Discolusure regarding psych meds

[1983PsychIntern101]

Hi,
Just wanted to get an opinion from the residents/attendings/PDs:

I will be starting as an intern in a major university based program in July. They require drug testing for employment, which is not a problem at all, I have never done any kind of drugs. My concern is that I am on Wellbutrin and I know it sometimes gives false positives on Utox for amphetamines. Its something that I didn't really want to disclose to my program. I've been on low dose Wellbutrin for 2 years and don't even think about it anymore - until now. I was put on it originally for anxiety/depressive symptoms second year of med school. I've never had any psychotic breaks, no hospitalizations or loss of function/reality etc. (just found myself unable to concentrate/sleep and crying a lot after death in the family and my divorce and it bothered me). Since then I've just been taking it along with my multivitamins and never had issues, so I wasn't really planning on telling the program about any of this, but now feel like I am kind of forced to.
I worry that they will look at me differently, or see me as less competent, problematic, even though I realize that we are in Psych. Has anyone else had this issue? How would the PD react? Would this change how the program treats me? Any other unforeseen problems with this?

I was also considering tapering for a month and then restarting after drug test, but not sure how long it stays in your system. I am pretty sure that if I get off the meds I will be totally fine, but don't really feel like messing with it during intern year. Any advice? Thank you!

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[F0nzie]

Drug testing is known to produce false positives. If it yields a false positive it will be sent for confirmatory testing via GC/MS.

 

[Doctor Bagel]

You'll be fine. When you take a drug test, they ask you to list your medications, and they'll figure out any reason for a false positive, which btw, likely won't stay positive with confirmation. Drug testing is done by occupational health, and occupational health information is generally protected from your program with some caveats.

If the wellbutrin is helping, now is not the time to taper off it because you're moving/starting internship is a stressful time in life. Your PD would likely think nothing of you being on Wellbutrin, but I probably wouldn't start my relationship with them by specifically disclosing that you take it either.

 

[deleted314290]

On a side note, does anyone know a good resource for common false positives?

 

[nitemagi]

On a side note, does anyone know a good resource for common false positives?

My app has a table for it.

 

[so721]

You'll be fine. When you take a drug test, they ask you to list your medications, and they'll figure out any reason for a false positive, which btw, likely won't stay positive with confirmation. Drug testing is done by occupational health, and occupational health information is generally protected from your program with some caveats.

If the wellbutrin is helping, now is not the time to taper off it because you're moving/starting internship is a stressful time in life. Your PD would likely think nothing of you being on Wellbutrin, but I probably wouldn't start my relationship with them by specifically disclosing that you take it either.

what would be the caveats? I don't know if this varies state by state, but I think some states don't tell your employer as long as you have a valid prescription.

Other states, if it may impair your clinical judgement, your employer/institution has a right to know. This is for the states that are not so lenient, so the occupational health office, has an obligation to report it to your empoyer

 

[Doctor Bagel]

what would be the caveats? I don't know if this varies state by state, but I think some states don't tell your employer as long as you have a valid prescription.

Other states, if it may impair your clinical judgement, your employer/institution has a right to know. This is for the states that are not so lenient, so the occupational health office, has an obligation to report it to your empoyer

I wonder if you could anonymously ask your occupational health department about how they handle privacy around a urine drug screen or other disclosures. It would be interesting to know what the quickest/best resource would be to answer this question. Lots of people are on things that are going to for sure test positive like amphetamines for ADHD, so there's got to be some way this is worked out.

 

[1983PsychIntern101]

Other states, if it may impair your clinical judgement, your employer/institution has a right to know. This is for the states that are not so lenient, so the occupational health office, has an obligation to report it to your employer

Which states? How can I find that info?

 

[1983PsychIntern101]

If the wellbutrin is helping, now is not the time to taper off it because you're moving/starting internship is a stressful time in life. Your PD would likely think nothing of you being on Wellbutrin, but I probably wouldn't start my relationship with them by specifically disclosing that you take it either.

I hate that this is such a double standard, and you are totally correct, it may undervalue their opinion of me as a competent physician able to handle stress. This especially rings true with the recent events in the media and NY Times analytical piece this morning on suicide/mass murders psychological profiling. http://www.nytimes.com/2015/04/07/science/the-mind-of-those-who-kill-and-kill-themselves.html?_r=0

The quote that bothers is me is this one: “Not all of them had a history of mental illness,” Dr. Hatters Friedman said of the pilots. “What keeps coming up is family stresses, relationship stress, work stresses, financial stresses.”

Plenty of people have all of the above and manage to cope by themselves, or sometimes need a little help. In my case I was a second year medical student, losing my father and grandmother in a span of a couple of months while going through a messy divorce (on basis of adultery) at the same time. I was able to cope to a certain extent, then I realized it was affecting my school work and sought help. Only because of that was able to finish school on time with good grades. I don't think it says anything else about my character other than what it is, something happened and I needed help. It was given and that's that. Hopefully, my PD won't care, but having the thought of such a benign psych medication being analyzed in a critical scope in psych residency is unsettling.

 

[Armadillos]

I wouldn't sweat it, your way overworrying. Your probably going to get some sort of pre employment physical and those are the people who will likely collect the drug test, so they will know your meds. They have nothing to do with your actual program except ultimately they would notify the program later down the line if you tested positive. Urine drug screening is just that, a screening test, possible screening false positives are nothing foreign to an employee health clinic.

 

[so721]

I wouldn't sweat it, your way overworrying. Your probably going to get some sort of pre employment physical and those are the people who will likely collect the drug test, so they will know your meds. They have nothing to do with your actual program except ultimately they would notify the program later down the line if you tested positive. Urine drug screening is just that, a screening test, possible screening false positives are nothing foreign to an employee health clinic.

If you have a prescription, it would not test positive, in most cases, correct? The employee health office doesn't have a right to just go ahead and violate your confidentiality by disclosing the info to the PD?

I mentioned, regarding various states, I think the only way to know for sure is to call your pgm.

 

[Armadillos]

If you have a prescription, it would not test positive, in most cases, correct? The employee health office doesn't have a right to just go ahead and violate your confidentiality by disclosing the info to the PD?

I mentioned, regarding various states, I think the only way to know for sure is to call your pgm.

This is just my own personal, non-professional opinion.

IMHO calling your program is not a good idea because not only will the poster end up disclosing information they wanted to keep private they also will possibly make a bad first impression as being seen as overly neurotic.

As far as I know employee/occupational health and your program are operating in different silos with extremely minimal info sharing. Employee health is not going to tell the program what meds your taking. Additionally workplace drug screening is highly regulated by the federal government. People get drug screened in basically every industry, they know how to handle this in patients taking meds. As mentioned above there are high end, forensic caliber send out tests done on positive workplace screens. Firing someone for drug use is a f-ing huge deal, you really think companies are firing a bunch of folks for taking
Wellbutrin? If you absolutely must call then you could call the people actually doing the test (not your program).