Random Urine Drug Screens for Healthcare Workers…Why Not?

The issue of whether or not to drug test healthcare workers who have access to controlled substances is a controversial one. For some reason there is there is strong opposition to requiring those who hold their patients’ lives in their hands to get tested. By federal law, many workers in transportation or other safety-sensitive areas are already subject to random drug tests. These include pilots, school bus drivers, truck drivers, flight attendants, train engineers, subway operators, ship captains and pipeline emergency response crews. (reference below link), so why not healthcare workers? Governor Walker is even trying to get those who receive food stamps to submit to drug testing. I know part of the reason, it is why I would have resisted it before I got clean and sober, there would be positive results. Those who are using would get found out. The hospitals and clinics would lose a good percentage of their workforce to those positive results. The pubic would know the extent of the problem. I think those are the biggest reasons. There are those too who feel it is an invasion of their privacy. They aren’t using drugs so why should they have to be tested, it isn’t fair. They are right, it isn’t fair, but too bad. Life isn’t fair sometimes. But the problem is real, it is growing and this is one small way to put a dent in it.

Below are a couple of articles I found on the topic, read them and give me your thoughts…

http://oig.hhs.gov/newsroom/news-releases/2014/drug-tested.asp

By DANIEL R. LEVINSON and ERIKA T. BROADHURST March 12, 2014

PEOPLE go to hospitals to get well. We all know that medical care involves risks, but what patients don’t expect is that the doctors, nurses and other staff members charged with their care may deliberately cause them harm. As an important recent case demonstrates, that’s exactly what can happen without stronger controls.

David Kwiatkowski was a medical technician and a prescription-drug addict who worked in more than a dozen hospitals in eight states. He stole the painkiller fentanyl that staff members had prepared for patients awaiting cardiac catheterizations. Mr. Kwiatkowski would take the prefilled fentanyl syringe, inject the drug into his own arm, refill the used syringe with saline, and replace it. Saline was not all he added to those contaminated syringes: Mr. Kwiatkowski has hepatitis C, a potentially fatal virus.

Over the course of a decade, he left a trail of 45 unexplained hepatitis C cases, including two deaths, before finally being arrested in New Hampshire. This past December, he was sentenced to 39 years in prison. Mr. Kwiatkowski’s surviving victims live with the consequences of his crime as well: David Porter (who happens to be a retiree from our Boston office) had to have a leg amputation. Alden Sanborn suffered liver failure.

This case is not unique. In Denver, a former surgical technician, Kristen Diane Parker, was sentenced to 30 years in prison in 2010 after doing the same thing as Mr. Kwiatkowski: injecting herself with fentanyl and refilling the used syringes with saline or water. She infected over a dozen patients with hepatitis C. In Florida, Steven Beumel was sentenced to 30 years in prison in 2012 for similar actions that infected at least five people with hepatitis C. One victim underwent a liver transplant and later died.

This is hardly a radical suggestion. By federal law, many workers in transportation or other safety-sensitive areas are already subject to random drug tests. These include pilots, school bus drivers, truck drivers, flight attendants, train engineers, subway operators, ship captains and pipeline emergency response crews.

We should also treat addiction as the chronic disease that it is, and get addicted health care workers help. This could prevent some from breaking the law to feed their addiction. One effective model is known as physician health programs. These work for and with state agencies to recommend treatment and monitor recovery while helping physicians avoid professional and criminal penalties. One 2008 study of 802 doctors with a history of substance abuse who were monitored for five years showed that 65 percent remained free of drug or alcohol use.

But addicted health care workers need not be physicians to put patients at risk. All health care workers with access to drugs, including medical doctors, nurses, nurse practitioners, radiological technicians and surgical assistants, should be subject to mandatory drug testing.

Daniel R. Levinson is the inspector general and Erika T. Broadhurst is a special agent for the Department of Health and Human Services.

http://www.drugfree.org/join-together/doctors-nurses-tested-drugs-alcohol-medical-ethicist/

Doctors’ groups have argued that the medical profession can regulate itself. “There’s some denial that there’s a problem, and fear about false positives,” he says. “There’s some notion that the problem requires therapy, rehabilitation and collegial monitoring, not drug testing. Doctors have put so much time into getting trained, and they don’t want to discuss something that could potentially be a career-ender.”

