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Drug testing for internship?

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by Pavlov81, Mar 26, 2012.

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  1. Pavlov81

    Pavlov81

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    Should I expect to be drug tested prior to starting a VA internship? I ask because I take a prescription stimulant, and I've read that it can cause you to test positive for amphetamines. I'm wondering if I should stop taking it for a week or so before I start, just to be safe.

    Long background story: I know that drug testing facilities will generally ask if you're taking any prescription medications, and that they're supposed to take this into account when looking at your results. But I also have a friend who nearly lost her practicum over this - she told the testing facility that she's prescribed adderall, but they overlooked this and reported to her practicum site that she'd failed the test, and the practicum site made a call to our department chair. It was eventually cleared up and she was able to start her practicum, but she ended up having to disclose her private medical history to a lot of people. I really don't want to have to provide copies of my prescriptions right at the start internship.
  2. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    If you are legitimately taking a stimulant (under the supervision of a licensed prescriber), there should be a 0% problem.
  3. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    1. I'm sure your not the only person in history who has ben taking a prescribed stimulant while also being drug tested for a job. I wouldnt be too paranoid about it if I were you.

    2.When you disclose your current medications before a drug test, you are providing it to the staff of Employee Health (in the VA system) or other health professionals. You seem to think you're talking about your medical history with your rotation supervisors or something...
  4. JeyRo

    JeyRo

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    They even drug test WOCs now (such as practicum students). When I was a practicum student they didn't test students (one of our project coordinators, very nice lady, has two kids and is an RN now, was a big daily pot smoker), now they test everyone. That's the world we live in now.

    If I was you I would simply make sure I had a copy of my prescription with me at the time I'm required to produce bodily fluids for the testing people, and if you're paranoid, get names of people there so you can know the chain of custody (probably not an unwise move anyways).
  5. Pragma

    Pragma

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    It sounds like that is what happened to their friend because of the paperwork issue. It is a valid concern and I would imagine if one is taking it prescribed, they should discuss how to handle drug testing with their physician. Despite our supposed understanding of these things, rotation supervisors may view you differently for taking a stimulant.
  6. 4410

    4410

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    At my internship site, I will have to complete a physical that includes drug testing as it is a Federally and State funded facility. I am Okay now but several years back I had some serious health issues so I am worried about going through the physical.
  7. Pavlov81

    Pavlov81

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    Yes, erg923, as I stated in my post, that is exactly what happened to a colleague of mine. She had a legitimate script, and she disclosed this at this the time she was tested. Because the testing company reported that her test was positive, she ended up having to show her prescription to several people in our program (department chair, DCT, advisor) as well as the practicum site (HR staff, new supervisor, program director) in order to be cleared to do her practicum there. My colleague did have to talk about her medical history with her supervisors.

    I have a legitimate prescription. I've worked in a VA setting before as an RA, but it was prior to grad school, and I wasn't taking medication at that time. And I understand how drug testing is supposed to work. My question is, should I expect to be tested prior to the start of internship. I'd rather go off meds for a while than risk having something like that happen to me.
  8. JeyRo

    JeyRo

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    I believe pretty much all VA Psychology jobs require preemployment drug testing at minimum, and random testing is usually part of it as well. If there's any drug testing going on it's preemployment (usually done during the hiring process). I would say expect it. Keep a current copy of your prescription with you and your doctor's telephone number with you at all times when you're going through the hiring process, just so you're not caught flat-footed.

    If you need the medication in order to function and you have your legal permission slip (e.g., prescription) I'd say don't go off it, stay on it, seriously. Moreover, you're not doing anything illegal or "wrong" (not that I consider illegal drug use morally wrong just because it's illegal, but that's just me and beside the point), so you have nothing to be ashamed of.

