Very sound advice. Additionally, when developing diversion investigation procedures, remember that diversion may not be for personal or immediate use. Diverted drugs could be passed to a friend or partner. They can be sold on the street, particularly if they are in pill form. They could be stockpiled for later use. Even if used by the diverter, some have a very short half-life and will have been cleared before the drug screen is collected. So, a negative drug screen does not rule out diversion by any means. In fact, if the evidence for diversion is otherwise strong, getting a drug test in the absence of any evidence of impairment may not be a wise or helpful step. The negative test later becomes a liability when the employee fights their termination in court. But of course, in less convincing cases it brings clarity when it is positive.

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We only test for the potentially diverted substances and have had “panels” that will go after the standard drugs of diversion. If there is no reasonable suspicion based on behaviors of employee(s) this is what we used. If It is truly a reasonable suspicion based on behaviors, clinical stigmata etc we do our standard reasonable suspicion which does include marijuana.

Miriam Alexander, MD MPH

Medical Director for Employee Health and Wellness

AVP Occupational Health

LifeBridge Health

2401 W.Belvedere Ave., Hoffberger 54

Baltimore, MD 21215

Phone: 410-601-0563

Mobile: 410-206-0579

Fax: 410-601-4643

Mhalexan@lifebridgehealth.org

From: MCOH-EH <mcoh-eh-bounces+mhalexan=lifebridgehealth.org@mylist.net> On Behalf Of Deanna Prater via MCOH-EH
Sent: Wednesday, June 24, 2026 7:29 PM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: Deanna Prater <dprater@luhonline.com>
Subject: [MCOH-EH] for cause/reasonable suspicion drug testing

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We are reviewing our employee health and occupational testing policies for medication discrepancy or diversion investigations (e.g., dropped controlled substances, unresolved medication count variances). In these situations, does your organization utilize targeted drug testing panels that exclude THC/marijuana, focusing instead on relevant controlled substances associated with the discrepancy? If so, are these panels standard or ordered case-by-case? The reason I am asking, is because marijuana is legal in Oregon, and if the employee would test positive for marijuana when we're really concerned about the results for the missing substance, it could be problematic.

Deanna Prater BSN, RN, CPHQ

dprater@luhonline.com

Phone: (541) 271-6323

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