If you send her your preferred MD for fitness for duty eval for a medical dx, endometriosis- not substance use disorder- to me this is physical and does not violate her rights.  I am attaching my fitness for duty form for your reference.  I created it for a similar reason and it has worked well.  It has a space for medications taking for condition/reason/if impairs duty to work, etc.  … that may clue your provider in to the methadone use. 

Hope that helps,

Maribeth Jenkins, MSN, RN, LMT, CWC

Employee Wellness Manager

Hendrick Medical Center

1900 Pine Street

Abilene, TX 79601

Phone: (325) 670-3010

Fax: (325) 670-3051

mjenkins@hendrickhealth.org

www.ehendrick.org

The job candidate relates that she uses Methadone for severe endometriosis. She will be working as an ultrasound tech in our imaging department.  I really like the idea of second opinion of a substance abuse professional but would this be in any violation of her rights. Although we have sent other candidates for fitness for duty for physical reasons to ensure they were able to perform job functions.

Cathy – One important question is what is the severe pain due to that this person is being treated for?  Is she able to perform the essential job functions with this pain?  What is the job she’s been offered? 

ACOEM just came out this month with practice guidelines on opioids and safety-sensitive work [JOEM 56(7) e46-52, July 2014].  They recommend against acute or chronic opioid use for patients who perform safety sensitive jobs, which they define to include tasks involving high levels of cognitive function and judgment.  This standard could easily be applied to nurses, physicians and others in the healthcare setting. 

A lot depends on the job.  I agree with others that a second opinion with a substance abuse professional would be wise for a, hopefully unbiased, opinion about whether she can safely and consistently perform the essential functions of the job, and that the applicant be monitored by her prescriber with periodic urine drug screens per the currently accepted practice recommendations. 

James Garb, MD FACOEM

Medical Director, Occupational Health Services

Cape Cod Healthcare

Hyannis, MA

We have a candidate for hire which is a known methadone user. This candidate does have a legal prescription for the drug but it makes me alittle nervous. We are considering doing random drug screens for a period of time just to be assurred that this person is not taking anything not prescribed. The candidate relates that the methadone is prescribed for severe pain and has been on it for the past year. Any thoughts and past experiences with this would be greatly appreciated.

Cathy Senior RN BSN CDE

Employee Health Director

Penn Highlands DuBois

100 Hospital Avenue

P.O. Box 447

DuBois Pa 15801

Phone 814-375-3392

Fax 814-372-2610

cesenior@phhealthcare.org

www.phhealthcare.org