Best Practices in Drug Testing for Professional Health Monitoring Programs

  • 06 Apr 2100
  • Virtual - at your desktop



Drug testing is an important component of a comprehensive monitoring program for healthcare practitioners with a history of substance abuse or dependence. The vast majority of drug tests in Professional Health Monitoring programs are urine drug screens.  Urine drug screening is very accurate, reliable and offers an extensive panel of drugs/substances that can be detected in the specimen.  The major disadvantage to using urine drug screening in these programs is the potential for program participants to manipulate the drug test outcome by specimen dilution, adulteration or substitution.  This presentation will explore “best practices” in urine specimen collections procedures, laboratory specimen validity testing, and review and interpretation of laboratory results that are designed to deter and detect program participants’ attempts to manipulate, defraud or compromise the integrity of urine drug screening.

Appropriate confirmation and interpretation of laboratory results by a qualified Medical Review Officer is needed for the monitoring agency to respond appropriately to non-negative results, especially when the participant denies use of the substance(s) in question or if evidence of tampering with the specimen is present. Some of the conundrums encountered in monitoring programs include repeated dilute specimens; test positive for opioids accompanied by participant’s report of having a doctor’s prescription; positive test for EtG and EtS at low to moderate levels; positive test accompanied by an unacceptable explanation. This presentation will discuss these and other outcomes encountered frequently, with suggested responses including additional testing, requirement for the participant to refrain from practice, and clinical evaluation.

Dr. Donna Smith is the Regulatory Affairs Officer for FirstLab, Inc., one of the largest providers of substance abuse testing administration for physicians, lawyers, nurses, and other health care professionals’ monitoring programs. Dr. Smith provides consultation and assistance to state programs using substance abuse testing as a monitoring tool for recovery and relapse prevention. Dr. Smith conducts periodic training and education events for monitoring programs on topics related to program effectiveness and available technologies for improving testing outcomes. She has over 20 years experience in the substance abuse testing field, including extensive work in the development and implementation of testing programs for the US. Departments of Defense and Transportation, International Olympic sports, Australian Civil Aviation Safety Authority, and substance abuse residential treatment and aftercare facilities.   She is a principal author of the regulatory framework for drug and alcohol testing programs of Department of Army civilian employees and for implementation of the Omnibus Transportation Employee Testing Act in the aviation, public transit, railroad and trucking transportation industries.

Penelope P. Ziegler, M.D. is Medical Director of the Virginia Health Practitioners’ Monitoring Program (HPMP), and Associate Clinical Professor, Department of Psychiatry, Virginia Commonwealth University. Dr. Ziegler is Board-certified in General and Addiction Psychiatry, Addiction Medicine, and is certified by and a Fellow of the American Society of Addiction Medicine (ASAM). She is on the Board of Directors of ASAM.  She is an AAMRO-certified Medical Review Officer, and serves on the Toxicology Committee of the Federation of State Physician Health Programs.
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