing of welfare recipients either improves employment outcomes or reduces harms associated with drug taking. </p>
</blockquote>
<h2>How could we shift the debate?</h2>
<p>The proponents and the opponents effectively slide past each other given these fundamentally different moral positions. For example, no matter how much empirical data shows the harms outweigh the benefits (utilitarianism), the contractualism view does not see this as relevant.</p>
<p>It seems proposals to drug test welfare recipients may be here to stay unless there is a shift in the moral frames.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">History, not harm, dictates why some drugs are legal and others aren't</a>
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<p>This may mean the critics need to mount effective arguments against paternalism, contractualism and communitarianism.</p>
<p>For example, for paternalism to be ethical, we need to show it can be justified and can actually help someone. This is highly questionable with the drug testing proposal.</p>
<p>We can also argue whether the conditions for contractualism are met. Contractualism is built on the premise of fair <a href="https://dictionary.cambridge.org/dictionary/english/reciprocity">reciprocity</a> by both parties (both parties are entering into the “mutual obligation” contract as equals). Given the structural inequality experienced by people with drug problems (such as unequal access to education or health services) the conditions for fair reciprocity may not be met.</p>
<p>If critics are willing to tackle the moral underpinnings of the recent proposals, we may be able to speak to policy makers in a language (and philosophy) they understand. This is essential if we are to block this unjust and discriminatory policy.</p><img src="https://counter.theconversation.com/content/123098/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Ritter receives funding from the National Health and Medical Research Council (NHMRC) and conducts commissioned research regarding drug treatment for federal and state governments. </span></em></p>We need to look at what’s behind arguments for and against drug testing welfare recipients to avoid repeating the same debate, over and over.Alison Ritter, Professor & Specialist in Drug Policy, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1230962019-09-09T04:56:55Z2019-09-09T04:56:55ZDrugs don’t affect job seeking, so let’s offer users help rather than take away their payments<figure><img src="https://images.theconversation.com/files/291422/original/file-20190909-175663-1kss60k.jpg?ixlib=rb-1.1.0&rect=7%2C136%2C5064%2C3482&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Drug testing risks further marginalising welfare recipients. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-confused-man-looking-laptop-sitting-180999986?src=LPOLOKvY9T2BDQE8aqVbJA-2-57">Iakov Filimonov/Shutterstock</a></span></figcaption></figure><p>The Morrison government is <a href="https://www.theguardian.com/commentisfree/2019/sep/06/the-recycled-drug-testing-plan-is-just-one-more-cruel-and-pointless-diversion">having another shot</a> at getting its proposal to drug test people on welfare through the Senate.</p>
<p>Welfare, health and drug treatment experts have consistently opposed the proposal since it was first introduced three years ago. They say these measures will only serve to <a href="https://ama.com.au/media/dr-chris-moy-doorstop-drug-testing-welfare-recipients">further marginalise people on welfare</a> and people who use drugs, and may have a range of <a href="https://www.theguardian.com/australia-news/2017/sep/14/drug-testing-welfare-recipients-an-absolute-disgrace-australian-of-the-year-says">unintended consequences</a> such as homelessness.</p>
<p>If the government really wanted to assist people who have drug problems to return to work, it would increase funding for drug treatment.</p>
<h2>What’s being proposed?</h2>
<p>The new proposal appears very similar to those the Senate <a href="https://parlinfo.aph.gov.au/parlInfo/download/legislation/ems/r6065_ems_5df415e5-bf55-4745-8db8-6d653265a900/upload_pdf/665144.pdf;fileType=application%2Fpdf#search=%22legislation/ems/r6065_ems_5df415e5-bf55-4745-8db8-6d653265a900%22">previously rejected</a> in 2017 and 2018.</p>
<p>A <a href="https://www.anneruston.com.au/media_release_drug_testing_trials_to_help_welfare_recipients_become_job_ready">two year trial</a> would test around 5,000 new recipients of Newstart Allowance and Youth Allowance for a range of illegal drugs in three locations in Queensland, New South Wales and Western Australia. </p>
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Read more:
<a href="https://theconversation.com/drug-testing-welfare-recipients-raises-questions-about-data-profiling-and-discrimination-77471">Drug testing welfare recipients raises questions about data profiling and discrimination</a>
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<p>Cocaine has been added to the list of drugs to be tested for. The list already included methamphetamine, MDMA (ecstasy), opioids (such as heroin) and cannabis in <a href="https://ajp.com.au/news/drug-testing-welfare-recipients-really-mean/">earlier versions</a>.</p>
<p>Welfare recipients who test positive will be placed on income management, with 80% of their income quarantined. </p>
<p>They will undertake a second test within a month. Two positive tests will result in a referral to a medical professional for treatment. Ongoing treatment may be a requirement of their job plan. </p>
<p>If they return two positive tests, or they dispute a test and ask for another test, they will be required to <a href="https://parlinfo.aph.gov.au/parlInfo/download/legislation/ems/r6065_ems_5df415e5-bf55-4745-8db8-6d653265a900/upload_pdf/665144.pdf;fileType=application%2Fpdf#search=%22legislation/ems/r6065_ems_5df415e5-bf55-4745-8db8-6d653265a900%22">repay the cost of the tests</a>.</p>
<h2>What is the rationale?</h2>
<p>The government is attempting to frame the measure as a helping hand for people who have problems with drugs. </p>
<p><a href="https://www.sbs.com.au/news/morrison-backs-drug-testing-politicians-as-well-as-welfare-recipients">Social services minister</a> Anne Ruston said the measure was not to punish people on welfare but to identify those who needed help. </p>
<p>During previous attempts to get this legislation through the Senate, former prime minister <a href="https://www.sbs.com.au/news/drug-test-trial-for-welfare-recipients-all-about-love-says-turnbull">Malcolm Turnbull</a> described it as a measure of “love”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=415&fit=crop&dpr=1 600w, https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=415&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=415&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=521&fit=crop&dpr=1 754w, https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=521&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=521&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the plan goes ahead, most people detected for drug taking won’t have problems with substance abuse.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/468262262?src=TC07ZbO2VeGASJShfquTbg-1-3&size=huge_jpg">TK Kurikawa/Shutterstock</a></span>
</figcaption>
</figure>
<p>But a positive drug test is not an indicator of problems. It cannot distinguish between one-off, irregular or regular use. It cannot indicate how much of a drug has been used. So it will not be able to fulfil the government’s wish to identify those who need help.</p>
<p>Most people who use drugs do not have problems with them. Only 20% of people who use methamphetamine, for example, <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/contents/table-of-contents">use it more than once a week</a>. Using more often than weekly is a marker for dependence. </p>
<p>So the majority of people who test positive will probably not have a problem, and will be inadvertently and unnecessarily caught up in the treatment system.</p>
<p>Alcohol and tobacco are the drugs that <a href="https://journals.sagepub.com/doi/abs/10.1177/0269881119841569">cause the most harm</a>, including dependence and longer-term health problems. They are also the biggest financial burden on the community. Neither is addressed under this measure, so it will not assist the majority of people who need help.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">History, not harm, dictates why some drugs are legal and others aren't</a>
</strong>
</em>
</p>
<hr>
<p>If the aim was to help people address ongoing drug problems, MDMA would not be on the list of drugs to be tested. There are <a href="https://theconversation.com/how-does-mdma-kill-109506">very few long-term problems</a> with MDMA. It rarely requires treatment, despite it being the <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/contents/table-of-contents">in the top three most commonly used illicit drugs</a> in Australia.</p>
<h2>Why it’s unlikely to be effective</h2>
<p>Prime Minister Scott Morrison <a href="https://www.sbs.com.au/news/morrison-backs-drug-testing-politicians-as-well-as-welfare-recipients">has said</a> the plan is “about helping people get off welfare, off the dole and into work”.</p>
<p>But there is no evidence drug use is a barrier to job seeking. In fact, most people who use drugs are <a href="https://theconversation.com/three-charts-on-who-uses-illicit-drugs-in-australia-110169">employed</a>.</p>
<p>A 2001 <a href="https://www.researchgate.net/publication/247245354_Drug_testing_and_mandatory_treatment_for_welfare_recipients">Canadian study</a> concluded drug testing welfare recipients was an expensive process that would result in a very marginal increase in employment.</p>
<p>A 2013 position paper from the <a href="https://www.drugsandalcohol.ie/20368/1/ANCD_paper_DrugTesting.pdf">Australian National Council on Drugs</a>, the Australian government’s previous drug advisory body, similarly concluded:</p>
<blockquote>
<p>There is no evidence that drug testing welfare beneficiaries will have any positive effects for those individuals or for society, and some evidence indicating such a practice would have high social and economic costs. In addition, there would be serious ethical and legal problems in implementing such a program in Australia.</p>
</blockquote>
<p>There’s also <a href="https://public-health.uq.edu.au/article/2017/09/evidence-or-against-drug-testing-welfare-recipients">little evidence such a measure would save money</a> by kicking people off welfare, given the costs of running such programs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-evidence-for-or-against-drug-testing-welfare-recipients-it-depends-on-the-result-were-after-83641">Is evidence for or against drug-testing welfare recipients? It depends on the result we're after</a>
</strong>
</em>
</p>
<hr>
<p>New Zealand originally looked at a scheme similar to the Australian proposal, but subsequently modified it to subsidise existing pre-employment testing. It tested more than 8,000 people on welfare and returned only <a href="https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11184479">22 positive results</a>.</p>
<p>Trials in the US found <a href="https://www.nytimes.com/2014/01/01/us/florida-law-on-drug-testing-for-welfare-is-struck-down.html?_r=0">relatively few people</a> who received government benefits tested positive to illicit drugs. Among seven states that trailed a similar measure in the US, nearly all of them had <a href="http://thinkprogress.org/economy/2015/02/26/3624447/tanf-drug-testing-states/">detection rates</a> of less than 1%. </p>
<p>The trials showed <a href="https://www.tandfonline.com/doi/abs/10.1300/J045v17n01_03">little net benefit</a>, also making it an expensive exercise.</p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395915003588">The evidence</a> in favour of forcing people into treatment is limited. It is <a href="https://www.health.harvard.edu/blog/involuntary-treatment-sud-misguided-response-2018012413180">less effective</a> than voluntary treatment for long-term outcomes, and increases overdose risk. </p>
<p>Financial sanctions can lead to <a href="https://www.drugfoundation.org.nz/assets/uploads/2011-uploads/Policy-Briefing-Welfare-Reform-and-Substance-Use-July-2011-0.pdf">poorer outcomes</a> in people with alcohol or other drug problems.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/forcing-ice-users-into-rehab-wont-solve-the-problem-heres-what-we-need-instead-45946">Forcing ice users into rehab won't solve the problem – here's what we need instead</a>
</strong>
</em>
</p>
<hr>
<h2>Instead, increase funding for drug treatment</h2>
<p>Every $1 spent on <a href="https://www.ncbi.nlm.nih.gov/pubmed/16430607">drug treatment saves</a> about $7 in health, welfare and other costs to the community.</p>
<p><a href="https://ndarc.med.unsw.edu.au/resource/new-horizons-review-alcohol-and-other-drug-treatment-services-australia">Drug treatment</a> reduces drug use and harms, which has knock-on effects of improving participation in the community (including employment and <a href="https://pdfs.semanticscholar.org/d6e5/e2aa51b17b1863d07c823a19a531e7f54788.pdf">training</a>), improving health and well-being, and reducing criminal behaviour. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Every dollar spent on drug treatment saves $7.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/343847333?src=LwGO8_sqWKmBO8aKvhrfpg-1-54&size=huge_jpg">Rawpixel.com/Shutterstock</a></span>
</figcaption>
</figure>
<p>Yet there are too few drug treatment places for people who want it, let alone forcing people who don’t want or need it into treatment.</p>
<p>Along with drug testing welfare recipients, the government has announced a <a href="https://www.anneruston.com.au/media_release_drug_testing_trials_to_help_welfare_recipients_become_job_ready">A$10 million treatment fund</a>. But we need at least double the <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/New%20Horizons%20Final%20Report%20July%202014.pdf">A$1.2 billion</a> currently spent to just meet the existing demand for voluntary treatment. </p>
<p>The proposed measure is a blunt response to a nuanced problem. There are much more effective, and cost effective, ways to address both alcohol and other drug problems and unemployment than drug testing welfare recipients.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/helping-drug-users-get-back-to-work-not-random-drug-testing-should-be-our-priority-77468">Helping drug users get back to work, not random drug testing, should be our priority</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/123096/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the alcohol and other drug sector. She has previously been awarded grants by state and federal governments, NHMRC and other public funding bodies for alcohol and other drug research. </span></em></p>There’s no evidence drug use is a barrier to job seeking. And testing can’t distinguish between one off, irregular or regular use.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1231462019-09-08T10:39:10Z2019-09-08T10:39:10ZSarah Henderson wins her way back to parliament<p>Former assistant minister Sarah Henderson, who lost her marginal seat of Corangamite at the election, will return to parliament after winning preselection for a Victorian Senate vacancy on Sunday.</p>
<p>She takes the spot left by former minister Mitch Fifield, who quit to become ambassador to the United Nations.</p>
<p>Henderson had the support of Prime Minister Scott Morrison. Treasurer Josh Frydenberg, who is deputy Liberal leader, lobbied hard for her.</p>
<p>She beat Greg Mirabella, husband of former senior Liberal MP Sophie Mirabella, 234 to 197 after other runners were eliminated.</p>
<p>Henderson, 55, a moderate, was assistant minister for social services, housing and disability services under Morrison.</p>
<p>After her win, Henderson thanked Morrison and Frydenberg for their support and promised to “hit the ground running”.</p>
<p>The NSW Liberal party has yet to choose a replacement for Arthur Sinodinos, who will leave the Senate soon to become ambassador to the United States.</p>
<p>Parliament returns on Monday after the winter break for a fortnight sitting, with the legislation including the extension of the rollout of the cashless welfare card and the introduction of a trial drug testing of 5000 new recipients of Newstart and the Youth Allowance. The government has previously not had the numbers to pass the trialling of drug testing.</p>
