Have you ever lost a job or career opportunity over cannabis testing? If not, you probably know someone who has. Sadly, so many aspiring professionals and minorities experience this kind of unnecessary discrimination through off-the-clock cannabis testing. There are also many who endure unequal or excessively harsh treatment over testing results rather than performance and qualifications. As a young, aspiring physician, I became one of them.
The Gray Area of Cannabis Testing
Unless you live in a state with explicit cannabis protections, most are still at the mercy of cannabis testing and its ramifications that are scientifically groundless. A 2020 systematic review of compiled research found that, “The current body of evidence does not provide sufficient evidence to support the position that cannabis users are at increased risk of occupational injury” (1). The National Academies of Science and Engineering echoes this, as well as a recent 2020 cross-sectional analysis which found that cannabis use within the last year was not associated with workplace injuries, even in high injury-risk work (2)(3).
The same analysis encouraged taking a “risk-based approach” to drafting workplace policies. However, it is widely known that cannabis policies and their disproportionate enforcement are rooted in institutionalized racism. Vague and subjective organizational policies leave plenty of room for introducing systemic bias. While on the surface cannabis testing appears impartial and lawful, it is often used as another vehicle of the war on drugs for discrimination.
Some organizations wish to punish select candidates or employees, while favorably giving others a second chance despite equal testing results. In a recent survey, about 30% of hiring managers said that it “depends on circumstances” whether a positive cannabis result should result in immediate disqualification (4). It is precisely in this gray area where I suffered substantial and disparate consequences worse than that of my peers or any side effect of cannabis itself.
A Crumbling American Dream
My story as a first-generation Costa Rican immigrant working to achieve the American dream is one many can relate to. When I was a child, my father became disabled by a rare, neurodegenerative disease called inclusion body myositis. It was through my caretaking of him that I became inspired to pursue a career in medicine. I worked hard to earn scholarships throughout my undergraduate studies at Boston University, and then a full ride to medical school at George Washington University in Washington, D.C.
As a medical student, I advocated heavily for medicinal cannabis. I started the first cannabis education group at a U.S. medical school, called the Cannabis as Medicine Interest Group, and published a study on the need for cannabis education in medical schools (5). When my class graduated, many of us celebrated our massive accomplishment with legal cannabis before moving on with our medical careers. Before moving to Pueblo, Colorado with my wife Meghan that summer to begin residency training, I abstained from cannabis in preparation for a routine pre-employment urine drug test (UDS).
I am just one voice in a sea of people who have experienced a painful and complete uprooting of livelihood, family dynamics, and career goals over a single pre-employment, off-the-clock positive THC test in a legal state. Several fellow residents at Southern Colorado Family Medicine Residency also tested positive for cannabis, and many reassured me there was no zero-tolerance policy since they were always offered retests to keep working and graduate. In fact, the policy simply stated that “any positive results will be sent to HR.” Thus, a single positive test was not presented as immediate grounds for termination.
Intentionally unclear policies like this can lead to biased interpretations of test results that very well hide institutional racism and bias underneath an ostensibly legal veil. Everyone at Centura Health, including Cynda Eklund of HR and co-residents, told me to continue moving to Colorado despite the uncertainty surrounding my positive cannabis test, putting my wife and me in a state of high anxiety for over a month with little reassurance. Shockingly, when I arrived, I was denied an equal opportunity retest and became the only resident negatively impacted by test results at any family medicine residency program in Colorado.
Hidden Institutional Discrimination
I asked my program director, Emillia Lloyd, why my co-residents were regularly offered retests and I was not. She informed me that it was due to my honesty about consuming and that if I just lied like the other residents, I would have been offered a retest. I was immediately filled with outrage and concern. What kind of world are we living in if we only want practicing doctors who lie? How can people be punished purely for honesty? Determined to make the most of the situation, I went straight to LabCorp and ordered a retest for myself, which came back negative for THC. Sadly, it made no difference.
To make matters even more painful, HR told my colleagues—without my consent—about my first test results and termination before informing me. After being randomly instructed not to come back to work following a week of orientation (that I completed while sick with food poisoning), I received a slew of texts from coworkers about the termination I was still unaware of. Thus, my nightmare evolved into a solitary yet public crucifixion with my friends, family, and coworkers watching in horror. Meanwhile, all my white colleagues were allowed to retest, continue training, and even graduate with positive cannabis tests on their records.
