Workplace drug testing in the medical sector

In late 2016, head of the NHS’s Practitioner Health Programme (PHP), Dr Clare Gerada, described working in the NHS as “an occupational hazard”. Reorganisations, funding issues and staff shortages sit alongside the emotional stresses of patient care, with the PHP having been set up to offer support for mental health and addictions for those working in the health service.

With 10% of the doctors in London alone seeking help from the Practitioner Health Programme, and a quarter of those registered relying on either prescription medication or drinking to combat stress, it’s a worrying trend that shows that the NHS itself is unwell.

Since its launch in 2008, the PHP has treated medical professionals addicted to ketamine, heroin and more: addictions that can prove costly to public health, to the professionals’ own health and the reputation of our health service. And it’s not just the UK where drug and alcohol problems occur in the health sector: in New Zealand, a cystic fibrosis patient filmed the drunken rant of a doctor on hospital premises in 2016, while a Las Vegas mum blames a drunk doctor’s forceful delivery of her baby for medical complications.

It is clear that the medical sector struggles with drink and drugs problems - both here in the UK, and across the globe. While regulations and guidelines are in place, the focus, we believe, should be on ensuring that employers can catch potentially harmful problems before they get out of hand.

So how do authorities test for drugs and alcohol in the medical sector across the globe, what do they test for, and when do they test?

UK

There is no random drug testing in the medical sector in the UK: over the years, there have been proposals to do so, but NHS Employers believes that there is “still no case for the introduction of random testing”.

Instead, tests are only conducted under two circumstances: as part of health assessments, and as part of medical supervision cases.

The former occurs when information is received suggesting that a doctor is unfit to perform his or her duties through ill health i.e. their fitness to practise is in question. These tests are designed to establish which substances, if any, are being misused, and to provide baseline measurements that can be compared against future tests. Official General Medical Council guidance states that the methodology used can vary depending on the nature of the case, but blood tests are typically used for alcohol and hair tests for drugs. Hair testing can also be used for alcohol tests should any concerns be raised through blood test results.

“Medical supervision” testing, on the other hand, involves testing doctors during a period of restricted activity, monitoring progress during a period where their fitness to practise is under review. Here, tests are generally carried out every three months (but can be more frequent or random if required), with the same testing methods used as in health assessments.

In both cases, hair testing has been chosen as the approved drug testing method thanks to its ability to show the use of drugs over a prolonged timeline: particularly useful during medical supervision testing, when supervisors are working to rehabilitate drug users in the medical sector.

US

The Drug-Free Workplace Act of 1998 in the US requires all Federal grantees and some Federal contractors to agree to provide drug-free workplaces as a precondition for receiving a grant or contract from a Federal agency. The requirements of this Act, however, make no mention of testing.

The American Medical Association’s Policy H95.984 (Issues In Employee Drug Testing) states that drug and alcohol testing, via urine tests or other means, be confined to three different situations: pre-employment where the role affects the health and safety of others; situations where it is suspected that the employee’s role is being impaired by substance abuse; and in monitoring for rehabilitation in confirmed instances of substance use disorders.

In a country where different states have their own sets of laws, certain states have pushed to try and implement random drug testing in the medical profession...but have failed. In 2013, two John Hopkins physicians called for mandatory random drug tests - calls that were ignored. In California, Proposition 46 - which proposed the same - failed in the second half of 2014.

It’s not just different states that have their own regulations either: even individual institutions within the same state can do things differently. In Virginia, for example, a bill was passed in 1994 that allows random drug testing amongst certain members of The Department of Mental Health, Mental Retardation and Substance Abuse Services. However, workplace drug testing is neither regulated or restricted throughout the state: it is up to employers to form their own policies.

Australia

In Australia, the Australian Health Practitioner Regulation Agency announced a new Drug and Alcohol Screening Protocol in early 2015, which sets out a clear framework for the handling of health practitioners with registration restrictions that are linked to prior substance abuse. This protocol added mandatory routine hair analysis to the existing urine testing regime that was introduced in 2014, creating testing standards that are nationally consistent, and with the same reporting thresholds used across the country.

For those with a history of prior drug or alcohol abuse, hair tests are conducted on a quarterly basis, with the frequency of urine tests varying depending on their history. The addition of hair testing ensures that any ongoing substance abuse patterns can be identified, giving greater assurance to employers that any impairment as a result of long-term substance abuse can be detected.

As in the UK and the US, random drug testing amongst healthcare workers (bar those with prior histories of substance misuse) does not currently take place. The March 2014 report, Testing for Impairing Substances in Health Care Professionals, by Professor Olaf Drummer of the Victorian Institute of Forensic Medicine, explains “This would be a costly program given the numbers of these practitioners across Australia, and with the rural practitioners quite difficult to implement, even if cost were not a factor.”

Netherlands

Things are very different in the Netherlands. Pre-employment testing is illegal, while only those who work in the “traditional” safety-sensitive professions are subject to any form of testing at all.

In a quote submitted to a Council of Europe report in 2007, Dutch authorities stated, “In the Netherlands, drug testing is perceived as an infringement on privacy according to Article 10 (privacy) and Article 11 (physical integrity) of the Dutch Constitution. Under specific circumstances, employers may invade such Constitutional rights, provided there has been made a statutory exception.

The question if employers can perform drug tests on their employees depends very much on the specifics of each case. If there is a dispute, it’s settled in court. There have been no appeals in such cases; until now, our highest legal office, the Supreme Court, has not been able to make a general remark about the admissibility of drug testing in the workplace.”

The bottom line

All across the globe, drug and alcohol testing in the medical sector is conducted in very different ways - if conducted at all. It’s a sector that’s characterised by high levels of stress, which can lead to an increase in substance abuse. For this reason, hair testing is the ideal method for establishing substance misuse history: in a profession where members of the public’s lives are at risk, authorities need to build up a clear, long term picture of employees’ habits, and catch and deal with potentially harmful problems before they get out of hand.

Random drug testing is not currently in use in any of the countries detailed above, with some citing the cost as a factor. As emergency medicine doctors M R Levine and W P Rennie stated in a paper for the BMJ, “The impact of substance use on patient safety is admittedly complex, but we must obtain further insight, especially as we devote our attention to achieving higher levels of patient safety.” Aside from the cost savings, having a workforce of fit to practise medical professionals may save lives too.