<p>The government is also proposing mandatory sentencing as part of a legislative crackdown on paedophiles. Attorney-General Christian Porter said last week 28% of child sex offenders convicted of federal offences in 2018-19 did not spend a single day in jail. Labor is against mandatory sentencing in principle, but has indicated it would agree to it when it is tied to a measure the ALP supports.</p>
<p>The government is casting items on its current legislative agenda as tests for Labor. Morrison, speaking to the NSW Liberal state council on Saturday, said: </p>
<blockquote>
<p>I like to set them tests when we come back to parliament. Because I’m just trying to help. I know they’re struggling to work out who they are and what they’re about so I just thought I should ask them a few questions every time we come to parliament.</p>
</blockquote>
<p>In relation to the cashless card, “The test is on them next week - whose side are they on when it comes to getting people off welfare and into work?”</p>
<p>On drug testing, “I want to help people get off welfare and into work. And drugs and substance abuse is an obstacle to that.”</p>
<p>Labor leader Anthony Albanese dismissed the government’s agenda as looking for distractions from economic issues.</p>
<p>He said there was no evidence the cashless welfare card had made any significant improvement on jobs. As for the drug tests, “are we really going to start drug testing those people over the age of 55 who are on Newstart?”</p>
<blockquote>
<p>What I want to see from the government this week is a plan for economic growth and a plan for jobs, because that’s the main game that is facing Australia at the moment. The fact is, it’s out of touch. </p>
</blockquote>
<p>Jackie Lambie, who holds a crucial crossbench vote in the Senate, said she had been a “big supporter” of the cashless card from the beginning.</p>
<p>She would not have a problem with the drug testing trials as long as anyone else who received money from the public purse - including parliamentarians and bureaucrats - was also subject to them. MPs and bureaucrats should “lead by example,” she said.</p>
<p>She had some concerns about mandatory sentencing. “It bothers me a little bit” because in some cases there might be mitigating circumstances.</p>
<p>Also in parliament this fortnight is legislation to protect farmers against trespassing activists.</p>
<p>But the government does not plan to push the medevac repeal legislation this fortnight. Lambie, who will hold the deciding vote on this, has made it clear she wants to see the Senate inquiry report, which will not be finished until October.</p>
<p>Pauline Hanson in a Sunday statement likened “Lambie’s sluggishness in supporting the medevac repeal bill to first calling for an official enquiry before firefighters can tackle raging bushfires.”</p>
<p>Hanson said she was keen to see the medevac repeal bill passed this week. Pointing also to the delay in the deportation of the Tamil family, whose case is before the federal court. Hanson said: </p>
<blockquote>
<p>We seem to be losing control of our own country, so let’s repeal the medevac laws and deport all those who are ruled ineligible for refugee status.</p>
</blockquote><img src="https://counter.theconversation.com/content/123146/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>After losing her marginal seat of Corangamite at the election, Sarah Henderson is set to return to parliament after winning preselection for a Victorian Senate vacancy.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1188272019-07-07T20:10:50Z2019-07-07T20:10:50ZTesting festival goers’ pills isn’t the only way to reduce overdoses. Here’s what else works<figure><img src="https://images.theconversation.com/files/282609/original/file-20190704-126376-1qy5c4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Festival goers bring their phones. So why not use them to receive tweets about high-dose drugs in circulation, as the UK is doing?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/grodno-belarus-september-17-2016-teenagers-1258396705?src=4km6UC1HndwfYPP9pnphCA-1-8&studio=1">from Vinnikava Viktoryia/www.shutterstock.com</a></span></figcaption></figure><p>The <a href="https://www.smh.com.au/national/nsw/music-festival-deaths-inquest-set-down-for-july-20190228-p510sz.html">NSW inquest into recent drug deaths at music festivals</a> is due to start this week. So focus is turning to how to make music festivals safer by reducing drug-related incidents. </p>
<p>We know that <a href="https://theconversation.com/australias-recreational-drug-policies-arent-working-so-what-are-the-options-for-reform-55493">prohibition doesn’t work</a> to reduce either harms or drug use. But what does?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-recreational-drug-policies-arent-working-so-what-are-the-options-for-reform-55493">Australia's recreational drug policies aren't working, so what are the options for reform?</a>
</strong>
</em>
</p>
<hr>
<h2>How do drugs cause harm?</h2>
<p>Most illicit drugs used at festivals, including <a href="https://adf.org.au/drug-facts/mdma/">ecstasy</a> (methylenedioxymethamphetamine or MDMA), started out as relatively benign pharmaceuticals. </p>
<p>MDMA is most commonly implicated in drug-related harm at festivals. Fatal and non-fatal MDMA overdoses <a href="https://theconversation.com/how-does-mdma-kill-109506">are usually a result</a> of high-purity MDMA, dangerous contaminants, or environmental factors such as overheating or drinking too much or too little water. So to reduce harms we need to address all these problems.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weekly-dose-ecstasy-the-party-drug-that-could-be-used-to-treat-ptsd-55149">Weekly Dose: ecstasy, the party drug that could be used to treat PTSD</a>
</strong>
</em>
</p>
<hr>
<h2>What doesn’t work</h2>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0955395916303899">Police presence, random drug searches and drug detection dogs</a> don’t deter drug use and may increase harms. Yet they are common at festivals and come at a substantial financial cost to festival goers, which has to be covered in the price of the ticket. </p>
<p>People who go to festivals say that <a href="https://www.ncbi.nlm.nih.gov/pubmed/30176423">police presence doesn’t discourage them</a> from taking drugs; and there are many documented cases of people <a href="https://www.ncbi.nlm.nih.gov/pubmed/30176423">taking multiple pills at once</a> to avoid searches and sniffer dog detection, which increases the risk of overdose.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-drug-detection-dogs-are-sniffing-up-the-wrong-tree-57343">Why drug-detection dogs are sniffing up the wrong tree</a>
</strong>
</em>
</p>
<hr>
<p>Publicly, the police focus is on drug dealing, but the reality is that most people who are arrested at festivals are people who use, rather than sell, drugs. NSW police reported that, at <a href="https://www.abc.net.au/triplej/programs/hack/nearly-200-drug-arrests-at-field-day-music-festival/10679504">Sydney’s 2019 Field Day Festival</a>, of the 28,000 people who attended, there were 155 drug-related arrests: 149 for possession and 6 for supply.</p>
<p>When police dogs are present, people are more likely to <a href="https://www.sciencedirect.com/science/article/pii/S0955395916303899">buy drugs inside the festival</a> rather than risk detection by carrying drugs in. This means they are more likely to buy from unknown sources, which <a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395918302755">increases their risk</a> of harm compared with buying from a trusted source.</p>
<p><a href="https://theconversation.com/australias-recreational-drug-policies-arent-working-so-what-are-the-options-for-reform-55493">Decriminalising illicit drugs</a> would significantly reduce harms and allow festival police to focus on public safety issues, such as antisocial behaviour and public drunkenness.</p>
<h2>What works</h2>
<p>There are already effective <a href="https://www2.health.vic.gov.au/Api/downloadmedia/%7B672393DE-E7DB-4118-8C9F-7BD1D5F045DB%7D">harm reduction strategies</a> in place at festivals. These include:</p>
<ul>
<li>presence of peer-led organisations, like <a href="https://www.hrvic.org.au/dancewize">Dancewize</a>, which provide harm reduction information and support</li>
<li>emergency services and first aid</li>
<li>chill out spaces</li>
<li>availability of cool clean water</li>
<li>good ventilation in indoor spaces, and</li>
<li>staff and volunteer training in responding to drug affected people.</li>
</ul>
<h2>Pill testing direct to consumer</h2>
<p><a href="https://theconversation.com/six-reasons-australia-should-pilot-pill-testing-party-drugs-34073">On-site pill testing</a>, which identifies the content and purity of drugs brought in by festival goers, also includes contact with a health professional to provide a brief intervention, that can include advice about risks of taking drugs and harm reduction information. Festival goers are always told that it is safest not to take drugs at all.</p>
<p><a href="https://www.aracy.org.au/publications-resources/command/download_file/id/106/filename/Interventions_to_reduce_harm_associated_with_adolescent_substance_use.pdf">Brief interventions</a> from a health professional can reduce risky drug use among young people. But without a way to offer an intervention, most young people who go to festivals will not come into contact with a health worker to receive that information.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-why-doctors-are-backing-pill-testing-at-music-festivals-across-australia-109430">Here's why doctors are backing pill testing at music festivals across Australia</a>
</strong>
</em>
</p>
<hr>
<p>Some <a href="https://www.theage.com.au/national/victoria/festivals-face-permit-system-as-ashton-brands-testing-a-distraction-20190131-p50uq9.html">Australian police</a>, <a href="https://www.abc.net.au/news/health/2018-12-21/guide-to-pill-testing-at-australian-music-festivals/10638732">politicians and policymakers</a> are reluctant to consider pill testing at festivals. That may be because, so far, only on-site, direct-from-consumer testing has been offered as a viable way of reducing harm. </p>
<p>Some people have concerns about the idea of accepting and testing illicit drugs direct from the people using them, given that they are still illegal.</p>
<p>But there are many other ways of pill testing that can also reduce harm.</p>
<h2>Testing of police-acquired drugs</h2>
<p>We could also test drugs on-site that have been seized by police, acquired from emergency services after an incident or surrendered in <a href="https://www.theage.com.au/national/victoria/pressure-mounts-to-introduce-drug-amnesty-bins-at-festivals-20160131-gmhwoi.html">amnesty bins</a>.</p>
<p>This approach has been used at a number of <a href="https://wearetheloop.org/about-us">festivals in the UK</a> since 2013. When a potentially problematic drug is identified during the festival, <a href="https://wearetheloop.org/drug-alerts">an alert</a> is issued on-site through social media usually within hours, to alert others who may have bought drugs from similar batches.</p>
<p>As well as potentially reducing harm for people who use drugs, these alerts mean police are better able to monitor the local drug market; on-site paramedics, first aid and outreach workers are better informed about drugs in circulation, helping to improve responses; and according to the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395918302755">UK testing facility</a>, medical services report having more confidence in dealing with presentations because of the alerts.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/282619/original/file-20190704-126376-rb2fhy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Medical services can also benefit from alerts letting people know which problem drugs might still be in circulation.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sign-pointing-hospital-emergency-room-melbourne-618969788?src=_Xu6Ho-TVA-Uon0TmZa_yw-1-35&studio=1">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>This approach is not as effective in reducing harms as direct-from-consumer testing. That’s because it doesn’t include contact with a health professional who can offer a brief intervention, and the information about pill contents doesn’t go direct to the people intending to use them. </p>
<p>But if testing of police acquired drugs is combined with real-time alerts about potential problem drugs to festival goers, it can still reduce harms.</p>
<h2>Off-site testing</h2>
<p>Testing of pills brought in by festival goers can also occur off site before the festival. It works the same way as onsite testing, and includes brief intervention, but operates away from the festival site.</p>
<p>It’s the primary model used in <a href="https://www.trimbos.nl/aanbod/webwinkel/product/af1677-the-drugs-information-and-monitoring-system-dims">The Netherlands</a>.</p>
<p>Off-site testing removes the need to change the way the drugs are policed at festivals, so may be more acceptable to some. If both off-site and on-site testing are implemented, testing services will have greater reach and be more effective in reducing harm.</p>
<h2>Testing drug purity</h2>
<p>The only official pill testing that has been undertaken in Australia has been at <a href="https://www.harmreductionaustralia.org.au/wp-content/uploads/2018/06/Pill-Testing-Pilot-ACT-June-2018-Final-Report.pdf">Canberra’s Groovin’ the Moo in 2018</a> and 2019. The on-site facility tested samples provided directly by consumers and identified the drugs present. But they could only estimate the purity of drug powders and did not measure the dose of MDMA in the pills.</p>
<p>High-dose MDMA has been implicated in a number of the recent festivals deaths. Knowing the dose may help reduce overdoses from MDMA pills because people can choose to take a smaller amount of the drug if they know the strength is high.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-to-seek-help-after-taking-a-pill-109876">When to seek help after taking a pill</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://wearetheloop.org">The Loop UK</a> has developed a method of more accurately measuring the dose in MDMA pills, which could help reduce the harms associated with high purity. The process does not require any specialised equipment and is performed on-site by trained chemists. At this year’s <a href="https://parklife.uk.com">Parklife Festival</a> the organisation identified high-strength pills and send out warnings.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=776&fit=crop&dpr=1 600w, https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=776&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=776&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=975&fit=crop&dpr=1 754w, https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=975&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/280815/original/file-20190622-61737-1fu9brf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=975&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Example of alerts from The Loop UK at this year’s Parklife Festival.</span>
</figcaption>
</figure>
<h2>Understanding drug use at festivals</h2>
<p>We also don’t really know how many young people use drugs at Australian festivals and how much they use. Most of what we know is from anecdotal reports. There’s probably differences between festivals.</p>
<p>We know both festival attendance and <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/contents/table-of-contents">illicit drug use</a> hit a peak among people in their 20s. So more research on how common drug use is at festivals and the kinds of drugs people use would help inform better and more targeted harm reduction policies.</p>
<p>We will never completely eliminate drug use at festivals but we can make them safer by implementing what we know works and stopping what we know doesn’t. It’s normal for young people to take risks. Whether you agree with drug taking or not, our young people don’t deserve to die just because they have taken drugs.</p><img src="https://counter.theconversation.com/content/118827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the alcohol and other drug sector. She has previously been awarded grants by state and federal governments, NHMRC and other public funding bodies for alcohol and other drug research. She contributes volunteer time to The Loop Australia.
