[MCOH-EH] Drug Testing For Suspected Diversion

[Swift, Melanie D., M.D.]

Hi Sumeet,
I would caution you against using drug testing to detect diversion. Not everyone who steals a drug uses it themselves, and not everyone who uses diverted drugs will test positive.

The absence of the drug in a forensic drug test does not mean the person did not divert the medication (short half-life, sold, given to someone, or squirrelled away with intent to use later). Doesn't matter. Diversion is a criminal act, and needs to be dealt with as any other theft (plus the reporting required by professional boards, DEA, etc).

However, a negative forensic drug test will most definitely be used by a diverter as "evidence" that they were wrongly accused. It creates plausible deniability.

You need a comprehensive diversion detection program (one example: https://assets.hcca-info.org/Portals/0/PDFs/Resources/Conference_Handouts/Regional_Conference/2014/Minneapolis/Dillonprint2.pdf ). You need timely, reliable reasonable suspicion testing. There may be isolated cases where testing an individual is warranted, but I would strongly recommend you not routinely perform employee forensic drug testing to detect  diversion.


Melanie

Melanie Swift, MD, MPH
Medical Director, Mayo Clinic Physician Health Center
Senior Associate Consultant
Assistant Professor of Medicine
Division of Preventive, Occupational, and Aerospace Medicine
Phone 507.284.2560
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
www.mayoclinic.org<http://www.mayoclinic.org/>





From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Sumeet Batra
Sent: Wednesday, June 26, 2019 11:07 AM
To: mcoh-eh at mylist.net
Subject: [EXTERNAL] [MCOH-EH] Drug Testing For Suspected Diversion

Hello,

My institution is in the process of revising our policies towards drug diversion and drug testing and I was hoping to get some feedback from members on their current policies.  Specifically, I would like to know if anyone is currently using hair testing as a means for assessing diversion.  There are some hair tests that have been FDA cleared for fentanyl, as well as the commonly tested drugs and this is something we are considering adding to our program.  I would also like to know how your institution handles drug testing for employees when there is a missed count or missing medication in the OR setting.  Do you test all employees who were present in the operating room or only specific employees with a high level of suspicion?  How quickly do you drug test these employees and do you utilize urine, hair, saliva, blood or some combination thereof?  Any insights would be greatly appreciated,

Sumeet Batra

Sumeet Batra, MD, MPH
Medical Director, Occupational Health Services
Cook Children's Health Care System
801 7th Avenue
Fort Worth, TX 76104
(682) 885-3837
(682) 885-6717 (fax)


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