Drug use policy

[M]

My local, large, group-practice has been purchased by a national organization.  We have been informed that all new hires (any position) must pass a drug test.  In my state, marijuana is legal.  Our new bosses at the national company say, "Marijuana is illegal at the federal level, so any positive test, even if the new hire has a prescription for it, is grounds for terminating the offer of employment."  My question for the Dahl-ers (I'm stealing this term from Johanna - it's brilliant) out there is, do any of you have experience with this type of policy?  In any case, what do you think of it?

My concern is that we recruit a great doctor (or nurse, or MA), who then tests positive for MJ and has the contract revoked.  Personally, though I don't use MJ, I don't care if one of my colleagues smokes a joint or eats a magic malt ball at the end of a long week.  Obviously, being impaired at work is a totally different animal and is totally unacceptable.  But I'm just talking about the after-hours recreational user here.  Are we protecting patients with this policy, or are we just covering the corporation's behind?

[Zaphod]

Anyone in care of pts has to be held to a higher standard, and especially for physicians, any drug use has to be monitored as substance abuse is a known problem.

From the corporations standpoint, I wouldnt want anything to do with it as it looks like a huge liability to me.

[Lithium]

How do you distinguish these after hours recreational users from those who may be using so often they come to work impaired?

If someone can't stop smoking the dope for just a month before they take a drug test they probably have a problem with it.

[M]

In response to Lithium, I think if someone is using MJ, alcohol, opiates, etc. so often that they are coming to work impaired, it is likely that would be recognized by colleagues.  My concern is, what is the NNT to catch one truly impaired clinician/nurse/MA?  I would argue that a positive urine drug screen for cannabis is much more likely to catch a recreational user than a substance abuser.  Do we really want to ruin that person's career?  Can't a health care provider do a great job at work and still enjoy the occasional MJ after-hours?

Now, you do bring up a good point about stopping the MJ one month prior to the drug test.  If the new hire can't stop for a month, then yes, I would agree they likely have a problem, and it's a good litmus test.  So I guess when I hire anyone new, I should (wink wink) let them know that they may wish to abstain from MJ for a month if that is something in which they typically indulge?

As for Zaphod's point about corporate liability, I'm very interested to see if this policy will ever result in a lawsuit by an aggrieved new hire who loses the contract due to a positive urine drug screen for legally-obtained and consumed MJ.

[ShadowDoc]

M wrote:

In response to Lithium, I think if someone is using MJ, alcohol, opiates, etc. so often that they are coming to work impaired, it is likely that would be recognized by colleagues.  My concern is, what is the NNT to catch one truly impaired clinician/nurse/MA?  I would argue that a positive urine drug screen for cannabis is much more likely to catch a recreational user than a substance abuser.  Do we really want to ruin that person’s career?  Can’t a health care provider do a great job at work and still enjoy the occasional MJ after-hours?

Now, you do bring up a good point about stopping the MJ one month prior to the drug test.  If the new hire can’t stop for a month, then yes, I would agree they likely have a problem, and it’s a good litmus test.  So I guess when I hire anyone new, I should (wink wink) let them know that they may wish to abstain from MJ for a month if that is something in which they typically indulge?

As for Zaphod’s point about corporate liability, I’m very interested to see if this policy will ever result in a lawsuit by an aggrieved new hire who loses the contract due to a positive urine drug screen for legally-obtained and consumed MJ.

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My understanding is that recreational MJ is still illegal in all 50 states by federal law. IOW, while your local PD won't enforce it, the FBI and DOJ could (theoretically) still arrest and prosecute even in a state like Colorado. This would make the civil suit you mentioned very interesting, but I don't see how the individual could win as it is technically illegal behavior.

[Lithium]

I think it is pretty standard for new hires to know about drug screens well in advance.  At least it was at my job.  It is also only fair, as though second-hand THC is unlikely to produce a positive screen, an employee should be given some time not to be exposed to that either.

[Zaphod]

M wrote:

In response to Lithium, I think if someone is using MJ, alcohol, opiates, etc. so often that they are coming to work impaired, it is likely that would be recognized by colleagues.  My concern is, what is the NNT to catch one truly impaired clinician/nurse/MA?  I would argue that a positive urine drug screen for cannabis is much more likely to catch a recreational user than a substance abuser.  Do we really want to ruin that person’s career?  Can’t a health care provider do a great job at work and still enjoy the occasional MJ after-hours?

Now, you do bring up a good point about stopping the MJ one month prior to the drug test.  If the new hire can’t stop for a month, then yes, I would agree they likely have a problem, and it’s a good litmus test.  So I guess when I hire anyone new, I should (wink wink) let them know that they may wish to abstain from MJ for a month if that is something in which they typically indulge?

