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The ethics of drug testing medical professionals

Should random drug testing be required for medical staff?

Many times, the question comes up and a discussion ensues about the ethics of requiring drug testing for medical professionals. For many years, this discussion has been a hot topic. The medical professionals say it is taking away one of their rights, but the public say they want to be protected. It is a constant tug of war. Lets look at the ethical issue from a couple different ways and break down the debate into different areas of medical care. This way, we can try to see both sides of the story.

Random healthcare worker drug tests

One of the areas that seem to have a high incidence of addiction is anesthesiologists. They are exposed to very highly addictive medications. Some residency teaching programs have implemented random urine drug testing. Many times a healthcare worker can disguise their addiction, so if the tests are random, it takes that aspect out of the equation. The theory is that early detection and deterrents can significantly reduce the impact of addiction among anesthesiologists. Unfortunately, you still have cases where you don’t know someone has a problem until they are found dead.

Scheduled urine drug screens for nurses

Now, let’s look at the area of nursing. The abuse of alcohol and other substances among nurses is unfortunate, but a very real health problem. Drug testing is not done randomly, but if an institution feels that there is a reasonable suspicion and/or objective evidence that job performance is or has been impaired byh alcohol or other drug use, then they can do a urine drug screen. The reason for these screens are to safeguard the quality of patient care and to provide guidance and support for the nurse to obtain appropriate treatment and regain health. The recommendation is that the employer should, prior to any testing, advise employees who may be subject to drug testing. They also should make sure that the privacy of the employee is maintained. Most importantly, the employee should be given the opportunity for assistance/treatment for their alcohol/drug problem.

Drug screening for health workers: A requirement or NOT?

The debate can be made on both sides of the spectrum about drug testing healthcare workers. In fact, employing a health care worker with an addiction is a complex, sensitive issue that involves the health care system as well as society in general. When appropriate, I feel healthcare workers should be drug tested so that if they have a problem, they can get the help they need. But what do you think? Should drug and alcohol testing be required of anyone working in medicine? Is drug screening an invasion of privacy? Or should patients have the right to know what their doctors, nurses, pharmacists, or specialists are consuming? Your comments are welcomed here.

Photo credit: karawynn

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10 Responses to “The ethics of drug testing medical professionals
Steve
9:59 pm February 23rd, 2011

Absolutely.
As an addiction counselor, I have had many associates who have been addicted to pain medication, Cocaine, Meth, Heroin. There has only been one situation that I know of that the counselor was using again. I had to blow the whistle on him, because the care people were getting was subpar, to say the least.

At the time, I was an intern and he was my supervisor. I went to the owner with the suspicion and sure enough, after drug testing, my supervisor admitted using for several months. He was offered help by the facility and then discharged when he wasn’t able to control his addiction.

I was commended by the other counselors in the office and it was great to be supported from the entire staff.

Jason Giles MD
3:57 am February 27th, 2011

Hello NNR,

Good to bring up the topic here. The group of physicians by specialty most likely to develop an addiction problem is Family Practice followed by Emergency Medicine and then Anesthesia. Their rates are not significantly different from all other physicians, however. Maybe 20% higher (1.2% instead of 1% per year according to Medical Board of California Physician Diversion Data from 2005. That program is now closed)

The group of health-care providers with the greatest un-monitored access to narcotics in the hospital is, of course, nurses. Many people do not realize that while doctors give the orders for medication it is the nurse who typically gets the medication from the hospital pharmacy and gives it to the patient. S/he can divert the drug for personal use between the pharmacy and the patient or s/he can say the left over portion was thrown away and keep it instead.

Many groups with public safety and public trust have seen the value in routine drug testing. The idea that your surgeon might be drunk in the OR is frightening to nearly everyone but no less to than the idea that your pilot is wasted and in the cockpit. Nuclear power plant operators and train conductors are subject to drug tests and doctors AND nurses should be as well. No question. Police, fire fighters, construction workers, lawyers and teachers should too.

As far as what to do with the results of a positive test, treatment and possible return to work are both excellent ideas. Once the person can prove that s/he is sober then returning to work becomes an option.

Great topic and article too!

Dr. G.

nursenrecovery
1:37 am March 4th, 2011

Thanks for your comments. I agree with the value of routine drug testing. Even the best nurses and doctors can become addicted. I also believe that alot of it is situational that makes us more prone to addiction. When a person is mentally and physically exhausted from their own illness, or an illness of a loved one, their judgement is impaired. Addiction is an awful disease, but recovery is attainable.

