The confirmatory imperative: Why Ghana's Drug Testing Policy Needs a Toxicological Recalibration

Yakubu Adam, Toxicologist

In the past year, Ghana's drug testing policy has come under sharp focus. The recent revelation by the Narcotics Control Commission that over 6,000 applicants for the security services, representing roughly seven percent of those screened failed mandatory drug tests has sent shockwaves through the nation. Interior Minister Muntaka Mubarak underscored the urgency, citing over 4,000 failures out of more than 100,000 applicants. As a toxicologist, I view this not as a cause for despair, but as a critical inflection point demanding a rigorous scientific reassessment. While the intent behind the policy is sound, ensuring a drug-free workforce. Its implementation reveals a troubling over-reliance on screening technologies that are fundamentally flawed, economically unsustainable, and potentially ruinous for the individuals they are meant to evaluate.

The Science of Screening vs. Confirmation

At the heart of our national drug testing dilemma lies a profound misunderstanding of what these tests actually do. The primary screening method used in mass testing is the immunoassay. It functions as a blunt instrument, a "needle in a haystack" search that casts a wide net to detect the presence of drug classes. These tests are prized for their speed and low cost which is crucial factors when processing tens of thousands of applicants.

However, speed comes at the cost of specificity. In toxicology, screening tests are presumptive, not definitive. They rely on antibodies that can bind to the target drug, but these antibodies are not perfect. They are susceptible to cross-reactivity, where structurally similar compounds, many of which are entirely legal and legitimate can trigger a positive signal. This is where confirmatory testing, the scientific gold standard, steps in. Techniques like Gas Chromatography-Mass Spectrometry or Liquid Chromatography-Tandem Mass Spectrometry actually separate and identify the specific molecular structure of a drug. While screening tells us if a substance might be there, confirmation tells us with absolute certainty what the substance is and its precise quantity.

The Prevalence of False Positives

The failure to consistently apply confirmatory testing in Ghana is not just a procedural oversight; it is a fundamental injustice. The rate of false positives in immunoassay screening can be alarmingly high, even in advanced clinical settings. For instance, recent evaluations of FDA-cleared fentanyl immunoassays have reported false-positive rates of up to thirty-eight percent before recalibration. Imagine the consequences for a young Ghanaian applicant whose life and career are derailed by a test that is, by scientific consensus, an unreliable indicator.

The problem is exacerbated by the wide array of prescription and over-the-counter drugs that can interfere with these tests. As a toxicologist, I am acutely aware of these interferents. Common antipsychotic medications such as risperidone and paliperidone have been conclusively shown to cause false-positive results for fentanyl. The active metabolite of risperidone, 9-hydroxyrisperidone, is chemically identical to paliperidone and has been known to cross-react with fentanyl immunoassays. In our context, where HIV/AIDS remains a significant health challenge, the anti-retroviral agent efavirenz, commonly known as Stocrin, can produce false-positive results for cannabis with certain test systems. Even common over-the-counter cold remedies containing pseudoephedrine and other sympathomimetics can be misidentified as amphetamines. The consequences of these false positives can be substantial, leading to inappropriate therapeutic decisions, exclusion from clinical studies, and administrative or legal consequences.

Can Ghana Afford This Path?
The question of sustainability is paramount. The recent announcement of new mobile scanners and a planned forensic laboratory is a welcome step. However, it also reveals a stark truth: Ghana's drug testing infrastructure is in its infancy. While the government is making commendable moves, such as expanding the Narcotics Control Commission's operational commands from fewer than ten to seventy-seven nationwide, the capacity for widespread confirmatory testing remains severely limited.

To juxtapose, the Philippines' National Police implemented a Random Drug Testing policy that achieved a positivity rate of just 0.03 percent across thousands of personnel, thanks to standardized protocols and forensic oversight. In the United States, the 2024 workforce drug positivity rate sits at 4.4 percent, but crucially, employers especially in safety-sensitive roles utilize Medical Review Officers to review positive tests. Confirmation tests are standard procedure for any result that could lead to termination, loss of driving privileges, or legal action. In Ghana, if we are to disqualify thousands based on a presumptive screen, we are effectively placing the entire burden of proof on the applicant, and the state's scientific capacity is not yet robust enough to bear that weight.

Policy Directions and Recommendations for Ghana

To navigate this complex terrain, Ghana must adopt a policy that respects both the need for workplace safety and the principles of scientific accuracy and procedural fairness. The National Drug Policy must be amended to mandate that a confirmatory test, using Gas Chromatography-Mass Spectrometry or Liquid Chromatography-Tandem Mass Spectrometry, is performed for every non-negative screening result that could lead to disqualification or stigmatization. This is not optional; it is the ethical baseline. The cost of confirmation is a necessary investment in justice.

Furthermore, a Medical Review Officer system must be established because the toxicology report is not a verdict. A positive result must be interpreted by a qualified professional who can assess an individual's medical history and medication use before a final determination is made. A positive result for fentanyl in a patient taking paliperidone is a clinical nuance, not a conviction. While the move towards a forensic lab is applauded, we must ensure that public and private labs are equipped and staffed to handle the volume of confirmatory testing required. Without this, our policies remain aspirational rather than operational. Finally, drug testing is a tool, not a solution. The National Safety Council recommends that testing be integrated into a broader workplace wellbeing strategy that prioritizes safety, prevention, treatment and recovery support. We must focus on rehabilitation and health, not just punitive action.

A Toxicologist's Call to Action

The disqualification of over 6,000 security applicants is a national scandal, but the scandal is not necessarily the number. The scandal is the potential that many of those individuals were victims of a flawed system, their futures compromised by the limitations of a technology that we have not been responsible enough to verify. As we fight the war on drugs, we must not lose sight of the scientific war for truth. Ghana must build a toxicological framework that is as robust as its ambitions. It must champion confirmatory testing, protect the integrity of its citizens, and ensure that when we say positive, we are sure.

Authored by: Yakubu Adam, Toxicologist/Lecturer

Forensic Investigation for National Development-Ghana (FIND-GH)