Observations of Drug Testing in Life Underwriting

Hank George, FALU, CLU, FLMI

In the North American market, life insurers screen for one drug of abuse routinely. That drug, of course, is cocaine and we have been testing for it in both urine and oral fluid for many years.

However, cocaine is not the only abused drug that has attracted insurer interest. While nearly all carriers include cocaine testing in their urine profiles, both marijuana and methamphetamine are also under “surveillance” on some basis by certain carriers.

When we started screening for cocaine (actually, for its primary metabolite benzoylecgonine), we were mainly concerned with what we didn’t know about users. Cocaine use is a formidable risk-taking behavior, associated with heavy alcohol and tobacco use, unsavory associates and many other insurability RED FLAGS.

In recent years, cardiology studies have shown that a significantly increased prevalence of heart attacks, strokes and other circulatory consequences linked to both occasional and habitual cocaine use.

A surprising number of heart attacks under age 40 are induced by the acute effects of cocaine ingestion. Cocaine also increases the risk of early-onset atherosclerosis (no doubt in part at least because of other undesirable health habits so often seen in its users).

North American insurance laboratories report that 2 specimens per thousand are cocaine-positive, with the rate almost twice as high in men. This rate declined dramatically in the last decade, consistent with the rise of “crystal meth” as the #1 abused stimulant drug in America.

The highest incidence of cocaine positives in both genders occurs at ages 40-49. While the likelihood of testing positive is greatest with smaller face amounts, we often see seven-figure (and even larger) applications with telltale evidence of cocaine abuse.

Toxicology studies tell us that widely-spaced cocaine use is probably detected only for up to 4 days after last ingestion. Heavier indulgence, on the other hand, can be unmasked a week or more after abstinence.

The confirmation test used by insurance laboratories is as fool-proof as any in laboratory science. In other words, if you test positive, you used cocaine! However, there are scenarios where the proposed insured could test positive unwittingly.

Consuming certain coca-laced herbal teas, mainly made in South America, could cause a positive cocaine test because coca is the source of cocaine. Because the importation of these teas is illegal, the likelihood of this scenario is minimal.

The other potential explanation for an “innocent” positive test is cocaine-based topical anesthesia. Because this drug has rather marked numbing effects, it continues to be used by some orofacial surgeons in specific contexts.

Government data show that crystal meth (methamphetamine) has emerged as cocaine’s number one “competitor” among abuse stimulant drugs. It has the advantage of being manufactured rather than imported, which explains why clandestine “meth labs” are being found more and more often.

Because it is less costly than cocaine, meth has become the drug de jour of over-the-road truckers and college students cramming for exams.

Less than 10% of U.S. insurers routinely screen for methamphetamine, even though the test is as reliable as the cocaine test.

Marijuana screening is more problematic.

While arguments fly back and forth over the nature and extent of its adversities, occasional pot smoking is hardly of much risk significance, especially when compared to cocaine and methamphetamine.

Another reality which challenges the wisdom of marijuana testing by insurers is that its metabolite, tetrahydrocannabinol, can be detected in urine as long as 30 days after use. It is difficult to see how widely-spaced use by healthy adults confers any genuine mortality risk significance.

Testing for heroin and opioids (synthetic narcotics similar to morphine) is rarely done in underwriting…but a case could be framed for rethinking our ambivalence at least regarding opioid analgesics.

Opioids – which have a high potential for abuse – are widely dispensed in managing chronic pain. And chronic pain is one of the most common conditions encountered by physicians and underwriters both.

We cover the issue of potential opioid abuse comprehensively in our 2010 Continuing Education course on Underwriting Chronic Pain.