When I finally received the anticipated call from HR that would determine my fate, I was asked to confirm that I had used cannabis in the past and then told that my negative retest would not be accepted. Refuting my coworkers’ stories, HR claimed that this was because retests are never offered to residents. Even after offering to be tested throughout all three years of residency, I was banned from further employment with Centura. In addition to being denied a second chance like my colleagues, I was denied any form of grievance or due process.
Unjust cannabis testing aside, I was appalled by Centura’s lack of respect for me as a resident and unwillingness to discuss this convoluted situation. My wife and I put our life savings toward moving to Colorado so I could help underserved communities as the only incoming Spanish-speaking resident. After stringing us along and then abandoning us over a single drug test, Centura refused to take a second look at the circumstances. When I calmly brought up the possibility of discrimination and racism, my superiors rebuked me for using such words and called me “an angry Hispanic.” I simply asked for a retest; instead, I got an unsympathetic termination letter with a large coffee stain on it.
Rising From the Ashes
Were my hardship and termination truly necessary? I was fired for being truthful about past cannabis consumption, but I was taught in medical school that honesty and integrity are paramount. Rather than being recognized and valued as a sincere physician without any kind of substance use disorder, I was publicly chastised over irrelevant and outdated testing results. Is there a net benefit to society leaving honest people like me out of clinical practice? I took this question and my situation to the Colorado Physician Help Program (CPHP), a statewide program that provides various services to promote the well-being of licensed physicians.
Immediately, CPHP identified racism at play since they had never met a resident in my situation. Upon completion of a day-long biopsychosocial evaluation and interviews with psychiatrists about my substance use history, I was fully cleared with supportive documentation. CPHP reassured me and Centura that I could practice safely, even pairing me with an attorney in Denver. While the attorney confirmed that I had an employment discrimination case, I was informed it would likely take over three years to pursue. Basically, I had to choose between reapplying to residency or a costly lawsuit.
Three years is the entire length of family medicine residency training. I knew I couldn’t afford the monetary cost or time of a lawsuit, so my attorney recommended submitting three months of random drug testing to prove to the next program that I was good to go. Despite offering a mountain of evidence and professional clearance to Southern Colorado Family Medicine and Centura, I was still denied employment and forced to look elsewhere. After already spending thousands to match into the first program, reapplying and interviewing to match into another residency was a special ring of hell to manage and finance.
I will never regret being honest about my cannabis use. Although the consequences were meant to demoralize, they instead galvanized my cannabis career. While I did eventually move on to a family medicine residency program in Seattle, I also put my cannabis expertise and business acumen services up for sale online as a freelancer. My wife scrambled to find teacher work with benefits at a nearby elementary school. We struggled to make ends meet, but together we forged a bright new life out of the ashes.
A Widespread Societal Problem
As a nation, we are being hindered by irrelevant and unscientific cannabis testing. Cannabis testing is a moral, ethical, and scientific failure for a variety of reasons. I consumed and still tested positive over a month later because drug testing takes advantage of cannabis’ exceptionally long lingering time in the body—especially in heavier-set individuals like me. Since our bodies don’t see cannabinoid metabolites as harmful, they don’t race to kick them out. Regrettably, this unnecessary and baseless discrimination against cannabis consumers happens every day across public and private industries.
Like me, Olympic athlete Sha’Carri Richardson defied all odds and devoted her entire life to training for a competitive opportunity that she was denied due to a single cannabis test. Then, she was heavily criticized and publicly shamed. I shared a lot of her pain when I heard she couldn’t run at the Olympics despite qualifying for the 100-meter race. Who is benefitting from the exclusion of highly capable athletes over a non-performance enhancing drug (6)? Sha’Carri was also honest about her use, saying cannabis helped alleviate the pain of her mother’s death while she was under immense competitive pressure (7). How many people would have at least one drink of alcohol under those circumstances?
As a society, we need to reconsider the purpose of drug testing and cannabis laws based on updated evidence and how drug testing disproportionately affects people of color. No one “fails” a drug test, because it is not a moral failing. It’s the other way around. Drug tests fail people—people who have just as much dignified human spirit or “spirit of sport” as the next competitor. The results and consequences are either truly positive or negative based mostly upon an interviewer and organization who can incorrectly judge and mistreat the candidate.
Thankfully, times are changing quickly. Following the wave of public support for Sha’Carri, the World Anti-Doping Agency—an international agency that conducts research on substance use in sports—is now rethinking its anti-cannabis policy (8). Every day there are more people, states, agencies, and employers reconsidering their views on cannabis testing. I urge organizations to repeal anti-cannabis policies based on existing cannabis research and believe the federal government should deschedule cannabis completely to prevent tragic personal and societal losses.
