Drug Policy Alliance | 131 10

th
Street, San Francisco, CA 94103
sf@drugpolicy.org | 415.241.9800 voice | 415.241.9801 fax


Drug Policy Alliance Says
NO on Prop 46
October 2014

What is Prop 46?
Proposition 46 (Prop 46) is the Drug and Alcohol
Testing of Doctors. Medical Negligence Lawsuits.
Initiative Statute. It is on the California ballot for the
November 4, 2014 election. According to the official
summary from the Attorney General it does the
following:
Requires drug and alcohol testing of doctors and
reporting of positive test results to the California
Medical Board.
Requires the California Medical Board to
suspend any doctor that tests positive, pending
investigation of the positive test result, and to
take disciplinary action if the doctor was
impaired while on duty.
Requires doctors to report any other doctor
suspected of alcohol or other drug impairment or
medical negligence.
Requires health care practitioners to consult the
state prescription drug history database before
prescribing certain controlled substances.
Increases $250,000 cap on pain and suffering
damages in medical negligence lawsuits to
account for inflation.

Drug Testing
The Drug Policy Alliance opposes mandatory,
suspicionless drug testing as ineffective and counter-
productive.

Research has repeatedly failed to show that random,
suspicionless drug testing prevents or reduces alcohol
or other drug use.
1
Drug testing does not reduce the
harms of drugs, but often creates incentives to use
riskier substances in counterproductive ways.
2

Mandatory drug testing of students, for example, has
been found not to reduce illicit drug use.
3
A recent
systematic review of drug testing in the workplace
found that the practice has been proven neither to
decrease workplace drug use nor to reduce
occupational injuries and accidents. The authors
concluded, [T]he evidence base for the effectiveness
of testing in improving workplace safety is at best
tenuous.
4


The drug testing scheme proposed by Prop 46 is not
the same as that used in aviation and transportation
industries; it is not focused on impairment and doesnt
include important due process protections.

Drug screens are prone to inaccurate results,
especially false positives.
5
The consequences of a
false positive are significant under Prop 46, as a
doctors medical license would be suspended with a
presumption of negligence until investigated further.

Drug testing cannot be used to determine the extent of
drug misuse, impairment, frequency or amount of use.
6

Standard tests cannot distinguish between use of
prescribed opioid pain medication and illicit opioids
such as heroin,
7
or between marijuana consumed over
a previous weekend and that consumed before seeing
a patient.
8


Drug testing is ineffective as an intervention to identify
people with substance misuse disorders,
9
and punitive
responses are less effective than supportive ones at
encouraging people to enter treatment for such
disorders. Physician health programs
10
and supportive
diversion programs have very high success rates at
treating doctors with impairments due to substance
misuse disorders.
11
Californias diversion program for
impaired physicians should be reinstated and fully
funded as a needed first step before instituting
random, suspicionless drug testing.




2 Drug Policy Alliance | 131 10
th
Street, San Francisco, CA 94103
sf@drugpolicy.org | 415.241.9800 voice | 415.241.9801 fax
Page
CURES Database and Drug Overdose
Prop 46 mandates that doctors use the California
prescription drug monitoring database, called the
Controlled Substance Utilization Review and
Evaluation System (CURES). Such databases can be
a part of a comprehensive strategy to reduce
prescription drug misuse and resulting harms such as
accidental drug overdose, but they are not sufficient to
end prescription drug misuse on their own.
12
The
CURES database does not currently have the capacity
to be used by all of the clinicians in California, as Prop
46 would require. The privacy protections of personal
information in CURES are seen as insufficient by
privacy experts. Law enforcement has access to the
prescription data in CURES without a warrant. CURES
is not covered by the same legal privacy protections as
medical records and other health information.

