The medical ethics of drugs and alcohol regulation and compliance testing in humans

In South Africa, the shift towards heightened awareness and regulation of both legal and illegal substances following the legalisation of cannabis for personal use calls for a nuanced approach to compliance testing. This lecture explores the intersection of legal, ethical, and scientific considerations in organisational drug testing policies, ensuring they are robust and defensible. The principalism approach, which hinges on four key ethical principles—autonomy, beneficence, non-maleficence, and justice—provides a framework for addressing the ethical challenges inherent in prohibited substance testing. This approach underlines the necessity of respecting human rights, including privacy, dignity, and bodily integrity, in the design and implementation of drug and alcohol testing programs. The lecture further discusses the impact of substances such as alcohol, cannabis, cocaine, amphetamines, and heroin, along with prescription and over-the-counter medications, on safety-sensitive environments. Adopting the principalism approach offers a way to ethically navigate the complexities of drug testing while upholding the fundamental rights of individuals.