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EDITORIAL Some Thoughts on Drug Abuse Marvin P. Rozear, M.D. At a recent Driver Medical Evaluation Conference, a presentation and discussion of drug screening for athletes at the University of North Carolina prompted some thoughts on drug abuse. It seems to me that the current massive effort to keep drugs out of the country is futile. The experience of prohibition in the 1920s and 1930s should have taught us that if a significant fraction of the population is determined to manufacture and consume a particular product, there is no legislation that will effectively prevent it. Enterprising citizens in a free society will always outwit the relatively slow-moving government and weak civil law enforcement agencies. Furthermore, when the authorities are successful in restricting activities, the price of the product is driven up, incentive for production is greater, and the profit motive wins out again. Successful raids and "sting" operations have the additional effect of encouraging the good guys, giving us the feeling that if we just tried harder, threw a little more money and effort into the fight, we could clean this mess up. Yet we smile at episodes of the "The Untouchables" romantically portraying the quixotic Elliott Ness and partners attempting to rid Chicago of illegal alcohol. Surely, our current efforts will be similarly portrayed to our children and grandchildren, who will also smile. The only way that law enforcement can keep drugs out of this country is to achieve something approaching a pohce state, a situation intolerable to most Americans. If Americans want the kind of freedom that they are used to, they will have to put up with a certain amount of freedom for the individual to choose whether to use drugs or not. Imagine the most absurd situation possible: every other American is assigned to guard another American against the use of drugs. Each guard tails his or her potential user 24 hours a day. When would the guards sleep? Who would guard the guards? There could not be one guard for two or more people, because the suspects would be going in differ- From the Department of Medicine. Duke University Medical Center, Box 3849, Durham 27710. ent directions at the same time. This is hopeless. There are of course some occupations which demand abstinence from drugs: operators of public transport vehicles, air traffic controllers, military personnel in certain situations, etc. Just as technology will always win out in the production, trafficking and distribution of drugs, I think technology can also be used effectively to monitor drugs. The requirement for young athletes to go in after a basketball game and urinate into a receptacle for testing seems Neanderthal to me. We must develop methods of detection using not fluids, but exhaled air. Sensitive equipment can detect the presence of a particular molecule in a large volume (a few parts per million). This should be developed for frequent and automatic screening of all people in certain positions. For instance, a 747 pilot (A) comes to work and, in the presence of witnesses, blows into a tube which screens exhaled air for alcohol, TCH, cocaine, etc. The airplane simply will not start until he or she does this. If pilot A does not blow clean, another pilot (B), who does, starts the plane and takes off. Pilot A stays on the ground and reports to the next level of testing. Possibly the problem was some harmless contaminant from a prior meal. Pilot A then has a more detailed and expensive but specific urine test which absolves him or her completely, and he or she goes back into the flying rotation. Nothing goes on the pilot's record and he or she mainly learns to avoid certain types of food before a flight. If the urine test confirms the presence of significant molecules, Pilot A is processed on up the line, and appropriate action taken. This would be similar to the process of using metal detectors to screen passengers at airports. An over-sensitive, nonspecific test screens everyone for metal. The majority who are positive have innocent materials such as large metal belt buckles and are cleared by the more time consuming but more specific detectors. In fact, this method probably prevents skyjacking attempts more often than it detects them in development The proposed method would similarly discourage drug use more often than detect it An approach of this type would also remove threatening aspects from the process. One would know before starting a job that everyone would complete the process daily, possibly several times a day. If one didn' t want to go through it, he or she could go into NCMJ November 1988, Volume 49. Number 11 595
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-Present] |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1988 |
Identifier | NCHH-17-049 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 49 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-049.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-049 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 595 |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1988 |
Identifier | NCHH-17-049-0971 |
Form General | Periodicals |
Page Type | all; editorial |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncmed491988medi_0971.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 49 |
Issue Number | 11 |
Page Number | 595 |
Health Discipline | Medicine |
Full Text | EDITORIAL Some Thoughts on Drug Abuse Marvin P. Rozear, M.D. At a recent Driver Medical Evaluation Conference, a presentation and discussion of drug screening for athletes at the University of North Carolina prompted some thoughts on drug abuse. It seems to me that the current massive effort to keep drugs out of the country is futile. The experience of prohibition in the 1920s and 1930s should have taught us that if a significant fraction of the population is determined to manufacture and consume a particular product, there is no legislation that will effectively prevent it. Enterprising citizens in a free society will always outwit the relatively slow-moving government and weak civil law enforcement agencies. Furthermore, when the authorities are successful in restricting activities, the price of the product is driven up, incentive for production is greater, and the profit motive wins out again. Successful raids and "sting" operations have the additional effect of encouraging the good guys, giving us the feeling that if we just tried harder, threw a little more money and effort into the fight, we could clean this mess up. Yet we smile at episodes of the "The Untouchables" romantically portraying the quixotic Elliott Ness and partners attempting to rid Chicago of illegal alcohol. Surely, our current efforts will be similarly portrayed to our children and grandchildren, who will also smile. The only way that law enforcement can keep drugs out of this country is to achieve something approaching a pohce state, a situation intolerable to most Americans. If Americans want the kind of freedom that they are used to, they will have to put up with a certain amount of freedom for the individual to choose whether to use drugs or not. Imagine the most absurd situation possible: every other American is assigned to guard another American against the use of drugs. Each guard tails his or her potential user 24 hours a day. When would the guards sleep? Who would guard the guards? There could not be one guard for two or more people, because the suspects would be going in differ- From the Department of Medicine. Duke University Medical Center, Box 3849, Durham 27710. ent directions at the same time. This is hopeless. There are of course some occupations which demand abstinence from drugs: operators of public transport vehicles, air traffic controllers, military personnel in certain situations, etc. Just as technology will always win out in the production, trafficking and distribution of drugs, I think technology can also be used effectively to monitor drugs. The requirement for young athletes to go in after a basketball game and urinate into a receptacle for testing seems Neanderthal to me. We must develop methods of detection using not fluids, but exhaled air. Sensitive equipment can detect the presence of a particular molecule in a large volume (a few parts per million). This should be developed for frequent and automatic screening of all people in certain positions. For instance, a 747 pilot (A) comes to work and, in the presence of witnesses, blows into a tube which screens exhaled air for alcohol, TCH, cocaine, etc. The airplane simply will not start until he or she does this. If pilot A does not blow clean, another pilot (B), who does, starts the plane and takes off. Pilot A stays on the ground and reports to the next level of testing. Possibly the problem was some harmless contaminant from a prior meal. Pilot A then has a more detailed and expensive but specific urine test which absolves him or her completely, and he or she goes back into the flying rotation. Nothing goes on the pilot's record and he or she mainly learns to avoid certain types of food before a flight. If the urine test confirms the presence of significant molecules, Pilot A is processed on up the line, and appropriate action taken. This would be similar to the process of using metal detectors to screen passengers at airports. An over-sensitive, nonspecific test screens everyone for metal. The majority who are positive have innocent materials such as large metal belt buckles and are cleared by the more time consuming but more specific detectors. In fact, this method probably prevents skyjacking attempts more often than it detects them in development The proposed method would similarly discourage drug use more often than detect it An approach of this type would also remove threatening aspects from the process. One would know before starting a job that everyone would complete the process daily, possibly several times a day. If one didn' t want to go through it, he or she could go into NCMJ November 1988, Volume 49. Number 11 595 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-049.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-049 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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