National Survey Exploring Drug Screening in Pharmacy Programs

Patricia L. Darbishire, PharmD; Patricia S. Devine, PharmD; Alexa J. Proctor, PharmD; Wesley J. Horner, PharmD; Emily M. Hoffman; Carol A. Ott, PharmD; David G. Fuentes, PharmD; Jeremy Hughes, PharmD; Priya B. Patel, PharmD


Am J Pharm Educ. 2019;83(3) 

In This Article

Abstract and Introduction


Objective: To explore drug screening programs, including requirements, policies, and procedures among pharmacy programs; frequency of drug-related incidents; and types of substances misused by pharmacy students.

Methods: IRB-approved web-based and paper surveys were sent to pharmacy deans, experiential education faculty, and student affairs personnel at 135 US ACPE-accredited and candidate status programs. Descriptive statistics and chi-square test were used to analyze the data, identify relationships and draw conclusions.

Results: Administrators from 98 programs responded (73% response rate). Sixty-one percent reported implementing a urine drug screen requirement for students, with a 10-panel screen as the most common required screen (72%). Ninety-three percent of programs require students to pay for the screen, with costs averaging $42 per screen. Programs reported an average of 2.2 substance-related events per 100 students annually, with alcohol, marijuana, amphetamines, opioids and benzodiazepines most commonly involved. Schools that do not screen reported twice as many incidents as those that screen.

Conclusion: A drug screening program can deter pharmacy students from inappropriate substance use. The results from this study can assist pharmacy administrators in evaluating the need to institute or enhance a drug screening program at their school or college of pharmacy.


Substance misuse is a national epidemic that threatens the health and welfare of all communities, resulting in social, economic and health care costs.[1–4] Substance use disorder (SUD) does not discriminate by age, race, gender, geographic location or income.[1,4] The Centers for Disease Control and Prevention (CDC) report that drug overdoses have escalated, killing nearly half a million people between the years 2000 and 2014.[4] One in 10 Americans age 12 or older report current use of an illicit drug, marijuana being the most prominent, followed by non-medical use of prescription pain relievers.[1] Sixty-nine million Americans report binge alcohol use and 17.3 million report heavy alcohol use in the past month.[1] Risk factors for substance misuse include young age, single status, peer pressure, easy access to illicit drugs, and prescription use (eg, narcotic analgesics for sports injuries, benzodiazepines to combat stressors, and/or stimulants to stay focused). Additional pressures common in college students include Greek life, high-stress lifestyles, and inconsistent sleep patterns.[1,5–8]

A focused literature search on alcohol and drug misuse in professional programs revealed a plethora of yet more risks for health care students. These include rigorous curricula with heavy workloads, longer than average study hours, expectations for work-related experience, leadership and service activities, high educational debt, burnout, and competition among peers for post-graduate opportunities.[5–13] Health care students have an interest in, knowledge of and access to various prescription drugs. Because of their drug knowledge, health care students may have misguided feelings of self-control, and believe that addiction could never happen to them. Alarming numbers of health care students report using substances during class, at work and while performing patient care activities.[5–13] In 2006, Baldwin and colleagues reported that 9% of health care students claimed recreational drug use in the past year, including those in medicine (12%), dentistry (10%), pharmacy (9%), nursing (9%), and allied health (8%).[10] One-third of the students reported heavy alcohol use in the past two weeks to cope with stressors, and 7% of respondents reported attending class or work under the influence of alcohol and other drugs. Three percent reported providing patient care under the influence.[10]

Studies have been conducted on student pharmacists' use of recreation drugs, including surveys of self-reports. Ranges reported in the literature include marijuana (5.9% to 28%), amphetamines (1.2% to 7%), cocaine (0.5% to13%), sedatives (3% to 9%), and opioids (0.7% to 8%).[5–7,10–12] One study reported that almost two-thirds of pharmacy students self-reported using a controlled substance at some time without a prescription.[14] Another study found that pharmacy students' use of sedatives (8%), amphetamines (6%), opiates (5%), and nonprescription stimulants such as pseudoephedrine (19%) was elevated relative to other health profession students.[7] Pharmacy students have reported going to class or work (8%) and conducting patient care activities (2%) while under the influence of alcohol or drugs.[10]

Inappropriate substance use poses risks to students, increases liability for training sites and pharmacy programs, and negates interprofessional and public trust. Of primary concern is that substance use by student health care professionals may lead to compromised judgement and skills while providing patient care. Many health care and government organizations have elicited calls to action among health care educators.[2,10,15,16] Additionally, an increasing number of pharmacy experiential sites require pre-screening for inappropriate drug use. In 2008, a national survey revealed that 12% of experiential pharmacy sites required students to have a pre-experience drug screen.[17] By 2013, this number had reached 45%.[18]

Drug screens are one deterrence mechanism and assist in determining the extent of substance misuse within a health care program. They are also controversial and have limitations. A literature review revealed articles on drug screening programs in different health care professions, with one article reporting on implementation of a drug screening program at a pharmacy college, and two articles on student attitudes toward drug screens in the health care professions.[19–22] However, no articles were found providing a national overview on drug screening policies and procedures in pharmacy programs. This gap highlights an opportunity to explore and evaluate practices across the Academy. In this article, a drug-related incident refers to a positive drug screen, positive drug test, or any occurrence where student behavior is of sufficient severity to cause reasonable suspicion, a problematic event, or criminal charges. An incident may occur within or outside of the academic setting.

The objective of this research was to provide a national overview of drug screening policies and procedures in pharmacy programs, experiential site requirements for drug screens, and the frequency and types of incidents known within schools. This information can serve as a foundation to assist health care administrators in evaluating the need to institute or enhance a drug screen program.