Pre-Clinical Drug Testing Policy and Procedure

Columbia University Medical Center is committed to assisting members of its community in facing the challenges associated with alcohol abuse and illicit drug use. The drug testing policy provides an opportunity for early identification and intervention before the consequences of such abuse adversely impacts a student’s health, professional growth, and patient care. Early intervention also provides for successful treatment without the involvement of formal disciplinary action or other sanctioning.

Background & Rationale

1. 1. Health care providers are entrusted with the health, safety, and welfare of patients; have access to confidential and sensitive information; and operate in settings that require the exercise of good judgment and ethical behavior. Thus, assessment of a student’s suitability to function in a clinical setting is imperative to promote integrity in health care services.

2. 2. Clinical facilities are increasingly required by the accreditation agency Joint Commission on Accreditation of Healthcare Organizations (JCAHO), to provide a drug screening for security purposes on individuals who supervise care, render treatment, and provide services within the facility.

3. 3. Clinical rotations are an essential element in certain degree programs’ curricula. Increasingly these rotations require drug screening for student participation at their site. Students with a positive drug screen may be barred from certain rotations and thus are unable to fulfill degree program requirements. Identification of such students prior to clinical rotations will enable appropriate assessment and indicated treatment and follow-up.

4. 4. New York Presbyterian Hospital and CUMC require drug screening of all employees. It is appropriate for clinical students to meet the same standards for the reasons stated above.

Policy

Pre-clinical drug testing is required of all students in the clinical schools at CUMC.

Procedure

1. Students in the School of Nursing, College of Dental Medicine, and the College of Physicians and Surgeons will be required to undergo a 10-metabolite urine drug screen during the semester prior to the beginning of their clinical rotations (or in the case of the nursing programs during their first semester at CUMC).

2. Students will receive a general orientation to the drug testing requirement prior to actual testing, including the testing procedure as well as possible common interfering substances or OTC medications (e.g. poppy-seed bagels, pseudoephedrine).

3. Chain of Custody Drug Screens will be performed under the auspices of Sterling Infosystems, Inc., who all provide pre-employment drug screens for CUMC employees

4. Students will pick up a requisition during an assigned two-week period for their drug screen from the Student Health Service. There is a 72-hour window for the requisition to be filled. Students will take the requisition to a LabCorp laboratory for testing. A list of nearby sites will be provided on the requisition.

5. Test results will be returned to the SHS. If a test is positive in the LabCorp laboratory, it is referred to the Medical Review Officer utilized by Sterling Infosystems. The MRO speaks with the patient to ascertain any medications the student may be taking that could either interfere with or cause a positive test. This review is NOT communicated to the SHS. MRO reviews are completed within 5 days and test results are then communicated to the SHS as positive or negative. (For example, a student legitimately on Adderall would test positive by the lab, but review by the MRO with the patient and his/her prescriber would confirm the legitimacy of the prescription and such a test would be reported to SHS as negative.)

6. All students with a positive test will be required to have an evaluation by the Director of the AI:MS program. The AI:MS Director will establish the appropriate follow-up, which could include referral to addiction specialist for further evaluation and treatment, referral to an outside drug treatment program, or follow-up and treatment within AI:MS and the SHS (including follow-up drug testing as requested by the AI:MS Director). Referral to an outside drug treatment program, assessment by the AI:MS Director or addiction specialist that the student could pose a risk to patient safety, non-compliance with AI:MS directed follow-up, or directed follow-up that would interfere with a student’s clinical placement will require notification of the Student Affairs Dean of the student’s school or program of the need for a medical leave and withdrawal from the clinical rotation.

7. Ideally drug tests will be completed 2 months prior to the beginning of clinical work to allow completion of the evaluation of students testing positive prior to the start of their clinical rotations. Students who are already on clinical rotations, or who complete testing less than 2 months prior to the start of clinical work may need to be withdrawn from their clinical rotation depending on the evaluation by the AI:MS director and/or addiction specialist.

8. If during or after treatment there is a question of the student’s suitability for clinical work, s/he will be referred to an outside clinician for evaluation.

9. Drug Screening reports will be held in strict confidence in the student’s medical record unless released at a student’s request or under the specific circumstances identified in sections 6-7.

10. Any results released to the Dean of a student’s program are also confidential and are subject to the Family Educational Rights and Privacy Act [FERPA] regulations. For additional information visit http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html

11. 11. Urine drug screens requested by a student for an outside program will be ordered through Sterling Infosystems, Inc. Results will be released to the student for submission to the outside program. Students with a positive test will not be able to participate in that clinical rotation. They will be referred to the AI:MS Office as outlined in section 6 above with notification of the appropriate Student Affairs Dean that the student must be on medical leave.