Carin Albertyn
8:55 am January 18th, 2012

Drug testing in the work place
Drug testing in the work place might seem to be a good idea but what happens when it comes to the privacy of employees? The Blog chosen argues both sides of this question and focuses on a few areas of medical care to investigate the problem.
Employees have the right to privacy according to the privacy act, and therefore employers have the legal duty to respect employee’s privacy and a moral duty to do so (Privacy, 2011; DesJardins & Duska, 1987). Employers can only obtain information about employees that is job relevant. It can be argued that the knowledge of drug use is relevant as it can reduce productivity – except in the case of performance enhancing drugs. If drug use does reduce productivity then this would give grounds for disciplinary action more so than the drug use. This would mean that knowledge of drug use is not really job relevant information that employers need (DesJardins & Duska, 1987). The author of the chosen blog does not address the question of productivity of health worker, but rather focuses on the result that drug use can have in their work environment.
Privacy is still a concern but when it comes to drug use in health care privacy may not be as important as the harm it can cause and patients should have the right to know that the medical practitioners are not affected by drugs.
Is drug testing the most effective way of finding out if drugs are affecting an employee’s judgement?
The author of the blog does not explore the advantages and disadvantages for drug testing in detail but employers do have the legal duty to prevent harm to their employees; this duty could become grounds for drug testing. If a person is under the influence of drugs or alcohol this can cause harm not only to themselves but also to others, especially in the medical environment. Health care work involves dealing with the health and safety of other people this means that if someone in the health care profession is taking drugs they are putting other people’s lives at risk (DesJardins & Duska, 1987; USA OSHA ,2011; Nurse N Recovery, 2011).
Is it fair however to be testing everyone? This is the question also asked in the blog but not necessarily answered there.
Most health care workers, especially anaesthetist are around drugs all day and therefore as stated in the blog above could be more prone to using and abusing drugs. There are however some health care professions that don’t deal with drugs on a daily basis and these workers would perhaps be less likely to be at risk of abusing drugs due to the nature of their jobs.
It is not fair to test all employees as employees with a clean record that have worked in a certain establishment for many years might see it as demoralising and unfair, because they feel like they have proven themselves to be reliable. Employees that however start to act erratically or have previous drug use on their record would be more likely to be using drugs or alcohol and therefore should be the ones being tested. To avoid employees feeling singled out or treated unfairly the only way of implementing drug testing in a work place would be random drug tests which will hopefully deter casual drug users from using drugs. This will also help to spot addicted users and provide them with support if needed.
Drugs and alcohol do not affect all individuals in the same way. Size, gender and many other factors come into account when talking about how drugs affect someone. This would suggest that there might be other ways of detecting is someone is abusing drugs rather than invading their privacy by doing drug tests. Testing how well someone can perform their job using test such as dexterity test might be less intrusive. If someone is affected by drugs then simulation of their job can identify this. For example, when it comes to surgeons using simulation tools to test the surgeon’s performance could be a more accurate way of reducing risk to patients than drug tests (DesJardins & Duska, 1987; USA OSHA ,2011; Nurse N Recovery, 2011). This test may however not deter drug users from still using drugs casually and then avoid using it when they know they will be tested. It will also not pick up drug addictions that can be managed and perhaps prevented by drug testing.
Some jobs require drug testing before employment. Health care employers could implement this as a starting point to make sure that employees hired are not taking drugs. Casual users will just clear their system before the test is to be done but addicted users will then be unable to apply for such jobs.
In conclusion I think that although both sides can be argued having some sort of drug screening for health care workers that have potential to cause harm such as doctors, pharmacist or in the article anaesthetist is important. It can be very costly to the employer to implement but preventing patients of being put at risk is far more important. Random testing would be the most effective and less costly way of drug testing employees. Other systems such as dexterity test should be looked at as well.
References:
Joseph DesJardins and Ronald Duska. (1987). Drug testing in Employment. Business & Professional ethics Journal 6 (1987).
Privacy Act. (2011). Privacy Act 1993 No 28 (as at 01 July 2011), Public Act. New Zealand Legislation: Acts.
USA OSHA (2011) Workplace Substance Abuse.
Nurse N Recovery (2011). Should random drug testing be required for medical staff

wanda
4:31 am May 23rd, 2012

I dont understand why as a patient with severe pain I was required to do a drug test given by the doc that prescibes the pain meds. of course they will come up dirty ,afterall I am prescribed methdone and Morhine sulfate,and also take ambien to sleep. What is the purpose when they are testing patients treatred with narcotics ! over a year ago I stopped smoking thc, pot completely and yet last week they say I was dirty and sent me a letter terminating my association with this Doc. they did’t ask about any thing that could cause false/ poss ie other meds or if it just not enough sample to test.they say must be bad if I couldnt pee enough for them. So why not retest right away give the benefit of doubt

