The administration's plan to test staffers at the National Institutes of Health for use of illegal drugs has set off a wave of protest from the research community.
Administration officials confirmed last week that large-scale drug testing of employees in all federal agencies is scheduled to begin around April 1. As word of the impending tests began to spread across the NIH campus in Bethesda, scientists at the nation's leading research center began searching for ways to block the plan.
"I know many people are upset about this," said Dr. James Wyngaarden, NIH director. "They said they would leave before they submit to it."
An ad hoc group of scientists from some of the institutes will gather later this week to examine options to prevent the drug-testing program, said Dr. Gary Felsenfeld of the National Institute of Diabetes, Digestive and Kidney Diseases. NIH is composed of 13 institutes.
"Our first concern, obviously, has to do with civil rights, in terms of invasion of privacy," Felsenfeld said. "The second issue is the practicality of choosing us as subjects for drug tests as a way of doing something about the drug problem in this country. It seems a futile gesture."
Only 2,300 of the 13,000 employees on the NIH campus would be in the pool of individuals to be tested, and only 10 percent of the eligible pool would be tested each year.
The testing plan comes at a time when many scientists at NIH are feeling under siege. The center has lost several senior researchers to the private sector and academia, where salaries are considerably higher. While this has happened in the past, the defection of such leaders as geneticist Philip Leder to Harvard Medical School and the rumored departure plans of AIDS researcher Robert Gallo have raised concerns that the federal research center is losing its edge in competing for talent.
Tempers flared last year during a near revolt by Public Health Service physicians at the NIH, causing Surgeon General C. Everett Koop to rescindhis proposal to make them wear their uniforms on a regular basis.
More recently, the Office of Management and Budget took a shot at NIH, many researchers felt, when it circulated a plan for turning the federal research center into a private enterprise. To some at NIH, testing for drugs is the last straw.
Wyngaarden said some of those threatening to quit over the drug-testing program were "key" people at the NIH.
At the same time, other administration officials are convinced that drug tests will improve the federal workplace.
The program for searching urine samples for illicit drugs is the product of a September 1986 presidential order that will be applied to all government agencies.
"The program is designed to be a deterrent," said Dr. Michael Walsh, director of the Office of Work Place Initiatives at the National Institute of Drug Abuse. Walsh, who is in charge of setting up the federal drug screening program, added: "Drug use on or off the job is not consistent with federal employment."
The Department of Health and Human Services, the NIH's parent organization, has been charged with developing the bureaucracy-wide testing program. In about two weeks, it expects to finish reviewing the draft testing programs submitted by all the agencies and departments.
HHS will send a report on the drug program to Congress and provide technical guidelines to the Office of Personnel Management. After 60 days for a comment period, the program will be implemented. That puts the starting date for drug tests around April 1, Walsh said.
A handful of departments and agencies with special concerns about safety and drug use already routinely conduct random tests of their employees. These include air traffic controllers and others at the Department of Transportation, Justice department employees such as those at the FBI, the Drug Enforcement Agency and the Immigration and Naturalization Service, and the Department of Defense.
Meanwhile, a handful of lawsuits seeking to ban the tests are currently working their way through the federal courts. The suits claim drug testing is a violation of the Fourth Amendment's prohibition against unreasonable searches and seizures. For the most part, however, the employees are losing the fight, with at least one appeals court recently concluding that random testing does not violate the Fourth Amendment. The U.S. Supreme Court has yet to decide whether it will hear arguments on the federal drug-testing programs.
The goal of the drug-testing program, according to administration officials, is to use the threat of being tested to intimidate people into not using drugs. As a result, only about 5 percent of the federal work force will be included in the drug-testing program, Walsh said. "The actual percentage of folks who are going to be tested is very small -- 95 percent or more will never be tested unless there's reason to suspect them."
The Transportation Department reportedly tested five employees in December on grounds of suspicion of drug use. One supervisor walked in on an employee smoking marijuana during his lunch break. He was tested. Two others were arrested for selling drugs on the weekend, and they were tested when they came to work on Monday.
Now, the federal drug-testing program is about to be greatly expanded to cover the more than 40 agencies and departments and their hundreds of thousands of workers. The Office of Personnel Management, expecting federal employees to be concerned about drug-testing programs, has set up a hotline to answer questions. "Because so few agencies have started testing, we got few calls," said OPM press officer James Lafferty, adding that the hotline no longer is staffed. "We put it on hold."
The level of concern could quickly mount. As news of the impending testing spreads at the NIH, the level of outcries already is on the rise.
"Given the personal affront to most people here, it seems like a wasteful thing to do," Felsenfeld said. "It is expensive. It is a gesture. In the face of the violations of privacy, the price just seems too great."
The NIH prides itself on its staff. As one of the biggest and most prestigious biomedical research centers in the world, it attracts some of the brightest scientists anywhere, and many tend to be fairly independent.