</span></em></p><p class="fine-print"><em><span>Monica Barratt receives funding from the National Health and Medical Research Council, the Marsden Foundation (NZ) and the National Institutes of Health (US). In addition to her academic research role, she volunteers as Director of Research at Bluelight.org and as Victorian Strategic Engagement Coordinator at The Loop Australia.</span></em></p>There are many ways to reduce harm from drugs at music festivals beyond the much publicised pill testing. Here’s what else we can do.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityMonica Barratt, Vice Chancellor’s Senior Research Fellow, Social and Global Studies Centre, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1037382018-10-24T22:49:00Z2018-10-24T22:49:00ZAthletes are rightly concerned about lifting Russia’s doping ban<figure><img src="https://images.theconversation.com/files/241562/original/file-20181022-105757-was177.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A and B sample bottles from a human urine doping test. The World Anti-Doping Agency (WADA) has set off a controversy by allowing Russia to test its own athletes.</span> <span class="attribution"><span class="source">(AP Photo/Matt Dunham, File)</span></span></figcaption></figure><p>The next Olympic Games won’t be held until 2020, but there is no break for the Olympic movement when it comes to doping controversies. The fallout from the <a href="https://www.nytimes.com/2018/09/20/sports/olympics/russia-wada-antidoping-reinstated.html">recent decision</a> by the World Anti-Doping Agency to lift its ban on Russia’s drug testing agency continues to reverberate across the sports world. </p>
<p>Canadian Olympian Beckie Scott, chair of WADA’s athlete committee, says she has been <a href="https://www.cbc.ca/sports/olympics/beckie-scott-says-some-wada-executives-attempted-to-bully-her-1.4860697">bullied by senior officials at the drug-testing body</a> after she publicly criticized the decision that will once again allow Russia to certify its athletes are clean to compete internationally.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1042570627318771714"}"></div></p>
<p>Other athletes were <a href="https://www.insidethegames.biz/articles/1070716/bach-criticised-by-athletes-after-claiming-critics-of-russian-reinstatement-misinterpreted-wada-decision">quick to back Scott’s concerns</a>, saying they were cut out of the decision-making process and that they have “<a href="https://www.insidethegames.biz/articles/1070354/wada-athlete-committee-claim-compliance-conditions-for-russia-could-change-again-as-criticise-decision-to-lift-ban">little assurance</a>” Russian authorities will fairly test its own athletes. There have now also been calls for <a href="https://www.bbc.com/sport/45937908">WADA to be investigated</a> over the bullying allegations levelled by Scott. </p>
<h2>Russia banned for two Olympics</h2>
<p>Russia was banned from the 2016 Summer Olympics and the 2018 Winter Olympics (although some Russian were allowed to compete as neutral Olympic athletes) after it was revealed that state-sponsored <a href="https://www.nytimes.com/2016/05/13/sports/russia-doping-sochi-olympics-2014.html?partner=rss&module=inline">drug cheating among Russian athletes was rampant</a> at the 2014 Winter Olympics in Sochi.</p>
<p>The International Olympic Committee has since lifted its ban, provided no more athletes test positive for performance-enhancing drugs. WADA’s ruling is seen as another important step to allowing Russia back into the world of international sports.</p>
<p>These latest controversies have put <a href="https://www.wada-ama.org/en/who-we-are">the spotlight on WADA</a>, which was formed in 1999 as a joint effort by global sport organizations and governments with the lofty goal to eradicate doping from sport. The focus is not just on Olympians — a main impetus to create WADA was a series of drug cheating scandals that rocked the sport of cycling in the 1990s.</p>
<p>Before WADA, there were other attempts to examine drug cheating in sports. After <a href="https://ca.sports.yahoo.com/news/ben-johnson-finally-sees-inconsistent-seoul-test-results-kept-medal-200716713.html">sprinter Ben Johnson tested positive for steroids</a> in 1988 and had to return his gold medal, the Canadian government set up a royal commission to investigate drugs in sports. The <a href="http://publications.gc.ca/collections/collection_2014/bcp-pco/CP32-56-1990-1-eng.pdf">Dubin Inquiry,</a> as it was known, produced a series of recommendations that made Canada a leader in the anti-doping movement — and, it could be argued, helped lead to the formation of WADA.</p>
<h2>Considerable impact</h2>
<p>In the two decades since its creation, WADA has had considerable impact on doping in sport. Although this is not an easy impact to measure, some have looked at advances in testing methods, athlete feedback and other variables to suggest that things are getting better.</p>
<p>Beckie Scott herself is an example. Scott’s <a href="https://olympic.ca/2003/12/18/court-orders-ioc-to-award-beckie-scott-gold-medal/">cross-country skiing gold medal</a> at the 2002 Olympics was originally a bronze that was upgraded to silver and then gold (more than two years later) after the original Russian medallists were found to have used performance-enhancing drugs.</p>
<p>WADA is headquartered in Montreal and its founding President was Dick Pound, who led the organization from 1999 to 2007. Pound was known for his strong public stand on doping, particularly when it came to cyclist Lance Armstrong and professional sporting leagues.</p>
<p>Many give Pound and WADA much credit for the changing stance of professional sport leagues in North America which now take doping seriously. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/XsTYYGELvFc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>The fight for clean sport is complicated. The pressures — be they financial, ego, political, interpersonal, systemic or cultural — on an athlete (or a coach or a physician or an administrator) to find any edge possible is enormous.</p>
<h2>Legal sanctions not enough</h2>
<p>Over the years, legal sanctions and education programs have not been enough. Nor have promotional efforts. Strong public outreach, strict sanctions and costly penalties have made an impact on athlete behaviour to not dope.</p>
<p>But WADA’s vision of “a world where all athletes can compete in a doping-free sporting environment” remains unachieved. Positive doping tests occur every year and at every major sporting event. There is also ample evidence that cheating continues to go on undetected.</p>
<p>If we draw from what we know about behaviour change in humans, we know that there are three general tools available to organizations and governments to change or maintain behaviours — education, law and marketing. And, for each situation, the mix of these tactics differs and shifts in terms of what works to alter behaviour.</p>
<p>In the case of doping in athletes, the following would characterize these options.</p>
<ol>
<li><p>Education: Programs put in place by WADA and its National Anti-Doping Association members (such as the United States Anti-Doping Agency that famously brought down Lance Armstrong) to inform athletes (elite and developing) and their support teams on doping-related issues. These are informational actions to let athletes know about the risks, penalties and consequences of doping behaviour and violations. In many situations, these are very effective. </p></li>
<li><p>Law: The sanctions and penalties put in place by WADA, NADAs, pro sports leagues, events and associations for doping violations. These could range from Armstrong’s lifetime ban to a warning for a first offence of not informing WADA/NADA of your whereabouts for random testing. These have impact, but again are not always effective.</p></li>
<li><p>Marketing: The final tactic is social marketing, which has been effective in changing social behaviours on smoking and drink and driving, where the athlete is “sold” that this is the best course of action. </p></li>
</ol>
<h2>Athletes remain skeptical</h2>
<p>Whether these tools will be effective in Russia is yet to be determined.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1048559529565323264"}"></div></p>
<p>Clearly, former athletes like Scott remain skeptical. Those still competing also feel WADA has not stood up for clean athletes. Although some other athletes, <a href="https://www.reuters.com/article/us-sport-doping-russia/ioc-athletes-commission-supports-wadas-lifting-of-ban-on-rusada-idUSKCN1M20K1">including the IOC Athlete’s Commission</a>, supported the WADA, most athletes who have gone public on their social media channels are aligned with Scott.</p>
<p>WADA’s decision was made after considering many issues, such as the notion of individual athlete rights (should all Russian athletes be considered dirty?) versus collective athlete rights (is there strong enough evidence that Russian athletes will be tested properly by the Russian doping agency?).</p>
<p>But Beckie Scott and others have made a strong argument — that by paving the way to allow Russia back into the international sports community, WADA has strayed from its core mission.</p><img src="https://counter.theconversation.com/content/103738/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Norm O'Reilly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The decision by the World Anti-Doping Agency to lift its ban on Russia’s drug testing has set off another controversy about whether there will ever be a level playing field in the world of sports.Norm O'Reilly, Assistant Dean, Professor & Director of the International Institute for Sport Business & Leadership, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1043832018-10-15T10:28:59Z2018-10-15T10:28:59ZDispatches from the morgue: Toxicology tests don’t tell the whole story of the opioid epidemic<figure><img src="https://images.theconversation.com/files/240281/original/file-20181011-154542-16imlcg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mortality data show only the final result of opioid overdose, not why it happens.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/scene-hospital-morgue-where-corpses-taken-761983000?src=UWs3b11-wDD_bFApQ5lCKg-1-0">Skyward Kick Productions/Shutterstock.com</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>“Drug overdoses killed more Tennesseans than ever last year, fentanyl deaths up 70 percent,” a recent headline from my hometown newspaper, <a href="https://www.tennessean.com/story/news/2018/08/20/tennessee-overdose-deaths-2017-opioid-fentanyl/1044057002/">The Tennessean</a>, proclaimed. </p>
<p>Variations of this headline have become routine across the U.S. In June 2017, a reporter at <a href="https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html">The New York Times</a> revealed that opioid overdose deaths in 2016 in the U.S. surpassed the peak number of car deaths, a record that had stood since 1972. <a href="https://www.vox.com/policy-and-politics/2017/7/7/15925488/opioid-epidemic-deaths-2016">Vox</a>, an internet media outlet, announced that “in one year, drug overdoses killed more Americans than the entire Vietnam War did,” while <a href="https://www.cbsnews.com/news/drug-overdose-deaths-heroin-opioid-prescription-painkillers-more-than-guns/">CBS News</a> claimed that “drug overdoses now kill more Americans than guns.”</p>
<p>These and similar dispatches from America’s morgues sound like an alarm bell. But, what do all these dead opiate users actually tell us about the opioid crisis? Having studied the history of drug screens, I’d say not much as much as we’d hoped, it turns out. </p>
<h2>The world the screens make</h2>
<p>Drug screens serve a number of clinical purposes. For clinicians in methadone programs, drug screens are an <a href="https://www.ncbi.nlm.nih.gov/pubmed/10473015">incomparable, albeit contentious, resource</a> to monitor patient compliance. For pathologists and medical examiners, screens identify chemicals present in a corpse. However, clinical care is only one fraction of why these screens matter. </p>
<p>Epidemiologists, scientists who study populations of people to learn about disease and injury patterns, aggregate machine-assisted, post-mortem diagnoses into the data of public health. Policymakers weigh these stats in forming governmental interventions. Screens, then, form a foundation on which decisions about medical care and governmental responsibility rest.</p>
<p>But, where did drug screens come from, how do they work and how reliable are they in helping us address the opioid crisis?</p>
<h2>Measuring drug addiction</h2>
<p>The first narcotics screens emerged in the <a href="http://jpet.aspetjournals.org/content/109/1/8">mid-1950s</a>. My own unpublished research has turned up two tests that composed most drug screening: the Nalorphine Test and chromatography. </p>
<p>The Nalorphine Test, also called the Nalline Test, comprised two steps. First, subjects received an injection of an opiate antagonist, N-<a href="https://ascpt.onlinelibrary.wiley.com/doi/pdf/10.1002/cpt196126713">allylnormorphine</a>. </p>
<p><a href="https://reference.medscape.com/drugs/opioid-antagonists">Opiate antagonists</a> are chemicals that sit on opioid receptors without activating them, essentially working the opposite of opiates. In the human body, antagonists induce withdrawal symptoms, including pupil dilation. After administering the antagonist, a clinician measured the pupil size against standardized circles – a ruler called the pupillometer.</p>
<p>Jailers and physicians were especially keen on this method. One <a href="https://www-heinonline-org.proxy.library.vanderbilt.edu/HOL/Page?handle=hein.journals/fedpro27&div=28&start_page=32&collection=journals&set_as_cursor=0&men_tab=srchresults">physician</a> remarked that “the test was designed to be and has been used as a club over the head of the addict whom no one should believe.” </p>
<p><a href="https://www.tandfonline.com/doi/abs/10.3109/10826087309048772">Critics</a> reaffirmed that the test was a club, describing the procedure’s painful induced withdrawals and its supposedly inexact methods. Accuracy was not paramount to the Nalorphine test. Its utility was forcing patients and prisoners alike to fear discovery. </p>
<h2>A gold standard emerges</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/240279/original/file-20181011-154583-1ryw65t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/240279/original/file-20181011-154583-1ryw65t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=359&fit=crop&dpr=1 600w, https://images.theconversation.com/files/240279/original/file-20181011-154583-1ryw65t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=359&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/240279/original/file-20181011-154583-1ryw65t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=359&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/240279/original/file-20181011-154583-1ryw65t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=451&fit=crop&dpr=1 754w, https://images.theconversation.com/files/240279/original/file-20181011-154583-1ryw65t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=451&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/240279/original/file-20181011-154583-1ryw65t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=451&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chromotography has been considered the best way to test for drugs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/illustration-chemistry-chromatography-technique-separating-components-1173724111?src=Fh-PjdNvU9UarRHL9735qQ-1-7">Nasky/Shutterstock.com</a></span>
</figcaption>
</figure>
<p><a href="https://www.britannica.com/science/chromatography">Chromatography</a> involves separating a specimen – urine, blood, hair, even organs! – into its constituent chemicals. </p>
<p>Two types of chromatography exist and serve distinct goals. Thin-layer chromatography identifies the component chemicals in a specimen, while gas-liquid chromatography combined with a mass spectrometer (GLC-MS) identifies and weighs the mass of each substance. </p>
<p>Chromatography, unlike the Nalorphine test, found an early audience among toxicologists and chemists. The benefit of chromatography is its ability to quantify, and, supposedly, to render objective diagnoses.</p>
<p>Eventually, chromatography won out. GLC-MS remains the gold standard in drug testing. Insofar as GLC-MS measures the quantities of a given chemical, these screens work great. However, I remain skeptical of marshaling its results to understand the opioid crisis.</p>
<h2>The pitfalls of a toxicological imagination</h2>
<p>Drug screens aren’t just a means of diagnosing overdoses. They constitute a distinct mode of making and interpreting biological data using specialized laboratory measuring devices, a perspective I call the “toxicological imagination.” That perspective imports pitfalls into individual, and, by extension, aggregate cases alike.</p>
<p>First, GLC can never prove conclusively that this or that drug is responsible for an individual death. GLC belches out results in milligrams/milliliter, but the significance of these numbers is relative. And there is no universal lethal dosage. GLC-MS can’t account for individual tolerance levels, which affect the dose at which a drug becomes lethal. </p>
<p>Screens have to be juxtaposed against other data: patient history, anatomical and histological observation, and social setting of the death. Synthesis of all this data reinjects the human, and all of its subjectivity, into diagnosis.</p>
<p>Second, screens overemphasize misleading concerns, especially drug potency levels. Remember when we thought crack was going to kill us all because it was supposedly so much stronger than cocaine? Fentanyl currently sits on crack’s vacated throne in this regard.</p>
<p>When we evaluate the opioid crisis by confirmed overdose deaths, we advance the kinds of interpretations that colored reactions to, for example, crack.</p>
<h2>An alternative to the toxicological imagination?</h2>
<p>Instead, I think we need to discern the medical landscapes that turn an overdose into a mortality. What is the availability of <a href="https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio">Narcan</a>, an opiate antagonist that reverses an overdose? Where is the nearest ER? How easily can drug users access in-patient rehab? </p>
