Will Doctors Be Able to Escape Random Drug Testing?

Leigh Page, MS

Disclosures

April 22, 2015

In This Article

Alternatives to Random Testing Aren't as Effective

There are other forms of drug testing that are either less intrusive or more focused than random testing, but they're not thought to be as effective.

Preemployment testing is quite common at hospitals, but according to American Alliance Drug Testing,[6] the positivity rate for these tests is much lower than for random testing. An obvious flaw in this approach is that job applicants are told the test is coming up, and they can take steps to avoid being detected. A recent study reported by Medscape[10] showed that it's possible to subvert tests by drinking a lot of water beforehand, adding bleach to the sample, or providing untainted urine from small containers hidden in the buttocks.

Meanwhile, physicians who oppose random testing often endorse "for-cause" testing, which is given only when someone is suspected of drug abuse. They argue that such testing is less costly and disruptive, and because it’s based on a suspicion, it is more likely to produce a positive result.

But testing experts say that for-cause testing can overlook people who are adept at masking their symptoms, which is easier for physicians to do than the general public. Also, the test often comes too late. Substance abuse is a serious accusation, and authorities may spend precious time deliberating whether the charge has merit. By the time they're reached a decision, all traces of the drug have left the person's system.

Also, for-cause testing can’t work unless physicians and other staff turn in abusing physicians, but many physicians are not willing to do so. In a 2010 survey,[11] less than two thirds of physicians said they were professionally committed to report physicians who are significantly impaired. Reasons for not reporting included believing someone else was taking care of the problem, believing a report would lead to nothing, and fear of retribution.

Similarly, a 2011 survey[12] for the American College of Physician Executives found that only 51% of physicians were comfortable reporting disruptive behavior, including drug abuse, and only 47% would feel comfortable directly confronting the behavior. However, the recent Medscape survey on physician attitudes toward testing showed a much greater willingness to turn in impaired colleagues. More than three quarters said they would do so, and only 4% said they would not.

In another form of drug testing, hospitals might test an entire clinical team after a sentinel event involving a patient death. A 2013 article[13] in JAMA made a case for this approach, noting that pilots and truck drivers are tested after crashes and near-misses. "Why is there such a difference between high-risk industries, which all pledge to keep the public safe?" the authors asked. However, the authors recognized that such tests would not identify all drug abuse, and they saw it merely as a first step toward random testing.

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