10:32 am May 23rd, 2012

Hi Wanda. Doctors test to make sure that both the MINIMUM and MAXIMUM amounts of a prescription drug are in your system. This is to ensure that you are not taking too much pain medicine, but also to be sure that you’re not selling it either.

If you have a prescription for other drugs that your Dr. is not aware of (the Ambien, for example), present the prescription and ask for a re-evaluation of the results based on your Rx.

Gil
3:34 am April 15th, 2013

The Healthcare Industry should follow the same rules on random drug testing as the transportation industry i work in. FMCSA requires a certain percentage of the drivers at an employer be randomly screened every month. Why? Because i hold everyone’s life around me in my hands. Why should it not be the same for healthcare workers? On top of that healthcare workers should be regulated on how many hours they can work in a twenty four hour period just like the transportation industry. I find it appalling that healthcare workers scream invasion of privacy! If you feel that way don’t ever make a career change to the transportation industry. There is no privacy here as there should’nt be in the healthcare field.

B Smith
9:05 am February 6th, 2014

I work at a hospital that recently instituted random drug screening for all staff. The reason given was (the state in which I live has a high level of meth lab accidents and prescription drug abuse). This is their response to protected their patient population. In an Q&A session it was further stated that it wasn’t only to determine if you are impaired while at work, but if you ever use. This is where the invasion of privacy comes in. It contradicts the reason they stated they were instituting testing in the first place (to protected patients).They stated it doesn’t matter if you visit a location such as Colorado/Washington where marijuana is now legal while on vacation because its still illegal in the state I work. I believe the real reason that this happened within one month of the legalization in Colorado is, that fact scares someone. Someone whom is miss informed and believes the sky is now falling. I know/believe that if my physician/nurse smoked pot last night or last weekend has no more effect on the care I receive from them than if they had a glass of wine. I say a lot of lives could be saved if cigarette/alcohol were made illegal today and substituted with pot. Get real people. Pot never kill anyone and if someone tells you different they are lying.We need to educate staff and put a system in place for reporting and dealing with medical staff that are visibly impaired at the time its happening. Random drug testing isn’t going to fix the problem. It might make someone sleep better at night, but it wont insure you are any safer when entering a hospital.

wanda
8:00 am January 26th, 2015

potential employees of many of the retail stores, if I am not mistaken are required to take a drug
test as part of the employment application process. Without a doubt healthcare professional should have to do the same and when warranted be randomly screened. A person with an addiction problem is impaired period, and their patients are at risk for subpar treatment, misdiagnosis, surgeries that can result with devastating results. Sometimes the addicted healthcare worker is enabled by coworkers and colleagues turning a blind eye. I would want to
know if the surgeon who is to perform any kind of surgery, my kids pediatrician etc; is under the
influence of drugs or alcohol. I’m for the right to privacy, but as a medical professional don’t you
take an oath to do your best and be your best for your patient.

Jacque
11:58 pm March 9th, 2015

If a psychiatric has the desk lady who asks to take your vitals n urine test at the doctor for prescribing suboxone randomly has reason to watch you urine because a ex friend out of spite says your urine is hot but when I urine the lady couldn’t fit in the bathroom n the waiting room was just on the other side full of patients maybe 12 ppl the lady keeps the door cracked after touching my body alll over like I brought fake urine? Or I’m not sure but stand there with the door open it took me 3 dif times to actually urine the 3rd time I felt it coming so I went to the bathroom she already checked me previously n found reason to do it every time considering I’m not use to a stranger also not even a doctor to be starring down at me while I’m trying to pee in a small cup she pounds on the door the last time n patted me for the last I urine. Dr calls me in terminates me Bc I have colazrmpram

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About Nurse N Recovery

Nurse N Recovery has been an RN for 16 years. Most of those years were spent in Critical Care. 4 years ago, she became addicted to narcotics. She is now in drug addiction recovery and has developed a website to help others suffering from addiction.

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