California has a significant drug overdose crisis:
accidental drug overdose is now the leading cause of
accidental death in the state. DPA has been at the
forefront of passing laws to create effective
interventions such as naloxone distribution in order to
reduce overdose deaths in the state. CURES can be a
part of a better strategy to reduce overdose deaths
but alone its use is unlikely to have significant results.
1
See e.g., Ken Pidd and Ann M Roche, "How Effective Is Drug Testing as a
Workplace Safety Strategy? A Systematic Review of the Evidence,"
Accident Analysis & Prevention 71(2014): 154-65; American Academy of
Pediatrics, "Testing for Drugs of Abuse in Children and Adolescents:
AddendumTesting in Schools and at Home," Pediatrics 119, no. 3 (2007).
2
See e.g., American Academy of Pediatrics, Testing in Schools and at
Home; E. E. Bonar, L. Ashrafioun, and M. A. Ilgen, "Synthetic Cannabinoid
Use among Patients in Residential Substance Use Disorder Treatment:
Prevalence, Motives, and Correlates," Drug Alcohol Depend 143(2014);
Yvonne M. Terry-McElrath, Patrick M. O'Malley, and Lloyd D. Johnston,
"Middle and High School Drug Testing and Student Illicit Drug Use: A
National Study 1998-2011," The Journal of Adolescent Health 52, no. 6
(2013): 707-15.
3
American Academy of Pediatrics, Testing in Schools and at Home; S. R.
Sznitman and D. Romer, "Student Drug Testing and Positive School
Climates: Testing the Relation between Two School Characteristics and
Drug Use Behavior in a Longitudinal Study," J Stud Alcohol Drugs 75, no. 1
(2014). R. Yamaguchi, L. D. Johnston, and P. M. O'Malley, "Relationship
between Student Illicit Drug Use and School Drug-Testing Policies," J Sch
Health 73, no. 4 (2003).
4
Pidd and Roche, "How Effective Is Drug Testing as a Workplace Safety
Strategy? A Systematic Review of the Evidence," 154.
5
See e.g., Alec Saitman, Hyung-Doo Park, and Robert L Fitzgerald, "False-
Positive Interferences of Common Urine Drug Screen Immunoassays: A
Review," Journal of Analytical Toxicology 38, no. 7 (2014): bku075; Kristina
Fiore, "APA: Drug Test Results Often Flawed," MedPage Today, May 23,
2010, http://www.medpagetoday.com/MeetingCoverage/APA/20253; and
National Research Council, "Strengthening Forensic Science in the United
States: A Path Forward," (2009). See also, P Chen et al., "The Poppy Seed
Defense: A Novel Solution," Drug Testing and Analysis 6, no. 3 (2014);
Opponents and Supporters
Prop 46 is opposed by a broad coalition of major
organizations, including the California Medical
Association, California Society of Addiction Medicine,
American Civil Liberties Union (ACLU) of California,
Planned Parenthood Affiliates of California, California
Teachers Association, California State Conference of
the NAACP, and California Chamber of Commerce, as
well as DPA. Prop 46 is supported by consumer
lawyers and was put on the ballot by Bob Pack.

DPA Position
The Drug Policy Alliance opposes Prop 46 because of
its invasive random drug testing provisions, its
ineffective and punitive approach to substance misuse,
and its lack of privacy protections for personal health
information. DPA is committed to reducing the harms
caused by drug misuse and drug prohibition. We
recommend fully funding physician-specific diversion
programs to address doctors with substance use
disorders, adding full privacy protections to CURES
(including protection from warrantless law enforcement
searches), and funding effective overdose mortality
prevention initiatives in California.
Michael L Smith et al., "Morphine and Codeine Concentrations in Human
Urine Following Controlled Poppy Seeds Administration of Known Opiate
Content," Forensic Science International 241(2014). Nancy C Brahm et al.,
"Commonly Prescribed Medications and Potential False-Positive Urine Drug
Screens," American Journal of Health-System Pharmacy 67, no. 16 (2010).
6
See e.g., Laura Radel, Kristen Joyce, and Carli Wulff, "Drug Testing
Welfare Recipients: Recent Proposals and Continuing Controversies,"
(Washington, DC: US Department of Health and Human Services, 2011);
Joel B Bennett and Wayne EK Lehman, Preventing Workplace Substance
Abuse: Beyond Drug Testing to Wellness (Washington, DC: American
Psychological Association, 2003); Sharon Levy et al., "Testing for Drugs of
Abuse in Children and Adolescents," Pediatrics 133, no. 6 (2014).
7
Saitman et al., "False-Positive Interferences of Common Urine Drug
Screen Immunoassays: A Review,; Brahm et al., "Commonly Prescribed
Medications and Potential False-Positive Urine Drug Screens."
8
Paul L. Cary, The Marijuana Detection Window: Determining the Length
of Time Cannabinoids Will Remain Detectable in Urine Following Smoking:
A Critical Review of Relevant Research and Cannabinoid Detection
Guidance for Drug Courts, Drug Court Review 5 (2005): 23, 23-24, 31; and
Levy et al., "Testing for Drugs of Abuse in Children and Adolescents."
9
See e.g., Radel, Joyce, and Wulff, "Drug Testing Welfare Recipients";
Bennett and Lehman, Preventing Workplace Substance Abuse: Beyond
Drug Testing to Wellness.
10
R. L. DuPont et al., "Setting the Standard for Recovery: Physicians'
Health Programs," J Subst Abuse Treat 36, no. 2 (2009).
11
M. R. Baldisseri, "Impaired Healthcare Professional," Crit Care Med 35,
no. 2 Suppl (2007).
12
Leonard J Paulozzi, Edwin M Kilbourne, and Hema A Desai, "Prescription
Drug Monitoring Programs and Death Rates from Drug Overdose," Pain
Medicine 12, no. 5 (2011).