As most producers know, life insurers screen for one drug of abuse routinely. That drug, of course, is cocaine, and the industry has been testing for it in both urine and oral fluid for many years.

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

When underwriters started screening for cocaine (actually, for its primary metabolite, benzoylecgonine), the main concern was what underwriters did not know about users. Cocaine use is a formidable risk-taking behavior, typically associated with heavy alcohol and tobacco use, unsavory associates and many other insurability red flags.

In recent years, cardiology studies have provided a second motive for doing this “nose candy” testing: the prevalence of circulatory consequences linked to both occasional and habitual use.

A surprising number of heart attacks under age 40 are induced by the acute effects of cocaine ingestion. Cocaine also enhances the risk of early-onset atherosclerosis, no doubt in part due to other undesirable health habits so often seen in regular users.

Overall, labs now report that two specimens per 1,000 are cocaine-positive, with the rate almost twice as high in men. This rate has declined by almost 50% in the last decade, consistent with the rise of “crystal meth” as the Number One abused stimulant in America.

Lab data show that the highest incidence of cocaine positives in both genders is–believe it or not–at ages 40-49, and while the likelihood is greater at lower face amounts, seven-figure (and even larger) applications are often seen with telltale evidence of cocaine abuse.

Toxicology studies have shown that widely-spaced use is probably detected only within 4 days or less after ingestion. Heavier indulgence, on the other hand, can be unmasked after a week or more of 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 rare scenarios wherein the proposed insured could do so unwittingly.

Consuming certain coca-laced herbal teas manufactured in South America could do the trick because coca is the source of cocaine. Fortunately, the importation of these teas is illegal and therefore the risk of this scenario is minimal.

Another explanation for an “innocent” positive test is cocaine-based topical anesthesia. The drug has rather marked numbing effects, as snorters can readily attest, and for this reason it is still used in some contexts by some orofacial surgeons.

Government data show that crystal meth has emerged as cocaine’s number one “competitor.” It has the advantage of being manufactured rather than imported, which explains why clandestine “meth labs” are found just about everywhere now.

Because it is less costly than cocaine, researchers find that meth is now the drug de jour of over-the-road truckers and college students cramming until dawn for exams. More ominously, it accounts for a significantly greater share of tragic health consequences than cocaine.

Marijuana screening is a bit more problematic. While arguments may fly over the nature and extent of its adversities, occasional pot smoking is a non-issue when compared to use of these other drugs.

Another reality questioning 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.

While testing for heroin and opioids (synthetic narcotics similar to morphine) is rarely done in an underwriting context, a compelling case could be framed for rethinking underwriters’ ambivalence. These are the drugs of choice in more severe cases of chronic pain. And chronic pain is one of the most common conditions encountered by physicians and underwriters both.

Heroin addiction is not an issue but medicinal opioid abuse is becoming more common and the most potent ones are insidiously addicting. This occurs across the socioeconomic spectrum. Fact is, anesthesiologists and banged-upon quarterbacks are among those at particularly high risk.