In November, California voters rejected a measure that would have required doctors in the state to submit to random drug and alcohol tests. The measure, known as Proposition 46, was opposed by doctors, hospitals and medical insurance companies. Currently no state has such a requirement.

Doctors are not the only medical professionals who should be tested, Dr. Caplan says. “There are likely to be more nurses than doctors with addiction problems, because there are more of them, not because they have a higher percentage of addiction. They can make mistakes that can kill patients, too.”

Comments from folks on the above article:

-When the preventive medicine taskforces consider whether widespread testing is reasonable, they look at the prevalence within the population, and thus whether positives will be true or false positives, and how much harm those false positives (and false negatives) may cause. This is called positive and negative predictive accuracy, and requires knowing the pre-test and post-test probability of a positive being a true positive and a negative being a true negative. We have NONE of this information about health care professionals. Before Dr. Caplan takes such a position, it would be HIS ethical responsibility to advocate for the studies that would provide these answers. To advocate for institution of this testing without those data is, simply put, unethical (and unwarranted).

My comment on this comment: The studies that would provide these answers can only be done if we actually perform the testing. I think it is a great idea to study this while we are doing it, let’s start doing random drug screens so we can study how many healthcare workers need help and so we can protect our patients.

-Dr. Caplan needs to start thinking about the cons as well as the pros of drug testing. In the first half of the 20th century a prominent surgeon and professor of surgery who was also instrumental in developing one of our best medical institutions practiced surgery for 40 years during the entire time of which he was addicted to morphine. Drug use does not equate with inability to perform important and exacting tasks. Had Dr. Halstead at Johns Hopkins been tested and caught out we’d have lost his valuable service. Some need their drug to perform at par or better. The regulatory regime in medicine is sufficient to weed out practitioners who are not reliable. Dr. Caplan’s comments show that he is only speculating that medical errors can be attributed to drug use, and he cannot rule out medical errors that were prevented by drug use. Lighten up Doctor.

My comment on this comment: So this goofball is saying it was acceptable for this doctor to use while practicing because he was a great doctor? I can only imagine what he may have done had he been clean. Maybe he would have been even better. How does he know this doctor didn’t make an egregious error while high and performing surgery? He very well may have. I suppose it is possible that there are those who can use and be very productive, most can’t. To say we should ignore drug use in healthcare professionals because one or some function fine is ignorant.

-I am sorry the report didn’t include Dr. Jeffrey Selzer follow up session on the topic. He reviewed the evidence for the role of random drug testing in the workplace and noted that there is very little evidence that random drug testing reduces accidents etc. It seems that testing for alcohol can have some impact- but with alcohol a positive test is directly related to immediate use. Drug testing has grown from being a (sometimes) therapeutic tool in drug treatment and a diagnostic tool to a huge industry that costs billions.  Rather than physicians just saying no to random testing of our profession I suggest we need to take a look at random testing in general. After all, being a lab test we are ultimately responsible. Identifying and intervening in problematic behaviors (not biological specimens) is hard but also covers a lot more bases than substance use.

My comment on this comment: Drug testing doesn’t reduce accidents, it prevents them. If we can determine who is using and get them help before they start making mistakes and costing the hospital or clinic thousands in sick time, lost staff and rehiring/retraining, we are doing all a benefit. Identifying problematic behaviors is very valuable (and staff should be trained on how to recognize), but the problem is that by the time those behaviors are recognized, the problem is quite advanced. By that point mistakes have already been made. If we can catch it earlier and treat instead of punish, we can help prevent the mistakes from occurring.

I am very curious what you all think about this. What do healthcare workers in Wisconsin think? What are your arguments for or against random drug testing for healthcare workers? I really want to know…

About the Author

Kristin Waite-Labott is a registered nurse and recovering addict who has firsthand experience with the challenges of addiction. She now works as the Head Nurse Coach at Veritus, a virtual treatment program for nurses with substance use and mental health disorders, and is dedicated to helping nurses overcome addiction and making a difference in the lives of others. Kristin is passionate about addressing the growing problem of addiction among healthcare professionals and encourages open discussions and action to prevent it from spreading further.

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