NIDA's Walsh, however, refuses to accept the implication that NIH researchers -- physicians and scientists who design new drugs, who potentially even had a hand in developing the drug-testing techniques -- are so unlikely to abuse drugs because of their education and professional status that they should be exempt.
Walsh pointed out that Dr. George C. Daniel, an endocrinologist and researcher finishing a three-year fellowship at NIH, was arrested in November and charged with selling nearly a dozen prescriptions for the narcotic painkillers Dilaudid, Percodan and Demerol to Drug Enforcement Agency undercover agents for $100 each.
He initially was held without bond because the federal agents feared that Daniels, a British citizen from the Caribbean island of Dominica, would flee the country. Later, Daniel was released to Dismas House, a Baltimore halfway house, where he remains awaiting a Feb. 1 trial. He was in the U.S. on a student visa that expired in 1979 and had established Geodan Medical House Calls Inc., a company to provide old-fashioned house calls to the elderly and invalids, in his Potomac home.
"At NIH, drugs are more readily available than at almost any other federal agency," Walsh said. "The clinical center at NIH has some of the most exotic drugs in the world."
One concern for NIH employees is how staffers would be selected for testing. What safeguards exist to prevent mistakes and false positives, and what would happen to someone accused of using drugs? Would they be fired? Reassigned?
NIH director Wyngaarden said that as the agency's draft plan stands, testing would include only certain administrators, employees involved in patient care -- doctors, nurses, technicians on the permanent staff, not clinical or research fellows -- and those handling hazardous substances, including radioactive materials. Laboratory and section chiefs, originally included, would be exempt, Wyngaarden said.
The way most drug tests work, an employee provides a urine sample in private. The sample is then sent to a laboratory to see if it shows any traces of illegal drugs such as marijuana or cocaine.
Studies have shown that such tests are accurate, but they cannot automatically distinguish between illegal and legal drug use. A person taking Percodan, a prescribed painkiller sometimes used for dental pain, for example, could show up as positive on routine drug tests.
"A lot of the concern is an unrealistic fear of false positives," Walsh said, adding that there are safeguards to prevent this. If a sample tests positive, the results and the employee are sent to a medical officer -- a physician charged with reviewing the results and determining whether there is a legitimate reason for a positive result, such as a prescription for a specific ailment. The medical officer can then change a positive result to a negative result or have the original sample retested.
If the employee has used illegal drugs -- on or off the job -- he or she is sent to that agency's employee assistance program (EAP) for help in quitting the drug.
"Depending on the employee's position -- if it is a sensitive or critical position -- the employee may be removed," Walsh said. An employee could be removed only temporarily for treatment and then could be reinstated or removed permanently. For example, Walsh said, "air traffic controllers would not remain on the screens in the towers while they went through treatment."
If the employee continues to use drugs after attending a treatment program, a number of disciplinary options are available, including reprimands, suspension and dismissal. The president's original order in September 1986 prohibits the use of the drug tests to prosecute any federal employee.
Edward E. Nicholas, NIH director of personnel management, confirmed that the general outline described by Walsh will be instituted at the NIH. Nicholas said he had no idea how many positives could be expected at the research center. The Department of Transportation is getting an estimated 3 to 5 percent positive rate among the estimated 25,000 employees in its drug-testing pool, he said.
About 19,000 in the DOT drug testing pool are air traffic controllers, Walsh said.
The cost of the program -- either for NIH or the rest the government -- is unclear. Some NIH staffers have raised objections that the drug screening would be paid for out of money earmarked for research.
Nicholas said the NIH will soon start an education program to explain the drug test to employees. But for many at NIH, the program's details offer little comfort. While many can understand the need to test airline pilots or air traffic controllers or even ConRail engineers, few understand the need to test administrators in NIH's Building 1, where no one performs operations that endanger anyone's life.
The feeling is the same in other federal agencies. Physicians at the Veterans Administration already had tried, apparently unsuccessfully, to get themselves exempted from the drug-testing program.
One administrator at ADAMHA, the Alcohol and Drug Abuse and Mental Health Administration, privately admitted planning to use the over-the-counter diuretic Aquaban, which turns urine blue, before submitting to the test. This would prevent the possibility of confusing that sample with anyone else's.
Others interviewed for this story simply said the drug-testing plan is just more in the continuing attack on civil servants.
A petition circulated by section and lab chiefs in the diabetes institute argued that widespread testing will make it harder for the NIH to attract post-doctoral researchers from universities, where such drug testing is not performed. Although the draft plan for testing employees now exempts post-doctoral fellows, the basic concerns about the program remain.
Many researchers who could work in universities point out that their university colleagues do not have to put up with urine tests for illegal drug use; federal researchers feel that neither should they.
" Said one employee likely to be in the testing pool. "It's an invasion of privacy, but I want to keep my job so I'll grit my teeth and give my donation."