    If you're matter-of-fact about it, then I don't think it should be (and it probably wont be) a problem. If it is, it's their problem and if it turns into a matter of prejudice or bigotry (e.g., treating you poorly or differently because you're taking some particular prescription drug) that's another matter, but that's really getting ahead of yourself.
  9. 4410

    4410

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    Stimulants have a very short half life unless you are taking extended release. Most stimulant medications or traces of these medications are difficult to detect with UA as they are metabolized quickly and excreted completely within two to three days. If you knew when you were going to be drug tested you could stop them for a week or so before hand. Also, many of the newer ADHD meds are not stimulate based medications and they have much fewer side effects. You may want to discuss this with your psychiatrist or primary care physician who is prescribing your medications. Strattera and Clonidine are non stimulant meds that help with ADHD and I believe they are meds for high blood pressure that help with reducing ADHD symptoms, most helpful for hyperactivity and less helpful for inattention. Another thing that many are recommending in neuro feedback in the treatment of ADHD and some are getting completely off of medications.
    Last edited: Mar 27, 2012
  10. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    Most places of employment will not require a soup to nuts physical like would be required for military service. Instead, there is usually a 1-2 page form that needs to be completed by the physician that covers the basics like if there are any physical limitations like weight restriction limits for lifting, etc. There are some exceptions though....the Federal Prison system has some of the more stringent requirements for staff (drag dead weight, climb flights of stairs, etc). Thankfully psychologists can typically be exempt from these requirements, though it is up to the discretion of the BOP.

    I do not believe this can be required. There are certain instances when the employer can reveal information to an outside source (medical emergency, national security :rolleyes:, etc), though I do not believe the employee must divulge their PHI to their supervisor/employer, and they almost certainly couldn't be made to disclose the information as a req. of employment. A quick search of HIPAA and the ADA should cover this.
  11. Pragma

    Pragma

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    Not required, but I am pretty sure that people are going to find out if the test comes back saying you failed. Occupational health or whatever third party is involved may not give them specifics, but it isn't going to sound good to know you didn't pass the drug test. I am sure that would require explanation in this case, and I would imagine it happens frequently enough that there is a protocol for letting the testing entity know in advance what medication you are taking without your supervisor getting ahold of the information.
  12. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    That should be covered in the paperwork you fill out prior to submitting a sample. They ask you to list what prescriptions you are currently taking. I'd be interested to see exactly how (and what) information is then given to the employer, though I'd hazard to guess that if your test matches up with the medications you listed....you would have "passed" the drug test.

    Pass/Fail is somewhat of a misnomer anyway, as I'd expect someone to test positive for a a benzo if they had a prescription for Xanax, etc. The typical drug screen looks for: Pot, cocaine, amphetamines, opiates, PCP, barbituates, anti-depressants, and alcohol. The ones I have done also typically include caffeine, diphenhydramine, MDMA, and some other stuff. Most jobs aren't going to spring for 'the works' because that can get quite pricey, though the standard screen I believe is 5-10 of the most common things. I don't have my lab book here, but I can check if someone really wants to know.
    Last edited: Mar 27, 2012
  13. JeyRo

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    I remember looking into this once when I got very mildly paranoid because I had been taking Vicodin for a while for a bulging disk issue (I'm now off the dope, thank goodness).

    Routine preemployment screens and random screens are generally the cheapo variety you speak of (usually looking for a half-dozen or so major drug classes, typically pot, cocaine, meth and opiates are included). If they get a positive result then you get the more expensive confirmatory assay for a wider variety of substances. I imagine if you get popped with "for cause" drug testing you probably get the more expensive, in-depth assay right off the bat. I think the type the VA routinely uses is probably similar to the SAMHSA "dot five-drug panel," but this is just speculation since obviously they don't want to widely publicize their methods.....
  14. syzergy

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    Just curious, what would be the point of testing for caffeine? Forgive my ignorance, is caffeine used in some sort of illicit drug? And what happens if you test positive? I go through about a bucket of caffeine a day. :rolleyes:
  15. JeyRo

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    Yeah, I didn't catch that before. Caffeine? Whut? If they test for that, I'm screwed, I'm a junkie many times over. :laugh::laugh:
  16. Pavlov81

    Pavlov81

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    In this case, my colleague didn't have much of a choice. Through some colossal screwup, the testing company overlooked the medications she'd listed on her paperwork at the time of testing. Her practicum site got a report that she had tested positive for amphetamines, and said that she couldn't start her practicum unless she could explain. The site informed our department of this report as well. I guess she could have refused to say anything, but that would have looked pretty bad, to her practicum site as well as the department. Regardless of whether it was legal, she had no choice but to divulge PHI in order to start her placement.