As for Zaphod’s point about corporate liability, I’m very interested to see if this policy will ever result in a lawsuit by an aggrieved new hire who loses the contract due to a positive urine drug screen for legally-obtained and consumed MJ.

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Theyd never win. Companies have all kinds of morality clauses and they have the full ability to enforce them, further, no jury, court, or public is going to side with someone in such a position of life and death taking care of people to have any hint of impairment. They would lose big time. No one would risk it, its just stupid and there is no upside as there are plenty of people to choose from who dont have these issues.

History has shown that even if physicians do know about impairment, it is not until things are dire or an actual event occurs that anyone steps in, I would not assume any difference in this case. Just because something is legal doesnt make it an okay thing to do, or without consequences. Much like the people who are not bright enough to realize that while freedom of speech allows one to say almost anything, it does not protect from the consequences of what you said.

Dont get me wrong, I think marijuana should be recreationally legal, and we've done a great disservice fighting the "war on drugs" the way we have instead of recognizing it for the social, economical, and physiological issue that it really is. Now, when its legal, I still wouldnt want any caretaker partaking much at all, there are certain trade offs you accept in medicine that are required in the profession, and thats the choice we made. All kinds of things you cant do simply for the optics regardless of actual impact on ability.

Now, I think we all agree its strange for the physician to be so overly concerned for his potential or current staff, unless its a significant other of course. So, choose wisely and dont jeopardize something that takes the better part of your adulthood to attain. It simply isnt worth it. Maybe one day the world will allow their doctors to be recreational users, etc...but that isnt today or even the near future.

[M]

I think we agree that the optics of a healthcare provider using MJ, even recreationally, are not good.  I expect that will change over the next 10-20 years as MJ becomes more accepted as a recreational endeavor.  I believe we are moving in that direction, but I probably have a biased view given how prevalent it is in my state.

And I also agree that it wouldn't be wise to indulge in a habit that could have devastating career consequences.  My main point is simply that I don't think it should have devastating career consequences.  Not for physicians, nurses, MAs or anyone else in the field.  I appreciate the debate, though.

Anyway, time for cocktails.  Gotta run.  

[Hatton]

I have always thought that healthcare is more forgiving for drugs and alcohol than any other industry.  I have known several physicians who have gone off to drug or alcohol rehab that continue their careers if they are willing to pee in a cup.  This is also true for nurses.  I also knew one doc that had very erratic behavior the hospital drug tested him several times.  He was always clean.  He developed some type of dementia and died in his early 50s recently in a nursing home.  Unless someone is acting impaired at work I don't see mj being a career ender. I don't use drugs and I agree it seems stupid

[Zaphod]

M wrote:

I think we agree that the optics of a healthcare provider using MJ, even recreationally, are not good.  I expect that will change over the next 10-20 years as MJ becomes more accepted as a recreational endeavor.  I believe we are moving in that direction, but I probably have a biased view given how prevalent it is in my state.

And I also agree that it wouldn’t be wise to indulge in a habit that could have devastating career consequences.  My main point is simply that I don’t think it should have devastating career consequences.  Not for physicians, nurses, MAs or anyone else in the field.  I appreciate the debate, though.

Anyway, time for cocktails.  Gotta run.

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I agree with you, but it just isnt so right now, and it can take a long time for attitudes to change...and 10-20 years is basically a career unless your just starting your training.

Medicine is conservative, and because of our roles we are regulated by even more conservative and some might say punitive agencies depending on the current tone socially. This is a poor combination.

It seems the national view is reaching critical mass, but it will take even longer for it to be accepted in specific fields. Companies will use it as a tool to rid themselves of people as long as it is legal to do so (you think disruptive was useful, this is more so). Not making any judgements, just pointing out the likely probabilities of the situation.

[Hatton]

When I was dept chief all kinds of docs had these types of issues.  As long as they would randomly pee in a cup to prove they were not currently abusing then all was ok with privleges and licensure. I think mj laws are changing and in the future no stigma will exist for this either. I say this in a very conservative state.

[Zaphod]

hatton1 wrote:

When I was dept chief all kinds of docs had these types of issues.  As long as they would randomly pee in a cup to prove they were not currently abusing then all was ok with privleges and licensure. I think mj laws are changing and in the future no stigma will exist for this either. I say this in a very conservative state.

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We will see, certainly the generation coming through has different opinions that the one going out, but things that advance one death at a time like this can be resilient. It may get legalized soon, I think Cali will do so this year in fact, but there is always some blow back to that and expect that groups will form to push back politically and am sure it will be targeted at high risk occupations like drivers, pilots, healthcare, etc...and a new version of "reefer madness" will come about. It wont be settled just because its legal.

I agree in the future there may not be a stigma and will be viewed like wine, I just disagree on the timeline. It'd be great if you were correct though. Millenials could not care less and have high use, and cant be scared out of it since they know better, and they also really dont care what others do so it will fall eventually.