1. Biasutti, W. R., Leffers, K., & Callaghan, R. C. (2020). Systematic Review of Cannabis Use and Risk of Occupational Injury. Substance use & misuse, 55(11), 1733–1745. https://doi.org/10.1080/10826084.2020.1759643
2. The National Academies Press. (2017, January). The Health Effects of Cannabis and Cannabinoids: Committee Conclusions. National academies press. Retrieved October 26, 2021, from https://www.nap.edu/resource/24625/Cannabis_committee_conclusions.pdf.
3. Zhang, J. C., Carnide, N., Holness, L., & Cram, P. (2020). Cannabis use and work-related injuries: a cross-sectional analysis. Occupational medicine (Oxford, England), 70(8), 570–577. https://doi.org/10.1093/occmed/kqaa175
4. Simply Hired. (2019, December 18). Hiring truths: Marijuana edition. Career Advice. Retrieved October 27, 2021, from https://blog.simplyhired.com/hiring-truths-marijuana-edition/
5. Benavides, A., Gregorio, N., Gupta, P., & Kogan, M. (2019, November 13). Medical students are unprepared to counsel patients about medical cannabis and want to learn more. Complementary Therapies in Medicine. Retrieved October 28, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S0965229919312956?via%3Dihub
6. Ware, M. A., Jensen, D., Barrette, A., Vernec, A., & Derman, W. (2018). Cannabis and the Health and Performance of the Elite Athlete. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 28(5), 480–484. https://doi.org/10.1097/JSM.0000000000000650
7. ESPN Internet Ventures. (2021, July 6). Sha’carri Richardson won’t run at Tokyo Olympics after being left off U.S. Relay List. ESPN. Retrieved October 28, 2021, from https://www.espn.com/olympics/story/_/id/31772245/shacarri-richardson-run-tokyo-olympics-being-left-us-relay-list
8. Chappell, B. (2021, September 15). Anti-doping group will review cannabis ban after Sha’carri Richardson’s suspension. NPR. Retrieved October 28, 2021, from https://www.npr.org/2021/09/15/1037286650/wada-world-anti-doping-review-ban-cannabis-shacarri-richardson?utm_term=nprnews&utm_medium=social&utm_source=twitter.com&utm_campaign=npr
Renee Reisinger says:
November 29, 2021 at 11:53 am
Thank you for this excellent editorial! I fully support you. Having educated and certified over 3000 patients in Maryland, cannabis heals and the stigma and damages need to cease!
Renee Reisinger Nurse Practitioner
Abraham Benavides says:
January 24, 2022 at 2:05 pm
Thanks so much for sharing your kind and supportive thoughts! It really means a lot and is much appreciated. Keep on rocking it out there in Maryland!
Honey Smith Walls says:
December 2, 2021 at 9:51 am
Cannabis stigma + racism still = corruption.
We’re gonna have to find the answers to “OTHER” and “Don’t bother me with the facts… I know what I think!” Hopefully before SCOTUS outlaws me being a woman!!!
Abraham Benavides says:
January 24, 2022 at 2:06 pm
Thank you for recognizing the true heart and seriousness of the issue. Hope things improve politically in many, much-needed respects.
December 11, 2021 at 11:23 pm
Thank you for this heart warming editorial. I came from the country with a hard cannabis prohibition law. I have a similar background with you, a MD, a government employee, but I have a PTSD Condition, LBP, and general anxiety which I choose to use cannabis even that is forbidden in my country.
And until that dark day is coming, I detained, And I go to jail because use cannabis. Now I’m released but sadly the persecution from my colleague and society never stop.
Hope someday I can found place which I can practice as a doctor and still medicated with cannabis legally.
Hope you can help me as a colleague, as a human who believe the benefit of this plant.
Sincerely, with big Love, hope and dream.
Abraham Benavides says:
January 24, 2022 at 2:12 pm
Hi Dr. Faizal,
So terribly sorry to hear about your unfortunate encounters with stigma and terrible experience with the justice system in that country. Sadly things aren’t much better in the US, and the laws need to change there as well. We can continue advocating and writing our stories to help change minds.
I hope you can find a way somewhere that is meaningful and good for you, too. Your efforts and skills are valuable and much needed around the world, regardless of whether you use cannabis or not.