<p>I choose these questions specifically to raise the point that when we see individual and aggregate deaths, or observe the potency of x, y or z drug, we miss out on distal causes that produce an overdosing death. Using overdose deaths or drug potency as a basis to address the opioid crisis is akin to responding to Hurricane Katrina knowing only its wind speed or inches of rain.</p>
<p>Let me be plain: I’m trying to say that drug screens, regardless of their sensitivity, can never reconstruct the social relations that underwrite individual mortalities.</p><img src="https://counter.theconversation.com/content/104383/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Justin Wade Hubbard does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The toll of the opioid epidemic is often derived from toxicology reports. These rely on drug tests. A medical historian explains these tests and how they fall short of capturing why people are dying.Justin Wade Hubbard, Doctoral Candidate, Medical History, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/947102018-05-30T10:38:17Z2018-05-30T10:38:17ZOrgans-on-chips: Tiny technology helping bring safe new drugs to patients faster<figure><img src="https://images.theconversation.com/files/220515/original/file-20180525-90281-17z2fmg.jpg?ixlib=rb-1.1.0&rect=46%2C84%2C4087%2C3038&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It doesn't look like a kidney, but this 'kidney-on-a-chip' is a breakthrough for new drug testing.</span> <span class="attribution"><span class="source">Alex Levine</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Getting a new pharmaceutical from an <a href="https://www.fda.gov/ForPatients/Approvals/Drugs/default.htm">idea in the chemistry lab to market</a> takes many years and billions of dollars. Each year just <a href="https://www.fda.gov/Drugs/DevelopmentApprovalProcess/DrugInnovation/ucm537040.htm">several dozen new drugs are approved</a> for use in the United States. </p>
<p>Human “organs-on-chips” are leading a revolution in drug safety testing. These devices use human cells to model the structure and function of human organs and tissues. By testing the potential effects of drugs on different organs faster than traditional methods, organs-on-chips can reduce the need for animal studies and better predict which new drugs will effectively treat human disease.</p>
<p><a href="https://scholar.google.com/citations?user=dHBPovIAAAAJ&hl=en&oi=ao">As part</a> of an interdisciplinary research <a href="http://depts.washington.edu/kellylab/">team</a> with funding support from the National Center for Advancing Translational Sciences, we’re working on a kidney-on-a-chip to improve our understanding of how kidney diseases begin and which drugs can safely treat them. </p>
<h2>Quicker and better testing</h2>
<p>Historically, laboratory testing for new drugs is performed in cells grown in dishes or flasks. If a drug passes initial screening tests in vitro, researchers next test it in vivo in live animals to determine the effects of a new drug on a whole system instead of just one cell type at a time. Finally, after many years of laboratory investigation, researchers will test a promising new drug in people to see if it is safe and effective. </p>
<p>The problem is <a href="https://www.pharmaceutical-technology.com/features/featurecounting-the-cost-of-failure-in-drug-development-5813046/">9 out of 10 of these drugs</a> never make it from small-scale human tests to the patient because they turn out to be ineffective or toxic, even if they showed promising results in early testing.</p>
<p>Organs-on-chips have the potential to completely transform that system. Ranging from the size of a fingernail to that of a credit card, they’re composed of fluid channels and tiny chambers that contain human cell samples. Organs-on-chips <a href="https://ncats.nih.gov/tissuechip/about">in development in labs around the country</a> include kidney, lung, liver, intestine, skin, brain, heart, bone and reproductive systems.</p>
<p>In an organ-on-a-chip, flowing liquid supplies the cells with oxygen and nutrients, similar to the way blood sustains cells in the human body. It’s this constant flow that makes these devices special. Cells grown in organs-on-chips devices act more like cells in a human organ than do cells grown in flat dishes without flow.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fluid circulates through a kidney-on-a-chip.</span>
<span class="attribution"><span class="source">Alex Levine</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Case of the kidney-on-a-chip</h2>
<p><a href="https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work">Kidneys are incredibly important</a> to overall human health. The two fist-sized kidneys remove drugs and unwanted compounds from the body and play a critical role in maintaining proper salt and water balance, blood pressure and vitamin D and bone health. Genetic conditions and even commonly administered medications can, in some circumstances, damage the kidneys.</p>
<p>In the U.S., <a href="https://www.cdc.gov/kidneydisease/pdf/kidney_factsheet.pdf">15 percent of adults have kidney diseases</a>. But most don’t even know it, because kidney diseases often display no symptoms until the condition is very advanced. There’s a pressing need to understand how kidney disease begins, and to develop new safe and effective treatments.</p>
<p>Here at the University of Washington, our kidney-on-a-chip research team is composed of scientists from many different disciplines, including pharmacy, pharmaceutical sciences, nephrology (kidney medicine), toxicology, biochemistry and bioengineering.</p>
<p>In partnership with <a href="https://www.nortisbio.com">Nortis, Inc.</a>, a local biotechnology company, our team has created a small device — the size of a business card — with up to three tiny tubes, each one-thousandth the size of a drop of water, containing 5,000 human kidney cells. When tiny amounts of fluid are pumped through the tubes, the <a href="https://doi.org/10.1016/j.kint.2016.06.011">kidney cells are exposed to important signals</a> that help the cells in the chip behave as if they were in a live kidney.</p>
<p>We’ve found that the kidney cells release signals – called biomarkers – of injury when exposed to known kidney toxins. Our research showed that cells on the chip released markers of injury commonly seen in the urine of people with kidney damage. Testing with the older method, using cells on plates, did not show any damage with the same treatment. This suggests that the <a href="https://doi.org/10.1681/ASN.2015010060">kidney-on-a-chip may be better</a> than existing methods at predicting if a new drug will cause kidney damage in humans.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&rect=60%2C68%2C892%2C589&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&rect=60%2C68%2C892%2C589&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These devices do a better job of testing how molecules affect living human cells.</span>
<span class="attribution"><span class="source">Alex Levine</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Connecting organs-on-chips to mimic systems</h2>
<p>Now that we’ve had these promising results, scientific teams across the country are starting to connect different organs together to replicate a more complex, multi-organ system, to give greater insights into how drugs affect people. For example, we were able to connect a <a href="https://doi.org/10.1172/jci.insight.95978">liver-on-a-chip to a kidney-on-a-chip</a> to learn how a plant extract used in some herbal medicines, called aristolochic acid, damages kidney cells. This chip-to-chip investigation reinforces the need for interconnected organs-on-a-chip to replicate the complex mechanics in the human body.</p>
<p>In the coming year, our kidney-on-a-chip project will be one of several <a href="https://ncats.nih.gov/tissuechip/projects/space">sent to the International Space Station</a> where low gravity speeds up changes in cells, sometimes causing health problems for astronauts. The Space Station could be the perfect place to find out more about kidney diseases in weeks, rather than years or decades.</p>
<p>Organs-on-chips can also be used to discover new drug targets. Our team is evaluating the kidney-on-a-chip as a tool to personalize drug selection and dosing in people with kidney cancer, polycystic kidney disease and chronic kidney disease. Other organs-on-chips labs around the country are studying diseases of the immune system, brain, lungs, heart and blood vessels. By working together, dozens of research teams are developing this new technology to revolutionize drug discovery, leading to the development of better and safer medications for all.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/CYBrpCUkdVQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A pocket-size revolution in kidney research.</span></figcaption>
</figure><img src="https://counter.theconversation.com/content/94710/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Yeung receives funding from The National Institutes of Health (NCATS, NIGMS)</span></em></p><p class="fine-print"><em><span>Edward Kelly receives funding from National Institutes of Health, Environmental Protection Agency and Center for Advancing Science in Space.</span></em></p><p class="fine-print"><em><span>Jonathan Himmelfarb has received relevant grant funding from the U.S. National Institutes of Health and the Center for Advancement of Science in Space.</span></em></p>Researchers who’ve created a kidney-on-a-chip explain why these kinds of devices are an improvement over traditional ways to test new drugs.Catherine Yeung, Research Assistant Professor of Pharmacy, University of WashingtonEdward Kelly, Associate Professor of Pharmaceutics, University of WashingtonJonathan Himmelfarb, Director of the Kidney Research Institute and Professor of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/949362018-05-04T09:53:25Z2018-05-04T09:53:25ZWhy it’s important to test drugs on pregnant women<figure><img src="https://images.theconversation.com/files/216835/original/file-20180430-135840-1rqqqpx.jpg?ixlib=rb-1.1.0&rect=0%2C61%2C998%2C517&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/405634465?src=ltxQLk8AXmTbnpWKLbzgKA-1-28&size=medium_jpg">Joe Besure/Shutterstock.com</a></span></figcaption></figure><p>Vulnerable groups, such as children, prisoners and people with limited mental capacity, are usually excluded from drug trials. And, until quite recently, it was considered unethical to test drugs on pregnant women, too (the <a href="http://broughttolife.sciencemuseum.org.uk/broughttolife/themes/controversies/thalidomide">thalidomide</a> scandal is probably not too far from people’s minds). But the tide is turning. The US Food and Drug Administration (FDA) recently published a draft <a href="https://www.fda.gov/ucm/groups/fdagov-public/@fdagov-drugs-gen/documents/document/ucm603873.pdf">guidance</a> for how and when to include pregnant women in drug trials. </p>
<p>According to <a href="http://dtb.bmj.com/content/51/6/61.short?g=w_dtb_currentissue_tab">Drug and Therapeutic Bulletin</a>, about one in ten pregnant women have a chronic medical condition that requires medication. And at least four in ten women take some form of medication during their pregnancy. Yet there is no drug-safety information for these women to rely on. Many women probably forgo their meds for precisely this reason. But, as the FDA guidance points out, this could result in more harm to the woman and the unborn child than if she had taken the drugs. </p>
<p>Pregnant women are entitled to high-quality, evidence-based healthcare as much as the rest of the population. The benefits and burdens of research must be distributed fairly. Pregnant women should no longer be considered a vulnerable group – at least, not in the context of drug testing.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217242/original/file-20180502-153866-mxxev4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217242/original/file-20180502-153866-mxxev4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=435&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217242/original/file-20180502-153866-mxxev4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=435&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217242/original/file-20180502-153866-mxxev4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=435&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217242/original/file-20180502-153866-mxxev4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=547&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217242/original/file-20180502-153866-mxxev4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=547&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217242/original/file-20180502-153866-mxxev4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=547&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The potential risks to the unborn child should be minimal.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/546641992?src=fdBODHDzAii2kHKaXZ-h9A-1-28&size=medium_jpg">GagliardiImages/Shutterstock.com</a></span>
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</figure>
<p>There is nothing specific about pregnancy that makes a woman unable to provide informed consent or renders her susceptible to influence or coercion. Of course, there are potential risks to mother and baby in taking part in this kind of research, and these risks must taken seriously, but they are not reason enough for excluding pregnant women from participating. </p>
<p><a href="https://cioms.ch/wp-content/uploads/2017/01/WEB-CIOMS-EthicalGuidelines.pdf">Ethical guidelines</a>, prepared by the Council for International
Organisations of Medical Sciences and the World Health Organisation, state that if research has no prospect of direct benefit to the pregnant woman, the risks to the foetus must be minimal (minimal risk being generally understood as the risks involved in everyday life). When research is likely to have a direct clinical benefit for pregnant woman, an increase over minimal risk may be permitted. </p>
<p>These guidelines can be difficult to interpret. For example, the concept of “minimal risk” is vague and may depend on context. It is also unclear how much risk to a foetus is acceptable if there is a prospect of direct benefit to the pregnant woman. </p>
<p>Suppose a treatment only available through research could save a pregnant woman’s life, but placed her foetus at a significant risk of being born with severe disabilities. Here, the potential benefits to the pregnant woman must be weighed against the potential risks to the future child. It is very often unclear how this balance should be struck.</p>
<h2>We can’t just avoid the issue</h2>
<p>Fortunately, a great deal of potential clinical research involving pregnant women does not require such a careful balancing of risks and benefits. Millions of pregnant women are already using various <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747530/#R18">drugs</a>. They could easily form a research population, investigating dosing and pregnancy outcome. Such studies would involve little or no additional risk to the foetus or the pregnant woman.</p>
<p>Simply avoiding the issue is not a viable solution. Guidelines, like those issued by the FDA, are useful and are needed to increase consistency in the regulation. Further funding for research, investigating drugs in pregnant women and for pregnant women, is needed. </p>
<p>Ethicists must continue to work to develop frameworks for managing the risk-benefit trade offs between woman and foetus. Failure to do so will continue to deprive pregnant women of a fair distribution of the benefits of research.</p><img src="https://counter.theconversation.com/content/94936/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mackenzie Graham receives funding from the Wellcome Trust. </span></em></p>The FDA recently issued a draft guidance for testing drugs in pregnant women. Here’s why it’s a good thing.Mackenzie Graham, Research Fellow, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/956162018-04-27T15:01:53Z2018-04-27T15:01:53ZSport is not clean: doping could be prevented if athletes had chaperones<figure><img src="https://images.theconversation.com/files/216643/original/file-20180427-95636-1984gqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cycling-competitioncyclist-athletes-riding-race-high-635675588?src=0yhfhyexHGyBdfjSi1AouQ-1-3">Shutterstock</a></span></figcaption></figure><p>Sport is facing a critical moment. As we head into a <a href="https://www.bbc.co.uk/sport/41527965">big sporting summer</a>, unanswered questions cast a large shadow over many high-profile athletes and countries. The ongoing <a href="http://www.sportsintegrityinitiative.com/cas-delivers-two-reasoned-awards-matter-39-russian-athletes-v-ioc/">legal appeals from Russian athletes</a>, the unresolved <a href="http://www.cyclingweekly.com/news/latest-news/everything-you-need-to-know-about-chris-froomes-salbutamol-case-362848">Chris Froome sanction</a>, minimal testing in some sports and countries, and <a href="http://www.sportsintegrityinitiative.com/analysis-criminalisation-supply-drugs-athletes-recommended/">calls for tougher measures</a> all point towards a need for new solutions. </p>
<p>Our recent <a href="https://www.routledge.com/The-Anti-Doping-Crisis-in-Sport-Causes-Consequences-Solutions/Dimeo-Moller/p/book/9781138681675">research</a> shows that the current system is highly ineffective. Of 300,000 global anti-doping tests conducted every year, fewer than 2% return a positive result – and of those a substantial number are either legitimate drug use (with a <a href="https://ukad.org.uk/medications-and-substances/about-TUE/">Therapeutic Use Exemption</a>), recreational drugs or inadvertent use of a banned substance (not intentional and often with little or no performance enhancing effect).</p>
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Read more:
<a href="https://theconversation.com/elite-sport-time-to-scrap-the-therapeutic-exemption-system-of-banned-medicines-89252">Elite sport: time to scrap the therapeutic exemption system of banned medicines</a>
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<p>By contrast, <a href="https://link.springer.com/article/10.1007%2Fs40279-017-0792-1">several studies</a> point to a true prevalence rate of over 20% and, in some instances, over 50%. If an athlete wants to dope, and has the required support, they can get away with it. The Russians were only caught because of whistleblower evidence and media investigations, not because the testing system works. Sport is not “clean”.</p>
