Issue link: https://maltatoday.uberflip.com/i/1431464
13 maltatoday | SUNDAY • 21 NOVEMBER 2021 OPINION Zero tolerance? Zero-empathy games THE recent, hysterical outcry by a Christian gang hiding behind a campaign of fear, and that by the Malta Employers Associa- tion (MEA) echoing previous at- tempts by the Chamber of Com- merce and other professional organisations to categorically stigmatise and label people who consume cannabis as non-re- sponsible workers, parents or members of society, is yet anoth- er unfounded attempt to derail a civil rights and social change process aimed at promoting a more just society for all. By calling for a strict zero toler- ance and zero-empathy approach at the workplace, including pro- posals to introduce registries of people who consume cannabis and mandatory psychiatric analy- sis, without taking into considera- tion important scientific evidence and the role of human rights, is unfortunately once more a clear example of rushed and unin- formed conclusions. Without giving the impression that ReLeaf Malta is in favour of promoting the consumption of mind-altering substances at the workplace, calls for a zero-toler- ance policy perpetuates a culture of stigma and discrimination cre- ated by prohibition and years of criminalising cannabis consum- ers. Calls by employers for a total zero-tolerance policy at the work- place could at face value be viewed by many as a logical and a most required step to ensure the safety and well-being of all employees. Random drug-testing is therefore heralded as the ideal approach to sort out the bad apples from the shiny rosy ones and ensure the company can boast of a drug-free environment. How to achieve this, you may ask? Obviously, have no mercy! Surprise them, line them up, test them and if found positive to can- nabis, cocaine, or heroin, dismiss on the spot and inform the police to take criminal action against the person! This militaristic approach pre- sents a number of problems, pri- marily: 1) how to safeguard priva- cy, 2) differences how to quantify and compare impairment and lev- el of toxicity for different drugs, 3) workers' rights, 4) occupational health and safety considerations for the company as a whole, and 5) cultural bias how to view drugs and accommodate, even at the workplace, the use of some drugs such as alcohol, whilst demonise the private and personal use of other drugs, such as cannabis. How many employers can de- clare that they do not offer alco- holic beverages on special occa- sions, or have stocked fine single malts in their offices for VIPs? Can the directors of the MEA, Chamber of Commerce, the Mal- tese Church, Caritas and OASI Foundation confirm that no al- cohol or other mind-altering sub- stance is used on their premises? Even government ministries have budgets to supply alcohol during special events or when hosting important dignitaries. Funnily enough, prior to 2013, even our Honourable MPs in par- liament had access to an alcoholic bar during parliamentary sessions. Yet, we never heard the Church or the MEA complain that the presence of alcohol at this most prestigious and important work environment, could jeopardise the Honourable members' sound judgment and ultimately derail the democratic process. Therefore, it's a mystery as to how the fact that zero tolerance for the use of mind-altering sub- stances at the workplace is only now dawning on the employ- er's and politician's imagination. Maybe some vociferous stake- holders with a history of drama, now turned PR humanitarians, might have an idea how to un- ravel and explain this cobweb of perceived threats, dualistic ap- proaches and made-up security issues. But, hey who cares? The discus- sion is about drugs; therefore, al- cohol is not in the equation. There is only one little problem with this approach: metabolisa- tion. Yes – science is once more finding an explanation for the most troubling of situations: how to ensure occupational health and safety at the workplace, whilst re- spect privacy and worker's rights. Different substances are me- tabolised differently by the body. For example, alcohol is metabo- lised by the body differently from cocaine or cannabis. A breath- alyser is a useful tool to estimate blood-alcohol concentration, to assess intoxication and ultimately levels of impairment. On the other hand, tests which actually should detect THC, the major psychoactive component of cannabis, are often built to detect the non-psychoactive, secondary metabolite THC-COOH (tetrahy- drocannabinol carboxylic acid). When THC blood levels drop be- low approximately 10 nanograms per millilitre (ng/mL) a few hours after use, there should be no sig- nificant impairment. However, inactive THC-COOH levels are much longer in the blood and even longer in the urine. Alcohol is metabolised via acetal- dehyde to acetic acid (also known as vinegar)... however, trace levels of vinegar in your blood are not making anyone drunk! The same applies to THC. THC is metab- olised via THC-OH to THC- COOH. This THC-COOH is as much of concern for impairment as vinegar. Hence, typical urine tests are not fit for purpose. Many drug tests create false pos- itive and false negative results. A sober person with non-psycho- active metabolites from use a few days ago but also a person con- suming hemp-based foods could easily become victim of a false positive test result. Furthermore, these tests can- not identify an acute intoxication when consumed a few minutes/ hours before the test is conduct- ed. This is a false negative. If such a test system fails to identify an acute intoxication, then it should be clear to every employer that these tests are not fit for purpose. Whilst there are some suppliers offering saliva tests or breatha- lysers with better false positive/ negative ratios, validation is cru- cial. Tests should not identify oc- casional or regular cannabis users but identify significant acute im- pairment. If there is an obvious suspicion, best-practice would be a proper medical examination with blood testing. Besides cannabis, false positive test results are known for many drugs; certain non-impairing medications but also food prod- ucts (e.g. poppy seeds) can trigger such test systems. On the other hand, there are many rather dangerous drugs (ex. novel psychoactive substances) which cannot be identified with typical test systems. It is impor- tant to not push people into more harmful drug use due to errone- ous drug testing. The professional careers and personal lives of people who consume cannabis are not feeble commodities which employers and institutions can choose to de- stroy on the sole reality of testing positive to a particular substance, and without proving impairment, risk to others, and decreased work productivity. Employers, especial- ly in the gaming, financial, cater- ing, building and legal industries could be missing out on prospec- tive star candidates deterred to apply for a job which so clearly invades their privacy and personal lives. In these, games of zero empa- thy, false negatives and false pos- itives, employers, experts from the rehabilitation field and other stakeholders vouching to rein- state a witch-hunt for people who consume cannabis, should recon- sider their position, and evaluate their conclusions on scientific ev- idence, leaving enough space for empathy, dignity and respect for all members of society. Andrew Bonello is president of ReLeaf Malta, Fabian Steinmetz MSc is a senior toxicologist and QSAR and computational expert Andrew Bonello & Fabian Steinmetz