Appendix A

Urine Drug Testing Requirement and Procedure

Background & Rationale

• Health care providers are entrusted with the health, safety, and welfare of patients; have access to confidential and sensitive information; and operate in settings that require the exercise of good judgment and ethical behavior. Thus, assessment of a student’s suitability to function in a clinical setting is necessary to promote integrity in health care services.
• Clinical facilities are increasingly required by the accreditation agency Joint Commission on Accreditation of Healthcare Organizations (JCAHO), to provide a drug screening for security purposes on individuals who supervise care, render treatment, and provide services within the facility.
• Clinical rotations are an essential element in certain degree programs’ curricula. Increasingly these rotations require drug screening for student participation at their site. Students with a positive drug screen may be barred from certain rotations and thus are unable to fulfill degree program requirements. Identification of such students prior to clinical rotations will enable appropriate assessment and indicated treatment and follow-up.
• New York Presbyterian Hospital and CUMC require drug screening of all employees. It is appropriate for clinical students to meet the same standards for the reasons stated above.

Because of the reasons stated above, CUMC now requires urine drug testing for students prior to the beginning of clinical rotations. The following is some information for you regarding testing.

1. SHS will order and record urine drug testing findings, but the actual testing is done under the auspices of Sterling Infosystems, who also provide drug testing for all CUMC employees.
2. The drug test includes: Amphetamines, Cocaine, Opiates, Methadone, Methaqualone, Propoxyphene, Phencyclidine, Oxycodone, Marijuana, Barbiturate, Oxycodone, Hydromorphone, Hydrocodone, Benzodiazepines, Ecstasy.
3. You will pick up a requisition for the test from the SHS. This requisition must be filled within 72 hours. You can go to most LabCorp sites to submit your test. A list of nearby LabCorp sites is attached, as well as the link to LabCorp to identify other collection sites.
4. Test results are communicated to the SHS, where they become a part of your confidential medical record.
5. If LabCorp technicians record a positive test, that information is sent to the Sterling Infosystems Medical Review Officer, not to the SHS. The Medical Review Officer will contact you, assess any medications you may be taking (for example, Adderall), and speak with that prescribing clinician. If the test result and the information from the student and clinician indicate that this is legitimate clinical use, the result is then reported to the SHS as negative. Only positive tests that cannot be explained by legitimate clinical use will be reported as positive to the SHS.
6. Students who have a positive test reported to the SHS will be required to have an evaluation by the Director of the AI:MS (Addiction Illness:Medical Solutions) program. S/he will determine further evaluation and follow-up, which may include evaluation by an addiction specialist, follow-up urine drug testing, evaluation in the Mental Health Service or referral to a drug treatment program.
7. If a student is already on a clinical rotation and evaluation or recommended treatment would interfere with that evaluation, or the evaluation indicates concerns about patient safety if the student is on a clinical rotation, then the appropriate Dean of the student’s school or program will be notified that the student must be on medical leave. Students will be required to have an Administrative evaluation to return from leave.
8. For students on clinical rotations, part of the assessment will be a report from that student’s clinical preceptor regarding his/her performance (without disclosing the reason for the request). This report will be obtained by the appropriate Dean and conveyed to the individual assessing the student (AI:MS Director or addiction specialist).
9. Students whose outside rotations require additional drug testing will also have tests performed through Sterling Infosystems. If one of these tests is positive, the rotation site must be notified and the student will not be able to participate in that clinical rotation. The appropriate Dean will be notified that the student must be on medical leave and the student referred for assessment and treatment through the AI:MS office as detailed in sections 5-7 above.
10. The AI:MS Director and/or addiction specialist will determine when the student can return to clinical rotations as well as the frequency of follow-up drug test monitoring

Appendix B

Information About Urine Drug Testing

· Some over-the-counter medications can test for THC and Ecstasy. These include Dexatrim, and non-steroidal anti-inflammatory medications (e.g., ibuprofen, Aleve). Skip those drugs for at least 72 hours before your drug test. Pseudoephedrine and Vicks Inhaler can cause false positives for amphetamines and should also be avoided. Fluoroquinolones (e.g., Cipro) can also cause false positive (barbiturates). Cough syrup with dextromethorphan (DM) can cause a false positive for phencyclidine.

· Watch what you eat. Certain foods can, for example poppy seeds, can cause a positive drug tests (opiates). If you eat anything with poppy seeds, such as bagels and muffins, avoid these foods for 72 hours before your test. Quinine in tonic water can also cause a false positive test for barbiturates..

· Avoid any exposure to marijuana. A casual marijuana user will test positive for 7-10 days after the last exposure. This extends to 2-4 weeks in a heavy user.

· Do NOT be concerned if you are on a legitimately prescribed chronic medication that may cause a positive drug tests (e.g. Adderall or Concerta). This will be reviewed by the Medical Review Officer as described in the drug testing procedure and will NOT be reported as a positive drug test.

Urine testing for drugs of abuse

Drug	Duration of detectability in urine	Drugs causing false positive preliminary urine screens
Amphetamines	2 to 3 days	Ephedrine, pseudoephedrine, phenylephrine, selegiline, chlorpromazine, trazodone, bupropion, desipramine, amantadine, ranitidine
Cocaine	2 to 3 days	Topical anesthetics containing cocaine
Marijuana	1 to 7 days (light use); 1 month with chronic moderate to heavy use	Ibuprofen, naproxyn, dronabinol, efavirenz, hemp seed oil
Opiates	1 to 3 days	Rifampin, fluoroquinolones, poppy seeds, quinine in tonic water
Phencyclidine	7 to 14 days	Ketamine, dextromethorphan

Adapted from The Medical Letter 2002; 44:71.