<h2>How do you solve a problem like doping?</h2>
<p>But how do you prevent athletes from using banned drugs in and out of competition? The current approach of occasional testing – and the vain hope that the threat of being caught is a deterrence – is obviously not enough. To properly address the problem, we need a more radical solution: athletes could be assigned a 24-hour chaperone to observe their daily life and ensure they are not doping.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/216644/original/file-20180427-67547-cy9p16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/216644/original/file-20180427-67547-cy9p16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=843&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216644/original/file-20180427-67547-cy9p16.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=843&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216644/original/file-20180427-67547-cy9p16.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=843&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216644/original/file-20180427-67547-cy9p16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1060&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216644/original/file-20180427-67547-cy9p16.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1060&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216644/original/file-20180427-67547-cy9p16.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1060&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">British cyclist Christ Froome returned an abnormal test result for the asthma drug Salbutamol at the Vuelta a España in 2017.</span>
<span class="attribution"><a class="source" href="https://www.paimages.co.uk/image-details/2.32164497">PA</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>This might sound ridiculous, because of intrusions into athletes’ privacy and the practicalities. But the current system already involves extensive surveillance of athletes. Athletes need to provide daily information on their whereabouts and those in the <a href="https://ukad.org.uk/education/athletes/high-performance/testing-programmes/">Registered Testing Pool</a> need a fixed location for one hour each day. They have their blood samples monitored for biological profiling, their urine samples analysed and then stored for 10 years for retesting. They are strictly liable if one of hundreds of banned drugs is detected, ruled ineligible for competition for four years if tested positive and excluded for life for second offences. </p>
<p>The practicalities of a 24-hour chaperone system can be addressed. The athlete would be assigned chaperones who work in shifts. They would initially search the house and training facilities for any doping products. Thereafter, it would only be a case of keeping a distance and following the athlete wherever they go. Almost like a celebrity or politician has a bodyguard.</p>
<p>The chaperones would ensure the athlete does not visit a corrupt doctor, meet with drug dealers or consort with coaches or other athletes who might be suppliers. Given that the internet is a source of doping products, the chaperone would have access to their computer (or have software installed to alert them to certain search words).</p>
<h2>The way forward</h2>
<p>Such an approach might actually be less intrusive than the current system. Any athlete who is tested needs to be observed urinating. They can currently be tested at home or on holiday, at which point the Drug Control Officer (DCO) follows them literally everywhere (even to their bedroom to change clothes) until they are ready to provide a sample. If they are under 18 the DCO and another person watches them urinate, which might be their coach or a team manager (if a parent is not available). The 24-hour chaperone system would not involve any of this.</p>
<p>Our proposal would solve a number of other problems that have long plagued anti-doping organisations and athletes. Less testing means much less chance of a false positive, a mistake in a laboratory, corruption of the scientific process or a sanction emerging from inadvertent use. An example of the latter would be recent <a href="https://www.telegraph.co.uk/sport/football/news/8833438/Over-100-players-test-positive-for-banned-drug-clenbuterol-at-Fifa-Under-17-World-Cup-in-Mexico-this-summer.html">clenbuterol cases</a> (a drug used to treat asthma) in which the athlete might have consumed the drug when in a country like Mexico, where it is in the food chain. The chaperone would be able to confirm or deny such explanations.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/216645/original/file-20180427-175044-o2kup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/216645/original/file-20180427-175044-o2kup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216645/original/file-20180427-175044-o2kup.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216645/original/file-20180427-175044-o2kup.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216645/original/file-20180427-175044-o2kup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216645/original/file-20180427-175044-o2kup.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216645/original/file-20180427-175044-o2kup.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘Olympic Athletes from Russia’ replaced the banned Olympic Russian team at the 2018 Winter Olympics in Pyeongchang, after athletes were stripped of 13 Sochi 2014 medals for doping.</span>
<span class="attribution"><a class="source" href="https://www.paimages.co.uk/image-details/2.34866982">PA</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>This system offers a potential way forward for countries that are currently suspected of allowing doping to occur and face the possibility of being excluded from international events. A country could set up the chaperone system with help from other countries, perhaps for 12 months leading up the event, thus being able to provide evidence that their athletes are clean. </p>
<p>Suppliers would soon recognise that their access to athletes would be so limited that they would go out of business: supply reduces if demand reduces – and this, in the long term, would be the best deterrent.</p>
<p>The system would be expensive, but there is enough money in sport to pay for it – and the savings from current testing could be diverted towards it. The risk of corrupt chaperones could be solved by extensive vetting. </p>
<p>While there are practical challenges and concerns over athletes’ human rights, the potential acceptance of such a model boils down to the question: do we want sport to be clean or not? This is the only way to address the ambition of anti-doping policy – that all athletes, in all sports, in all countries follow the rules 365 days a year.</p>
<p>If there is a critical reaction to this solution then it is the policy that needs to be reconsidered, as it is naïve, idealistic and flawed. This solution is a logical outcome of how the problem is defined. It might not be ideal, but it would be an improvement – more effective, less intrusive and would reduce demand for, and supply of, banned drugs. It would be one step toward clean sport.</p><img src="https://counter.theconversation.com/content/95616/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We need a radical solution to clean up doping in elite sport.Paul Dimeo, Senior Lecturer, Faculty of Health Sciences and Sport, University of StirlingVerner Møller, Professor of Sports Science, Aarhus UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/923312018-03-27T10:41:23Z2018-03-27T10:41:23ZSelf-driving cars can’t be perfectly safe – what’s good enough? 3 questions answered<figure><img src="https://images.theconversation.com/files/212038/original/file-20180326-188622-1f09cip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is it going to stop?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/futuristic-self-driving-car-waiting-when-489690373">marat marihal/Shutterstock.com</a></span></figcaption></figure><p><em>Editor’s note: On March 19, an Uber self-driving vehicle being tested in Arizona <a href="https://www.nytimes.com/2018/03/19/technology/uber-driverless-fatality.html">struck and killed Elaine Herzberg</a>, who was walking her bike across the street. This is the first time a self-driving vehicle has killed a pedestrian,
and it raises questions about the ethics of developing and testing
emerging technologies. Some answers will need to wait until the full investigation is complete. Even so, <a href="https://scholar.google.com/citations?user=N_0jmg8AAAAJ&hl=en">Nicholas Evans</a>, a philosophy professor at the University of Massachusetts-Lowell who studies the ethics of autonomous vehicles’ decision-making processes, says some questions can be answered now.</em></p>
<h2>1. Could a human driver have avoided this crash?</h2>
<p>Probably so. It’s easy to think that most people would have trouble seeing a pedestrian crossing a road at night. But what’s already clear about this particular event is that the road <a href="https://arstechnica.com/cars/2018/03/police-chief-said-uber-victim-came-from-the-shadows-dont-believe-it/">was not as dark as the local police chief initially claimed</a>. </p>
<p>The chief also <a href="https://www.bloomberg.com/news/articles/2018-03-20/video-shows-woman-stepped-suddenly-in-front-of-self-driving-uber">originally said</a> Herzberg suddenly stepped out into traffic in front of the car. However, the <a href="https://arstechnica.com/tech-policy/2018/03/video-uber-driver-looks-down-for-seconds-before-fatal-crash/">disturbing and alarming video footage</a> released by Uber and local authorities shows this isn’t true: Rather, Herzberg had already walked across one lane of the two-lane road, and was in the process of continuing the road-crossing when the Uber hit her. (The safety driver also didn’t notice the pedestrian, but video suggests <a href="https://arstechnica.com/tech-policy/2018/03/video-uber-driver-looks-down-for-seconds-before-fatal-crash/">the driver was looking down</a>, not through the windshield.)</p>
<p>A normal human driver, someone actively paying attention to the road, would likely have had little problem avoiding Herzberg: With headlights on while <a href="https://www.nytimes.com/2018/03/19/technology/uber-driverless-fatality.html">traveling 40 mph</a> on an actually dark road, it’s not difficult to avoid obstacles on a straightaway when they’re <a href="https://www.wsj.com/video/experts-break-down-the-self-driving-uber-crash/1E24A9B7-0B7B-4FA6-96BD-AD1889B921C5.html">100 or more</a> <a href="http://www.kylesconverter.com/speed-or-velocity/miles-per-hour-to-feet-per-second">feet ahead</a>, including people or wildlife trying to get across. This crash was avoidable.</p>
<p>One tragic implication of that fact is clear: A self-driving car killed a person. But there is a public significance too. At least this one Uber car drove itself on populated streets while unable to perform the crucial safety task of detecting a pedestrian, and braking or steering so as not to hit the person.</p>
<p>In the wake of Herzberg’s death, the <a href="https://www.nytimes.com/2018/03/23/technology/uber-self-driving-cars-arizona.html">safety and reliability of Uber’s self-driving cars</a> has come into question. It’s also worth examining the ethics: Just as Uber has been criticized for <a href="https://www.independent.co.uk/voices/uber-drivers-employment-tribunal-never-existed-a7385691.html">exploiting its drivers for profits</a>, the company may arguably be <a href="https://www.recode.net/2018/3/24/17159936/uber-self-driving-arizona-crash-report">exploiting the driving, riding and walking public</a> for its own research purposes.</p>
<h2>2. Even if this crash was avoidable, are self-driving cars still generally safer than human-driven cars?</h2>
<p>Not yet. The death toll on U.S. roads is indeed alarming: approximately <a href="https://www.cdc.gov/vitalsigns/motor-vehicle-safety/index.html">32,000 deaths per year</a>. The <a href="https://www.nytimes.com/2018/03/19/technology/uber-driverless-fatality.html">federal estimate</a> is that 1.18 people die per 100 million road miles driven by humans. Uber’s cars only <a href="https://www.nytimes.com/2018/03/23/technology/uber-self-driving-cars-arizona.html">drove 3 million miles</a>, however, before their first fatality. It’s not fair to do statistical analysis from a single point of data, but it’s not a great start: Companies should be aiming to make their robots at least as good as humans, if not yet fulfilling the <a href="https://www.telegraph.co.uk/technology/2016/04/25/elon-musk-teslas-autopilot-makes-accidents-50pc-less-likely/">promise of being significantly better</a>.</p>
<p>Even if Uber’s autonomous cars were better drivers, the numbers don’t tell the whole story. Of the 32,000 people who die on U.S. roads each year, <a href="https://www.cdc.gov/motorvehiclesafety/pedestrian_safety/index.html">5,000 to 6,000 are pedestrians</a>. When aiming for safety improvements, should the goal be to reduce overall deaths – or to put special emphasis on protecting the most vulnerable victims? It’s certainly hypothetically possible to imagine a self-driving car system that cuts overall road deaths in half – to 16,000 – while doubling the pedestrian death rate – to 12,000. Overall, that might seem far better than human drivers – but not from the perspective of people walking along the nation’s roads!</p>
<p>My research group has been working to develop ethical decision frameworks for self-driving cars. One potential approach is called “<a href="https://doi.org/10.1007/s10676-017-9419-3">maximin</a>.” Most fundamentally, that way of thinking suggests people designing autonomous vehicles – both physically and in terms of software that runs them – should identify the worst possible outcomes of any decision, even if rare, and work to minimize their effects. Anyone who has been unfortunate enough to be hit by a car both as a pedestrian and while in a vehicle knows that being on foot is far worse. Under maximin, people should design and test cars, among other things, to prioritize pedestrian safety.</p>
<p>Maximin probably isn’t the best possible – and certainly isn’t the only – moral decision theory to use. In some cases, the worst outcome could be avoided if a car never pulls out of its driveway! But maximin provides food for thought about how to integrate self-driving cars into daily life. Even if autonomous cars are always evaluated as safer than humans, what counts as “safer” matters very much.</p>
<h2>3. How much better should self-driving cars be than humans before the public accepts them?</h2>
<p>Even if people could agree on the ways in which self-driving cars should be safer than humans, it’s not clear that people should be okay with self-driving cars when they first become only barely better than humans. If anything, that’s when <a href="https://theconversation.com/before-hitting-the-road-self-driving-cars-should-have-to-pass-a-driving-test-90364">tests on city streets</a> should begin.</p>
<p>Consider a new drug developed by a pharmaceutical company. The company can’t market it as soon as it’s proven not to kill people who take it. Rather, the drug has to go through a <a href="https://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/">series of tests proving it is effective</a> at treating the symptom or condition it’s intended to. Increasingly, drug tests seek to prove a medication is <a href="https://dx.doi.org/10.3345%2Fkjp.2012.55.11.403">significantly better</a> than what’s already on the market. People should expect the same with self-driving cars before companies put the public at risk.</p>
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<figcaption><span class="caption">How should self-driving cars make decisions?</span></figcaption>
</figure>
<p>The crash in Arizona wasn’t just a tragedy. The failure to see a pedestrian in low light was an avoidable basic error for a self-driving car. Autonomous vehicles should be able to do much more than that before they’re allowed to be driven, even in tests, on the open road. Just like pharmaceutical companies, massive technology companies should be required to thoroughly – and ethically – test their systems before their self-driving cars serve or endanger the public.</p><img src="https://counter.theconversation.com/content/92331/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas G. Evans receives funding from the National Science Foundation for Award 1734521, "Ethical Algorithms in Autonomous Vehicles."</span></em></p>In the wake of a self-driving Uber car killing a pedestrian in Arizona, an ethicist examines the state of autonomous vehicle development.Nicholas G. Evans, Assistant Professor of Philosophy, UMass LowellLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/903642018-02-22T11:39:48Z2018-02-22T11:39:48ZBefore hitting the road, self-driving cars should have to pass a driving test<figure><img src="https://images.theconversation.com/files/206669/original/file-20180215-131013-xdy6uo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People have to pass road tests – so should self-driving cars.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-passing-driving-license-exam-562188766">Africa Studio/Shutterstock.com</a></span></figcaption></figure><p>What should a self-driving car do when a nearby vehicle is swerving unpredictably back and forth on the road, as if its driver were drunk? What about encountering a vehicle driving the wrong way? Before autonomous cars are on the road, everyone should know how they’ll respond in unexpected situations.</p>
<p>I <a href="http://unmanned.tamu.edu">develop, test and deploy autonomous shuttles</a>, identifying methods to ensure self-driving vehicles are safe and reliable. But there’s no testing track like the country’s actual roads, and no way to test these new machines as thoroughly as modern human-driven cars have been, with <a href="https://www.fhwa.dot.gov/policyinformation/statistics/2016/vmt421c.cfm">trillions of miles driven every year</a> for decades. When self-driving cars do <a href="https://jalopnik.com/motorcyclist-sues-gm-over-crash-with-self-driving-chevy-1822358606">hit the road</a>, <a href="https://techcrunch.com/2018/02/01/we-were-in-an-accident-during-an-automated-driving-tech-demo/">they crash</a> in ways both <a href="https://www.nytimes.com/2016/07/01/business/self-driving-tesla-fatal-crash-investigation.html">serious</a> and <a href="https://www.theguardian.com/technology/2017/nov/09/self-driving-bus-crashes-two-hours-after-las-vegas-launch-truck-autonomous-vehicle">minor</a>. Yet all their decisions are made electronically, so how can people be confident they’re driving safely?</p>