    I get that this isn't how testing is supposed to work. Testing facilities are supposed to ask about prescription medications (again, my colleague disclosed this in her testing paperwork) and to take this into account when they interpret the tests. And no employee should have to disclose their medications directly to their employer. But this is what happened, and I'm not willing to risk it. I will list my medication when I get tested pre-internship, just in case they find traces, but I'm going to get it out of my system a few days beforehand to be sure that this doesn't happen to me.
  17. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    If that is how it happened...then I'd take serious issue with the lab. There are disclaimers about what can be shared and with whom, though it was triggered by a procedural screw-up (e.g. failing to check the findings against known medications being taken by the person).
  18. 4410

    4410

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    Some employers have a zero tolerance due to the security of their facility. You don't want to have a positive UA even if you have prescriptions and other verifiable documentations as people abuse and become dependent upon prescription drugs, as well. My take is to stop taking the stimulant medication two or three weeks before your testing and to not even bring it up that you take prescribed meds as you have HIPPA rights to privacy and confidentiality. Once you get through your internship and work in different settings, it most likely will not be an issue.
  19. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    It is irresponsible (not too mention outside your scope of practice) to give medical advice on this forum. You are not this person's physician and you have not examined him/her. Thus, you should NOT advise them on discontining potent psychotropic medications!

    If you do this again, I will have you banned. Being annoying and ignorant isnt a TOS violation...giving medical advice is.
  20. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    Another great point. :rolleyes: Obviously patients shouldn't be prescribed medications because they will all get addicted. That blood pressure medication is getting premium dollar on the black market! :laugh:

    btw...giving medical advice is not only unethical, but it is against the policies of SDN.
  21. JeyRo

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    Drug testing, even for so-called "sensitive" positions (truck drivers, doctors, whatever) is a waste of money at best, just my (I think fairly educated) opinion.

    Aside from that, advising people to stop medication that a doctor may have recommended to them for specific, potentially serious medical reasons is stupid-ass. I'm blocking you just because life is too short for stupid, and I hope you get banned next.
  22. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    What's unfortunate is that there seems to be a lack of awareness that such advice, even if provided in person and with sufficient access to appropriate background information, would be outside the bounds of both competence and scope of practice. This type of suggestion, even if "only" made in passing and in an attempt to be helpful, could cause some very serious problems for patients/clients down the line. It also opens you up to all sorts of malpractice issues, and can potentially result in pitting the client and his/her prescribing physician against one another (e.g., "well my psychologist said I should/could stop taking this").
    Last edited: Mar 28, 2012
  23. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    There is some case law (varies by state) that supports psychologists being allowed to comment on and/or recommend meds to a patient, though that doesn't mean it is ethical or remotely a good idea in most circumstances. As you mentioned above, even if the psychologist is adequately informed about medications, there are ethical considerations about how your input may compromise the relationship between the patient and the prescriber.

    I work as part of a multi-disc team, and frequently we have overlap in what we talk about with the patient. Even with the understanding there is known overlap on the team, I still tread very lightly if a patient asks me anything about medications because that isn't my core area. I typically stick with patient education about the med in question and then direct the patient to the physician for answers about their specific treatment. I know I wouldn't want a physician telling the patient what assessments should be given to them for their neuropsych eval., so I try not to do the equiv. to them.
  24. JeyRo

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    In California, when I fill out capacity declarations for my dementia patients, I'm directly asked on the form what specific medications I would recommend prescribing for a proposed conservatee to address their dementia. Usually I just avoid filling out that part and make a note on the form reminding them I'm not a prescribing clinician. Although I've filled out capdecs a number of times this way, once or twice I've had the forms sent back and they've asked me directly what meds I would recommend. I usually write in something like, "recommend medication consultation for dementia meds" and usually that stops them.

    When it comes to working with patients I never directly tell them I think they need medications, but I sometimes tell them I think they should be evaluated by their physician as to whether medications are appropriate, and then I tell them why.
  25. Markp

    Markp Clinical Psychologist

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    Wow.
  26. thepug

    thepug

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    Still mad at the world bro?

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