<p>Fortunately, there’s a common, popular and well-studied method to ensure new technologies are safe and effective for public use: The testing system for new medications. The basic approach involves ensuring these systems do what they’re intended to, without any serious negative side effects – even if researchers don’t fully understand how they work.</p>
<h2>Wide-ranging effects</h2>
<p>Self-driving cars <a href="https://theconversation.com/are-autonomous-cars-really-safer-than-human-drivers-90202">are expected</a> to <a href="https://theconversation.com/redefining-safety-for-self-driving-cars-87419">improve road safety</a>, <a href="https://theconversation.com/why-silicon-valley-wants-you-to-text-and-drive-87972">freeing up drivers’ time and attention</a> and <a href="https://theconversation.com/governments-car-companies-must-resolve-their-competing-goals-for-self-driving-cars-84178">transforming cities</a> and even societies. </p>
<p>The regulations that are created for self-driving cars will have massive effects that <a href="https://blogs.thomsonreuters.com/financial-risk/risk-management-compliance/regulation-vs-innovation-what-do-the-experts-think/">ripple throughout the economy and society</a>. The rules are likely to come from some combination of the two current automotive regulators, the federal <a href="https://www.nhtsa.gov">National Highway Traffic Safety Administration</a> and <a href="http://www.txdot.gov">state departments of transportation</a>. </p>
<p>Federal rules focus primarily on safety standards for structural, mechanical and electrical components of the vehicles, like airbags and seat belts. States can enforce their own safety rules – for example, regulating emissions and handling driver licensing and vehicle registration, which often also includes requiring insurance coverage.</p>
<h2>Current regulations</h2>
<p>Today’s state and federal rules treat drivers and cars as separate entities. But self-driving cars, by definition, combine the two. Without consistency between those regulations, confusion will reign.</p>
<p>The Obama administration came up with <a href="https://www.transportation.gov/sites/dot.gov/files/docs/AV%20policy%20guidance%20PDF.pdf">116 pages of regulations</a> with lots of details, but little understanding of how self-driving cars worked. For example, they called for each car to have human-readable permanent labels listing its specific self-driving capabilities, including limits on speeds, specific highways and weather conditions, all of which would be extremely confusing for users. The regulations also called for ethical decisions to be made “consciously and intentionally” – which is <a href="https://theconversation.com/finding-trust-and-understanding-in-autonomous-technologies-70245">questionable, if not impossible</a>, for a machine. </p>
<p>The Trump administration pared down the rules to <a href="https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/13069a-ads2.0_090617_v9a_tag.pdf">26 pages</a>, but have not yet addressed the important issue of testing self-driving cars.</p>
<h2>Examining algorithms</h2>
<p>Testing algorithms is very like testing medications. In both cases, researchers can’t always tell exactly why something works (especially in the case of <a href="https://theconversation.com/teaching-machines-to-teach-themselves-88374">machine learning</a> algorithms), but it is nevertheless possible to evaluate the outcome: Does a sick person get well after taking a medication? </p>
<p>The U.S. Food and Drug Administration <a href="https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143534.htm">requires medicines be tested</a> not for their mechanisms of treatment, but for the results. The two main criteria are effectiveness – how well the medicine treats the condition it’s intended to – and safety – how severe any side effects or other problems are. With this method, it’s possible to prove a medication is safe and effective without knowing how it works.</p>
<p>Similarly, federal regulations could – and should – require testing for self-driving cars’ algorithms. To date, governments have tested cars as machines, ensuring steering, brakes and other functions work properly. Of course, there are also government tests for human drivers. </p>
<p>A machine that does both should have to pass both types of tests – particularly for <a href="https://www.npr.org/sections/thetwo-way/2018/01/12/577688125/gm-says-car-with-no-steering-wheel-or-pedals-ready-for-streets-in-2019">vehicles that don’t allow for human drivers</a>.</p>
<h2>Evaluating judgment</h2>
<p>In my view, before allowing any specific self-driving car on the road, NHTSA should require test results from the car and its driving algorithms to demonstrate they are safe and reliable. The closest standard at the moment is <a href="https://www.dmv.ca.gov/portal/dmv/detail/vr/autonomous/testing">California’s requirement</a> that all manufacturers of self-driving cars submit annual reports of how many times a human driver had to take control of its vehicles when the algorithms failed to function properly.</p>
<p>That’s a good first step, but it doesn’t tell regulators or the public anything about what the vehicles were doing or what was happening around them when the humans took over. Tests should examine what the algorithms direct the car to do on freeways with trucks, and in neighborhoods with animals, kids, pedestrians and cyclists. Testing should also look at what the algorithms do when both vehicle performances and sensors’ input is compromised by rain, snow or other weather conditions. Cars should run through scenarios with temporary construction zones, four-way intersections, wrong-way vehicles and police officers giving directions that contradict traffic lights and other situations. </p>
<p>Human driving tests include some evaluations of a driver’s judgment and decision-making, but tests for self-driving cars should be more rigorous because there’s no way to rely on human-centered concepts like instinct, reflex or self-preservation. Any action a machine takes is a choice, and the public should be clear on how likely it is that those choices will be safe ones.</p>
<h2>Comparing with humans</h2>
<p>Self-driving cars’ algorithms constantly calculate probabilities. How likely is it that a particular shape is a person? How likely is it that the sensor data means the person is walking toward the road? How likely is it that the person will step into the street? How likely is it that the car can stop before hitting her? This is in fact <a href="https://doi.org/10.1111/j.1467-9280.2006.01780.x">similar to how the human brain</a> works. </p>
<p>That presents a straightforward opportunity for testing autonomous cars and any software updates a manufacturer might distribute to vehicles already on the road: They could present human test drivers and self-driving algorithms with the same scenarios and monitor their performance over many trials. Any self-driving car that does as well as, or better than, people, can be certified as safe for the road. This is very much like the method used in drug testing, in which a new medication’s performance is rated against existing therapies and methods known to be ineffective, like the typical <a href="https://www.webmd.com/pain-management/what-is-the-placebo-effect#1">placebo sugar pill</a>.</p>
<p>Companies should be free to test any innovations they want on their closed tracks, and even on public roads with human safety drivers ready to take the wheel. But before self-driving cars become regular products available for anyone to purchase, the public should be shown clear proof of their safety, reliability and effectiveness.</p><img src="https://counter.theconversation.com/content/90364/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Srikanth Saripalli does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s a common, popular and well-studied method to ensure new technologies are safe and effective for public use – even if researchers don’t fully understand how they work.Srikanth Saripalli, Associate Professor in Mechanical Engineering, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/836412017-09-12T19:42:43Z2017-09-12T19:42:43ZIs evidence for or against drug-testing welfare recipients? It depends on the result we’re after<p>The government’s <a href="http://www.abc.net.au/news/story-streams/federal-budget-2017/2017-05-12/federal-budget-2017-pm-says-welfare-drug-test-plan-based-on-love/8520564">announcement in the May 2017 budget</a> of a trial of random drug testing of 5,000 Youth Allowance and Newstart recipients has been almost universally criticised. While the prime minister claimed the program is <a href="https://www.buzzfeed.com/aliceworkman/based-on-love?utm_term=.oxGVVrx480#.cvDaakj6mQ">“based on love”</a>, the CEO of Jobs Australia has warned it will be so demeaning as to <a href="http://www.abc.net.au/news/2017-08-31/welfare-drug-testing-trial-could-lead-to-crime-and-prostitution/8858264">drive young people to sex work</a>. And the government shows no sign of being overwhelmed by the reportedly “<a href="http://www.abc.net.au/news/2017-09-07/labor-greens-warn-against-coalition-drug-testing-welfare-policy/8879968">overwhelming” medical evidence</a> that its policy will not work. </p>
<p>There is a certain amount of hyperbole on both sides of this issue, which is skewing the evidence. This makes it difficult to interpret, largely due to the lack of clarity on what the aims of this program are. Is it to help struggling addicts, reduce the number of drug users, or save money by reducing welfare payments? </p>
<p>Most of the evidence drawn on by critics of the trial comes from places that have implemented such programs. While it has been considered in the UK and Canada, variations on testing welfare recipients for drug use have only previously appeared in the US and New Zealand. So, have they worked? And is there a convincing link between welfare recipients and drug use at all?</p>
<h2>Drug use and welfare</h2>
<p>The most <a href="http://jhppl.dukejournals.org/content/25/4/623.abstract">recent estimates</a> from the US found about one in five people receiving welfare had used illicit drugs in the previous year. That makes <a href="https://scholars.opb.msu.edu/en/publications/drug-use-among-welfare-recipients-in-the-united-states-4">drug use up to 50% more common</a> in welfare households than the general population. </p>
<p>The impact this drug use has on their lives varies widely, however. <a href="https://www.ncbi.nlm.nih.gov/pubmed/11786289">Less than 5% of welfare recipients</a> met the diagnostic criteria for having a substance abuse problem, which would make them eligible for <a href="http://www.journals.uchicago.edu/doi/abs/10.1086/339669">withdrawal treatment</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/185617/original/file-20170912-11525-15odjgb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185617/original/file-20170912-11525-15odjgb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/185617/original/file-20170912-11525-15odjgb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185617/original/file-20170912-11525-15odjgb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185617/original/file-20170912-11525-15odjgb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185617/original/file-20170912-11525-15odjgb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185617/original/file-20170912-11525-15odjgb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185617/original/file-20170912-11525-15odjgb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Less than 5% of welfare recipients have a substance abuse problem.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Closer to home, a <a href="http://igps.victoria.ac.nz/WelfareWorkingGroup/Downloads/Final%20Report/WWG-Final-Recommendations-Report-22-February-2011.pdf">New Zealand government survey</a> found 32% of welfare recipients reported using illicit drugs, in comparison to 18% of the general population. The clandestine nature of drug use, and the reliance on self-reporting in these statistics, make prevalence estimates imperfect. Nevertheless, drug use has been treated as a key driver of welfare dependency in the US, where testing has been implemented intermittently <a href="http://www.newrepublic.com/article/117033/mississippi-drug-testing-welfare-recipients-wont-work">since the turn of the century</a>.</p>
<h2>Drug testing in Florida</h2>
<p>As numbers of such programs grew in the US, <a href="http://www.tandfonline.com/doi/abs/10.1300/J045v17n01_03">one study directly analysed</a> the difference in employment and earnings between welfare recipients who were and were not using drugs in Florida. The study reviewed 6,642 applications as part of drug testing for the <a href="http://www.dhs.state.il.us/page.aspx?item=30358">Temporary Assistance for Needy Families</a> program. This involves the federal government providing financial assistance to pregnant women and families with one or more dependants.</p>
<p>The authors found a small but insignificant difference between groups, which is a difficult result on which to base conclusions. This study also didn’t collect information about the extent of problematic drug use as opposed to recreational use. And it had limited ability to control for related social and demographic factors.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/helping-drug-users-get-back-to-work-not-random-drug-testing-should-be-our-priority-77468">Helping drug users get back to work, not random drug testing, should be our priority</a>
</strong>
</em>
</p>
<hr>
<p>The confounding effect of these other factors is often alluded to as <a href="http://www.ijdp.org/article/S0955-3959(14)00035-8/abstract">implied evidence against</a> drug-testing programs. For instance, some <a href="http://jhppl.dukejournals.org/content/25/4/623.abstract">studies have argued</a> depression, physical health problems and limited education are the most common barriers to improving the conditions of <a href="https://www.ncbi.nlm.nih.gov/pubmed/11786289">drug-using welfare recipients</a>. Yet this is not a clear argument against targeting drugs, as there is also evidence <a href="https://www.ncbi.nlm.nih.gov/pubmed/9843121">cannabis</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/18368605">methamphetamine</a> use can exacerbate <a href="https://www.ncbi.nlm.nih.gov/pubmed/19837255">depression and other health</a> conditions. </p>
<h2>Too costly an exercise?</h2>
<p>The other <a href="http://www.huffingtonpost.com.au/2017/05/30/drug-testing-of-welfare-clients-found-only-tiny-number-of-users_a_22118237/?utm_hp_ref=au-homepage">argument against the proposed trial</a>, as put forward by the Australian Greens, is that it’s an ineffective use of money as detection rates of drug users will be minimal. Indeed, in <a href="https://beehive.govt.nz/release/pre-employment-drug-testing-jobseekers">New Zealand</a>, $1 million was spent on a similar scheme, which <a href="http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11184479">detected 22 positive</a> results in a sample of 8,001. </p>
<p><a href="http://www.huffingtonpost.com.au/2017/05/30/drug-testing-of-welfare-clients-found-only-tiny-number-of-users_a_22118237/?utm_hp_ref=au-homepage">Data have also been released</a> for detection rates in a similar program in Arizona, Missouri, Utah and Tennessee over an 18-month period in 2013-14. With a total of just under 200,000 tests at a collective cost of over US$1 million, these states disqualified 14, 780, 29 and 24 people from receiving benefits, respectively.</p>
<p>The Australian government won’t disclose the cost of its current proposal, as it is commercial in confidence. Yet <a href="http://www.news.com.au/national/politics/welfare-drug-tests-for-sydneys-southwest/news-story/d194ac53559b60d7e132c77206e4b337">A$10 million has been set</a> aside to support welfare recipients who test positive, presumably to enter treatment or rehabilitation. In the current system, however, <a href="https://ndarc.med.unsw.edu.au/resource/new-horizons-review-alcohol-and-other-drug-treatment-services-australia">less than half</a> of all people seeking drug treatment are able to get access to it. And the most recent reviews of compulsory drug treatment have reiterated it <a href="https://www.ncbi.nlm.nih.gov/pubmed/26790691">does not improve treatment outcomes</a>.</p>
<p>This A$10 million alone would seem to offset any savings made from withdrawing payments following the very low numbers of positive tests that can be expected. The government has not provided any estimate of potential savings under this policy, so we don’t know if this trial will save money.</p>
<h2>What about drug-related harms?</h2>
<p>No assessment has been made thus far of how drug-related harms – such as emergency department presentations, mental health conditions, or interpersonal violence – changed in response to testing programs. But that doesn’t mean we don’t have reason to think such programs had no effect. </p>
<p>There is <a href="https://academic.oup.com/bjc/article-abstract/50/6/999/404023/What-Can-We-Learn-From-The-Portuguese?redirectedFrom=fulltext">evidence</a>, for example, that <a href="http://journals.sagepub.com/doi/abs/10.1375/acri.36.1.77">prohibition limits</a> drug use. Some studies have found when addicts do enter rehabilitation, they can be <a href="http://www.tandfonline.com/doi/abs/10.1080/09638230126722">motivated by the desire</a> to avoid <a href="http://trove.nla.gov.au/work/6794339?q&sort=holdings+desc&_=1505182991114&versionId=44698886">risk of punishment</a> and frequent interactions with police. This would imply additional hurdles that increase the potential cost of using drugs can effectively reduce levels of use.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/185623/original/file-20170912-11525-11hevrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185623/original/file-20170912-11525-11hevrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/185623/original/file-20170912-11525-11hevrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185623/original/file-20170912-11525-11hevrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185623/original/file-20170912-11525-11hevrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185623/original/file-20170912-11525-11hevrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185623/original/file-20170912-11525-11hevrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185623/original/file-20170912-11525-11hevrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Interactions with police can motivate people to enter rehabilitation.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Some critics argue this program will penalise people with advanced levels of dependence. But to base policy on this is to <a href="http://journal.frontiersin.org/article/10.3389/fpsyt.2013.00031/full">ignore the evidence</a> that addicts can and do <a href="http://www.sciencedirect.com/science/article/pii/S2352853216300530">exercise control</a> over their drug use in response to external factors. The point at which many addicts enter treatment is usually “rock bottom”, when the external motivating factors become <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629650/">sufficient to overpower</a> the persistent desire to use. It’s not clear how removing these factors will encourage addicts to enter treatment.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/viewpoints-is-addiction-a-disease-63113">Viewpoints: is addiction a disease?</a>
</strong>
</em>
</p>
<hr>
<h2>What’s the ultimate goal?</h2>
<p>With regards to the public health argument, the evidence exists but is unsettled and complex. This controversy is not resolved by marginalising the broader picture of relevant research. In terms of the economic argument, there is no reason to expect the costs of this program will be outweighed by the welfare payments that may be cancelled. </p>
<p>It can be said, as some of the architects of this program do say, that the very purpose of this trial is to collect the evidence everyone is clamouring for. The government has committed to ongoing reviews of the program and its outcomes. But this will only be useful if they answer the deeper question of what it is they’re looking for.</p><img src="https://counter.theconversation.com/content/83641/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samuel Brookfield does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most of the evidence drawn on by critics of the trial comes from places that have implemented such programs. So, have they worked?Samuel Brookfield, Emergency Registered Nurse & Public Health PhD Candidate, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/796762017-07-24T23:56:44Z2017-07-24T23:56:44ZThe next pharmaceutical revolution could be 3D bioprinted<figure><img src="https://images.theconversation.com/files/177674/original/file-20170711-21764-fxgyap.JPG?ixlib=rb-1.1.0&rect=400%2C34%2C2479%2C1496&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">3D bioprinted channel, representing a blood vessel within a hydrogel that mimics human tissue.</span> <span class="attribution"><span class="source">Forget, Heiny, Derme, Mitterberger, Shastri</span></span></figcaption></figure><p>Body organs such as kidneys, livers and hearts are incredibly complex tissues. Each is made up of many different cell types, plus other components that give the organs their structure and allow them to function as we need them to. </p>
<p>For 3D printed organs to work, they must mimic what happens naturally – both in terms of arrangement and serving a biological need. For example, a kidney must process and excrete waste in the form of urine. </p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1002/adhm.201700255/full">Our latest paper</a> shows a new technique for 3D printing of cells and other biological materials as part of a single production process. It’s another step towards being able to print complex, living structures. </p>
<p>But it’s not organ transplants we see as the most important possible consequence of this work. </p>
<p>There is already evidence that 3D cell printing is a technology useful in drug development, something that may reduce the burden on animals for testing and bring new treatments to market more quickly and safely.</p>
<h2>How we 3D bioprint</h2>
<p>3D printing was first developed for <a href="http://patents.google.com/patent/FR2567668A1/en">rapid fabrication of industrial parts</a> using methods known as <a href="http://patents.google.com/patent/US5236637A/en?inventor=Charles+W.+Hull">sterolithography</a> and <a href="http://www.google.de/patents/US5121329">fuse deposition modelling</a>. </p>
<p>Add “biology” (that is, cells) to the printing technique and it becomes an entirely new process: 3D bioprinting. </p>
<p>3D bioprinting requires sterile conditions to avoid contamination of the bioprinted sample, and an appropriate temperature and humidity so the cells don’t die. Also, the plastic materials traditionally used in 3D printing cannot be used in bioprinting, as they require high temperatures or toxic solvents.</p>
<p>We and other researchers around the world are developing materials that can be manipulated in a 3D printer while causing minimal harm to the cells. </p>
<p>However, each cell type that makes up the different tissues of the human anatomy requires a unique mechanical environment. Each requires unique structural supports to function normally.</p>
<p>As an example, bones are a resistant and brittle material, muscles of the heart are elastic, tough materials, and internal organs such as the liver are soft and compressible. </p>
<p>In a <a href="http://onlinelibrary.wiley.com/doi/10.1002/adhm.201700255/full">recent publication</a>, we and our colleagues show that new materials extracted from marine algae can be used to 3D bioprint human stem cells in distinct environments, and without harming the cells. We believe that these findings pave the way toward the printing of complex tissue structures.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/176508/original/file-20170702-8214-1oydz3n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/176508/original/file-20170702-8214-1oydz3n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176508/original/file-20170702-8214-1oydz3n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=336&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176508/original/file-20170702-8214-1oydz3n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=336&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176508/original/file-20170702-8214-1oydz3n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=336&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176508/original/file-20170702-8214-1oydz3n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=422&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176508/original/file-20170702-8214-1oydz3n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=422&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176508/original/file-20170702-8214-1oydz3n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=422&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The bioprinting process is performed under sterile conditions and using milder temperatures than are used in 3D plastics printing.</span>
<span class="attribution"><span class="source">Steffen Harr</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Hoping for new organs</h2>
<p>Currently, patients needing replacement organs must wait for availability (from living or deceased donors) and are then required to be on immunosuppressive drugs for <a href="http://www.webmd.com/a-to-z-guides/organ-transplants-antirejection-medicines-topic-overview#1">most of the rest of their lives</a>, causing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618138/">side effects</a> and creating a tremendous cost for the <a href="https://www.ncbi.nlm.nih.gov/books/NBK225248/">healthcare system</a>. </p>
<p>The development of 3D-printed biological tissues for organ replacement hopes to <a href="https://www.nature.com/nbt/journal/v32/n8/full/nbt.2958.html">offer a new solution</a> for the <a href="http://transplant.org.au/statistics/">1,500 patients</a> on the organ receiver waiting list every year in Australia. </p>
<p>But printing of entire organs is an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189697/">incredibly complex process</a>, one that takes weeks of time that a patient may not have up his or her sleeve. </p>
<p>Also, while this process is somewhat advanced for relatively simple tissues such as <a href="http://iopscience.iop.org/article/10.1088/1758-5090/9/1/015006">skin</a>, the next phase of the technology requires <a href="https://www.nature.com/nbt/journal/v32/n8/full/nbt.2958.html">incorporation of nerves, blood vessels and lymphatic vessels</a> that would integrate with the host system to create transplantable whole organs such as kidneys, lungs, hearts or livers. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/176567/original/file-20170703-32591-100f65h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/176567/original/file-20170703-32591-100f65h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176567/original/file-20170703-32591-100f65h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=336&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176567/original/file-20170703-32591-100f65h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=336&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176567/original/file-20170703-32591-100f65h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=336&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176567/original/file-20170703-32591-100f65h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=422&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176567/original/file-20170703-32591-100f65h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=422&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176567/original/file-20170703-32591-100f65h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=422&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">How to print whole organs for transplantation: cells from the patient are extracted and cultured in the laboratory. An organ is printed with several type of cells, then grown and transplanted into the same patient.</span>
<span class="attribution"><span class="source">Steffen Harr</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>We’re probably many many years and millions of dollars away from being able to bioprint whole, functional human organs. </p>
<p>But there’s another way bioprinted cells can be used: for testing new drugs in the laboratory. </p>
<h2>Bioprinted cells for drug testing</h2>
<p>Using current methods, bringing a new drug to market has been estimated to cost <a href="http://csdd.tufts.edu/news/complete_story/tufts_csdd_rd_cost_study_now_published">US$2.5 billion</a>, and can take more than ten years from start to finish. </p>
<p>Even if you manage to identify a new candidate drug, the likelihood of regulatory approval is low: in 2016, <a href="https://www.bio.org/sites/default/files/Clinical%20Development%20Success%20Rates%202006-2015%20-%20BIO,%20Biomedtracker,%20Amplion%202016.pdf">less than 10%</a> were approved. </p>
<p>When starting human clinical trials, the probability of a drug to make it to the market is between <a href="http://www.nature.com/nbt/journal/v32/n1/abs/nbt.2786.html">10 and 15%</a> depending on the type of molecule , with illness or even death for participants. We know that these drugs mainly fail due to poor <a href="http://www.nature.com/nbt/journal/v32/n1/abs/nbt.2786.html">efficacy</a> in humans despite promising results in animals. This disconnect is due to the different physiology between species: rodents and other trial animals are very different from humans in many key ways. </p>
<p>3D printing technology allows us to print more complex 3D models that reproduce aspects of the <a href="http://organovo.com/science-technology/publications/">liver, kidneys</a> or <a href="https://www.regenhu.com/3d-bioprinting-bionic-heart-patches/">heart muscles</a> that are suitable to test and identify novel pharmaceutical molecules. These models are already starting to be used by <a href="http://organovo.com/merck-bio-inks-deal-to-use-organovos-3d-printed-liver-for-preclinical-studies/">multinational pharmaceutical companies</a>. </p>
<p>While the use of <a href="http://www.huffingtonpost.com.au/2016/02/17/animal-testing-australia-primates_n_9247608.html">animals in research</a> is still inevitable, the regulatory agency <a href="https://www.statnews.com/2017/05/11/fda-drug-testing-safety-animals/">the Food and Drug Administration</a> and its <a href="https://www.c-span.org/video/?426502-1/fda-commissioner-nominee-scott-gottlieb-defends-accusations-conflicts-interest">new director</a> have already started to consider integrating alternatives for drug safety and efficacy assessment. </p>
<p>The idea that bioprinted tissues have promise for drug development is already recognised, with funding agencies here in <a href="https://www.challenge.gov/challenge/nei-3-d-retina-organoid-challenge-3-d-roc/">Australia</a> and <a href="https://gcgh.grandchallenges.org/challenge/develop-novel-platforms-accelerate-contraceptive-drug-discovery-round-17">globally</a> supporting projects. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/176568/original/file-20170703-32631-1kiqulh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/176568/original/file-20170703-32631-1kiqulh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176568/original/file-20170703-32631-1kiqulh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=336&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176568/original/file-20170703-32631-1kiqulh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=336&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176568/original/file-20170703-32631-1kiqulh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=336&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176568/original/file-20170703-32631-1kiqulh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=422&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176568/original/file-20170703-32631-1kiqulh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=422&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176568/original/file-20170703-32631-1kiqulh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=422&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">3D bioprinting could revolutionising drug discovery: cells from one patient are extracted and cultured in the laboratory. A tissue sample is printed, on which new molecules can be tested as treatments for whole populations.</span>
<span class="attribution"><span class="source">Steffen Harr</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Toward the end of the animal testing?</h2>
<p>In 2013 the European Union passed a new <a href="https://ec.europa.eu/growth/sectors/cosmetics/animal-testing_en">law</a> prohibiting the use of animal testing for cosmetic development on its territory, and of retailing products tested abroad on animals. </p>
<p>This regulation has accelerated the development of human-based <a href="http://www.henkel.de/blob/23978/f177175beb1ce4c0ee7100fba0945685/data/phenion-full-thickness-skin-model-flyer.pdf">3D models of skin</a> for the testing of new cosmetic formulations. These resolutions were accepted because the technology was available and has enabled a reduction in the number of research animals. This is about to be translated in <a href="https://theconversation.com/australia-will-finally-ban-cosmetic-testing-on-animals-78768">Australia</a> as well. </p>
<p>The changes operated in other industries combined with the exciting technological advances let us have a glance at how 3D bioprinting may be able to contribute to faster and cheaper ways to create effective new drugs.</p><img src="https://counter.theconversation.com/content/79676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aurelien Forget receives funding from The Bill & Melinda Gates Foundation</span></em></p><p class="fine-print"><em><span>Tim Dargaville receives funding from The Australian Research Council. </span></em></p>3D bioprinting of living cells and materials may contribute to faster and cheaper ways to create effective new drugs - and even reduce animal testing.Aurelien Forget, Associate Lecturer in Macromolecular Chemistry, Queensland University of TechnologyTim Dargaville, ARC Future Fellow, A/Prof Polymer Chemistry, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/774682017-05-15T05:17:20Z2017-05-15T05:17:20ZHelping drug users get back to work, not random drug testing, should be our priority<figure><img src="https://images.theconversation.com/files/169262/original/file-20170515-3675-v2w0rn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Urine samples can pick up some types of illicit drugs but can't say whether that drug use affects someone's ability to look for work.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/275331890?src=oGoKwSo8CDfGFJOwtsfPiQ-1-4&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p><a href="http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/BudgetReview201718/WelfareRecipients">Drug testing people on welfare</a>, <a href="http://budget.gov.au/2017-18/content/speech/html/speech.htm">as proposed</a> in this year’s federal budget, is a blunt way of tackling problems drug users face when looking for work.</p>
<p>The underlying concept of increasing employability for people with substance use disorders has some merit. However, any drug testing needs to be <a href="https://theconversation.com/drug-testing-welfare-recipients-raises-questions-about-data-profiling-and-discrimination-77471">better targetted</a>, may be open to <a href="https://theconversation.com/budget-2017-welfare-changes-stigmatise-recipients-and-are-sitting-on-shaky-ground-77394">legal challenges</a>, and needs to have checks and balances built in to ensure fairness and transparency if welfare payments are quarantined.</p>
<p>The federal government has proposed a <a href="https://www.humanservices.gov.au/corporate/budget/budget-2017-18/jobseekers/better-targeting-assistance-support-jobseekers#a3">two-year trial</a> of random drug testing of 5,000 Newstart and Youth Allowance recipients for illicit drugs, <a href="https://www.dss.gov.au/sites/default/files/documents/05_2017/budget_2017_-_welfare_reform_-_fact_sheet_for_web_0.pdf">as part of wider welfare reforms</a>. Those testing positive for drugs such as <a href="https://www.dss.gov.au/sites/default/files/documents/05_2017/budget_2017_-_welfare_reform_-_fact_sheet_for_web_0.pdf">ecstasy, marijuana and methamphetamines (including ice)</a> would have their welfare payments quarantined, limiting cash withdrawals. Further positive tests would have a range of consequences, including a medical assessment with possible referral for treatment.</p>
<h2>We need better targetting</h2>
<p>Unemployed people have <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/A24556C814804A99CA257BF0001CAC45/$File/mha26.pdf">higher rates</a> of substance use disorders (defined as harmful or dependent use) than employed people (8.5% vs 5.5%), so we should applaud the government for trying to address the complex issues of substance use and its impact on people’s ability to work. </p>
<p>However, the proposed intervention should be <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/A24556C814804A99CA257BF0001CAC45/$File/mha26.pdf">better targetted</a>. Alcohol is by far our biggest “drug problem”. Some 4.3% of Australians have an alcohol use disorder, compared with 1% for cannabis and 0.7% for stimulants (amphetamines, ecstasy or cocaine). Alcohol causes <a href="http://www.health.gov.au/internet/drugstrategy/publishing.nsf/Content/34F55AF632F67B70CA2573F60005D42B/$File/mono64.pdf">over twice</a> the productivity lost in the workplace than all illicit drugs combined.</p>
<p>If we are serious about enhancing employment in our under-employed, then addressing alcohol use must be our top priority.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/169261/original/file-20170515-3692-1raaxk4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/169261/original/file-20170515-3692-1raaxk4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/169261/original/file-20170515-3692-1raaxk4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/169261/original/file-20170515-3692-1raaxk4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/169261/original/file-20170515-3692-1raaxk4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/169261/original/file-20170515-3692-1raaxk4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/169261/original/file-20170515-3692-1raaxk4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The emphasis on illicit drugs ignores the bigger problem, alcohol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/568799311?size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Then there’s the nature of who random drug tests actually identify. While they can identify some people who use drugs, they don’t necessarily identify people with a significant drug problem.</p>
<p>That’s because, despite <a href="https://theconversation.com/alcohol-leads-to-more-violence-than-other-drugs-but-youd-never-know-from-the-headlines-72281">common media portrayals</a>, only a minority of people who use substances (including alcohol, cannabis and stimulants) have a substance use disorder. This is defined as clinically and functionally significant impairment caused by the recurrent use of alcohol and/or drugs. </p>
<p>Such a disorder is often estimated in about one in ten users. For example, <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">10% of Australian adults</a> reported using cannabis in the past 12 months, but only 1% had a cannabis use disorder in the same period.</p>
<p>So randomised drug tests will entangle many people who do not have significant problems from their substance use. </p>
<h2>We need checks and balances</h2>
<p>There may well be a place for financial quarantining for people with severe substance use disorders, namely people experiencing severe harms from dependent substance use. But there are already systems in place to manage this.</p>
<p>For instance, <a href="http://www.ncat.nsw.gov.au/Pages/guardianship/gt_matter_about/matter_guardianship.aspx">guardianship</a> involves a tribunal appointing a guardian to make decisions about a person’s health, accommodation, services or other lifestyle matters. And <a href="http://www.sacat.sa.gov.au/types-of-cases/administration/what-is-an-administration-order">administration orders</a> can be put in place to manage people’s finances if they lack the mental capacity to do it themselves.</p>
<p>But these are restricted to people with severe conditions and there are a number of checks and balances, such as a tribunal process.</p>
<p>A “one strike” approach to welfare quarantining based on a single drug test is not a sufficiently robust approach.</p>
<h2>We need specialist (and timely) referral options</h2>
<p>The proposal to refer regular users for treatment and support should be encouraged. When targeted appropriately, treatment can have major benefits to the individual, their families and the broader community.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/169260/original/file-20170515-3689-sf1iqw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/169260/original/file-20170515-3689-sf1iqw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/169260/original/file-20170515-3689-sf1iqw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/169260/original/file-20170515-3689-sf1iqw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/169260/original/file-20170515-3689-sf1iqw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/169260/original/file-20170515-3689-sf1iqw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/169260/original/file-20170515-3689-sf1iqw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are already waiting lists for drug and alcohol treatment. So, how will referrals from this proposed random drug testing program fit in?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/569794762?src=cyfPwyLkfPWYjKjlJgUj0g-1-33&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>However, this will require a considerable expansion of drug and alcohol treatment services across Australia. In 2015-16, fewer than <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/">one in six people</a> with a substance use disorder received specialist treatment (an estimated 133,895 received treatment of the approximately one million Australians with a substance use disorder).</p>
<p>The current proposal risks further lengthening treatment waiting lists for people with severe substance use disorders. Having treatment places filled with clients with less severe problems motivated by their need to retain welfare payments may not be clever use of resources.</p>
<h2>We need to avoid stigmatising drug users</h2>
<p>The current proposal may also have unintended consequences. The focus on random drug tests with financial consequences heralds a “war on drugs” approach that <a href="https://theconversation.com/budget-2017-welfare-changes-stigmatise-recipients-and-are-sitting-on-shaky-ground-77394">worsens discrimination and stigma</a> against people who use drugs, which in turn limits their willingness to seek help from services and their community.</p>
<p>Targeting particular drugs such as cannabis increase the likelihood that people turn to more harmful drugs not screened for, such as <a href="https://theconversation.com/labs-make-new-dangerous-synthetic-cannabinoid-drugs-faster-than-we-can-ban-them-47896">synthetic cannabinoids</a> or <a href="https://theconversation.com/easier-access-to-prescription-drugs-puts-teens-at-risk-34910">prescription drugs</a>. </p>
<p>We must also recognise many people turn to substance use as a way of coping with stress, such as can occur with long-term unemployment. This strategy further risks increasing the stress and sense of futility experienced by many, particularly in an environment of high unemployment and youth unemployment in particular.</p>
<h2>We need to keep an eye on costs</h2>
<p>The government has not released the cost of this proposed measure, saying it is <a href="https://www.dss.gov.au/sites/default/files/documents/05_2017/budget_2017_-_welfare_reform_-_fact_sheet_for_web_0.pdf">commercial-in-confidence</a>. But the project is likely to be expensive to implement.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/169256/original/file-20170515-3659-pjohhq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/169256/original/file-20170515-3659-pjohhq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/169256/original/file-20170515-3659-pjohhq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/169256/original/file-20170515-3659-pjohhq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/169256/original/file-20170515-3659-pjohhq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/169256/original/file-20170515-3659-pjohhq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/169256/original/file-20170515-3659-pjohhq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Relying on urine samples to detect illicit drugs can bring on legal challenges, which will be costly to defend.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/12506668?src=yeDok7Y7gKCbgKdjK0VLkw-1-42&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>It’s not just the random drug tests and the required workforce that are costly, but the likelihood of fighting expensive legal challenges if saliva tests are relied on. So, <a href="https://www.ncbi.nlm.nih.gov/pubmed/11786289">any positive saliva test</a> will need to be corroborated using urine or blood tests, which increases costs considerably.</p>
<p>Previous attempts at introducing similar drug testing schemes for welfare recipients in the US, UK and New Zealand have either <a href="http://www.ncsl.org/research/human-services/drug-testing-and-public-assistance.aspx">stalled or been halted</a> through legal challenge.</p>
<p>Then there’s the cost of medical assessments, and drug and alcohol treatment referrals.</p>
<p>If the <a href="https://thinkprogress.org/what-7-states-discovered-after-spending-more-than-1-million-drug-testing-welfare-recipients-c346e0b4305d">experience in the US</a> is anything to go by, it’s very unlikely there will be any net savings in welfare payments.</p>
<h2>We need to fine-tune the proposal</h2>
<p>Despite these limitations, the underlying concept of increasing employability for under-employed people with substance use disorders has some merit. Yet the government needs to refine the proposal before implementing it.</p>
<p>Refinements should focus on people with severe substance use disorders (including alcohol), and ensuring appropriate drug and alcohol treatment and other services are available to address barriers faced when looking for work.</p>
<p>For example, in a US study of a similarly designed scheme, only <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764122/">one in 20</a> welfare recipients who tested positive for drugs identified no other significant barrier to employment. Most had a range of other legal, education, general and mental health, housing, and child welfare barriers to finding work.</p>
<p>Integrated and coordinated service packages and partnerships with employers are likely to have longer term benefits, and provide better value than spending money on drug testing programs. Financial or welfare quarantining for people with severe problems may have a role as part of the overall approach, not be the centrepiece.</p><img src="https://counter.theconversation.com/content/77468/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Lintzeris does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The proposal to drug test welfare recipients needs to be fine-tuned otherwise the government will be targetting the wrong people and be tied up in legal challenges.Nicholas Lintzeris, Clinical Professor and Addiction Medicine specialist, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/774712017-05-12T06:07:18Z2017-05-12T06:07:18ZDrug testing welfare recipients raises questions about data profiling and discrimination<figure><img src="https://images.theconversation.com/files/169066/original/file-20170512-32618-19518y4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Five thousand people on Newstart or Youth Allowance may be targeted for a drug test trial.</span> <span class="attribution"><a class="source" href="http://one.aap.com.au/#/search/centrelink?q=%7B%22pageSize%22:25,%22pageNumber%22:2%7D">AAP Image/Dan Peled</a></span></figcaption></figure><p>The Australian government’s proposed random drug test trial for welfare recipients is not so random.</p>
<p>Announced as part of <a href="http://budget.gov.au/2017-18/content/speech/html/speech.htm">the 2017 federal budget</a>, Treasurer Scott Morrison wants 5,000 people on Newstart or Youth Allowance in three locations to undergo random drug testing from January next year.</p>
<p><a href="https://www.dss.gov.au/sites/default/files/documents/05_2017/budget_2017_-_welfare_reform_-_fact_sheet_for_web_0.pdf">Traces of drugs</a> including ecstasy, marijuana and ice will be sought using saliva, hair follicles and urine samples. If drugs are detected, the user could find their welfare quarantined.</p>
<p>But rather than doing people “a big favour”, as Prime Minister Malcolm Turnbull <a href="https://www.pm.gov.au/media/2017-05-10/interview-fran-kelly-abc-rn-breakfast">put it on ABC Radio</a> Wednesday, such data-based programs often disproportionately target those of low socio-economic status.</p>
<p>Concerns <a href="https://theconversation.com/budget-2017-welfare-changes-stigmatise-recipients-and-are-sitting-on-shaky-ground-77394">are already being raised</a> that the trial undermines the needs-based focus of Australia’s welfare system. The use of data tools to profile people seeking help only adds to the problem.</p>
<h2>How job seekers will be profiled</h2>
<p>The characterisation of the testing as “random” is questionable.</p>
<p>The government <a href="https://www.dss.gov.au/sites/default/files/documents/05_2017/budget_2017_-_welfare_reform_-_fact_sheet_for_web_0.pdf">says the testing</a> will be “based on a data-driven profiling tool developed for the trial to identify relevant characteristics that indicate a higher risk of substance abuse issues”.</p>
<p><a href="http://christianporter.dss.gov.au/node/1121">In a press conference</a> Thursday, minister for social services Christian Porter said a “combination of data” developed with Data61 and the CSIRO would be used, as well as internal information from the Department of Human Services and Department of Social Services.</p>
<p>“We’ll put all of that together and identify a broad group of people and then randomly select inside that broad group inside each of the three trial sites,” he said.</p>
<p>In an interview <a href="https://www.buzzfeed.com/robstott/the-government-will-test-your-waste-water-before-deciding?utm_term=.mopWoyMew#.rkxXP9M3G">with BuzzFeed</a> Thursday, Scott Morrison also suggested the three test areas may be chosen using the results of a national program that looks at drugs <a href="https://www.acic.gov.au/sites/g/files/net1491/f/national_wastewater_drug_monitoring_program_report_1_0.pdf?v=1490333695">in wastewater sewage</a>.</p>
<p>While we may think profiles built from such data sets are rational and without prejudice, computational models are not necessarily free from discrimination. </p>
<p>Rather than being “pure”, like any model, they are based on human-generated assumptions.</p>
<h2>Stereotyping on steroids</h2>
<p>The use of data to profile consumers is nothing new. </p>
<p>Insurance companies, for example, use it <a href="https://rac.com.au/car-motoring/info/car-insurance-terms">to assess customer risk</a> based on factors such as age, profession and type of car. This modelling is used to identify those more “at risk” of having an accident, with insurance premiums priced accordingly. </p>
<p>Even the most careful under-25 driver will feel the impact of falling into a high risk age-based profile, whether or not they’re a bad driver.</p>
<p>But data profiling can become stereotyping on steroids, with human assumptions magnified by computational power.</p>
<p>Data-driven profiling often looks for a target attribute – or class attribute – that the profiler is most interested in predicting. When looking for groups to participate in a drug test trial, for instance, the class attribute could possibly be sensitive groupings such as race, gender, socio-economic background and education level. </p>
<p>This could lead to discriminatory practices where an entire category of people is considered suspect and therefore is more heavily scrutinised.</p>
<p><a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2182773">A 2012 analysis of American privacy laws</a>, for example, found lower socioeconomic groups were more impacted by invasive surveillance, such as mandatory drug testing. </p>
<p>I suggest that to be representative and not discriminatory, the sites selected for the federal government’s drug testing trial would need to have the same proportion of drug users as the general population, with the same distribution of ages, gender split and mix of high- and low-skilled labour. </p>
<p>Instead, as previously mentioned, the trial site selection may be informed in part by analysis of drug trace levels found in sewerage. </p>
<p><a href="http://christianporter.dss.gov.au/node/1121">Porter said</a> “astonishingly high” levels of ice usage found in some regions helped prompt the trial: “We want to drive behavioural change in some of those areas at that critical point where people are job searching,” he added.</p>
<h2>Too many unanswered questions</h2>
<p>The data-driven profiling of welfare recipients raises a number of ethical questions the government should answer.</p>
<p>Among them:</p>
<ul>
<li><p>Can the security of the data be adequately protected? </p></li>
<li><p>Will the information be used solely for its original purpose? </p></li>
<li><p>What procedures will there be to challenge your selection for a drug test? </p></li>
</ul>
<p>Not to mention, if the welfare recipient is open to scrutiny, to what extent is <a href="https://www.dss.gov.au/sites/default/files/documents/05_2017/budget_2017_-_welfare_reform_-_fact_sheet_for_web_0.pdf">the “contracted third party provider”</a> running the testing also required to be transparent? Already, the cost of the measure has been deemed “commercial-in-confidence”.</p>
<p>A government spokesperson declined to comment, saying it would make further announcements about the trial at an appropriate time. </p>
<p>Many of our actions are now observable, searchable and traceable, and surveillance is more intrusive and extensive than ever. But the impact of this can fall more heavily on disadvantaged communities.</p>
<p>So-called “random” drug testing is just another example of this worrisome trend.</p><img src="https://counter.theconversation.com/content/77471/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bronwen Dalton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The government’s proposed drug test trial shows how data profiling and surveillance targets the poor.Bronwen Dalton, Associate professor, Management Discipline Group UTS Business School, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.