drug testing

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southernhospitality12

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Given the recent legalization of marijuana in certain states (and it looks like more to come) and a somewhat higher propensity of anesthesia providers to abuse drugs, I have a question about drug testing of residents: say you misplace or spill some fentanyl and have to pee in a cup, do they do a full drug panel including THC, amphetamines, etc or is it just for opiates or drugs in question? given that THC can be detected for months after use, I am wondering if this would be or has been an issue for anyone who has used it while off duty?

also, this is not a thread to discuss what doctors should or should not be doing, please keep that out of the thread.
 
southernhospitality12 said:
Given the recent legalization of marijuana in certain states (and it looks like more to come) and a somewhat higher propensity of anesthesia providers to abuse drugs, I have a question about drug testing of residents: say you misplace or spill some fentanyl and have to pee in a cup, do they do a full drug panel including THC, amphetamines, etc or is it just for opiates or drugs in question? given that THC can be detected for months after use, I am wondering if this would be or has been an issue for anyone who has used it while off duty?

also, this is not a thread to discuss what doctors should or should not be doing, please keep that out of the thread.
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If your hospital policy is no Marijuana and you have a reason to get tested assume you will get the standard 9 panel urine drug test.

So yes they will test for THC unless you are told otherwise.

And no this hasn't actually happened to me but I lived in Colorado and as far as I know the hospitals there have a no THC policy for providers.
 
NOsaintsfan said:
If your hospital policy is no Marijuana and you have a reason to get tested assume you will get the standard 9 panel urine drug test.

So yes they will test for THC unless you are told otherwise.

And no this hasn't actually happened to me but I lived in Colorado and as far as I know the hospitals there have a no THC policy for providers.
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are you a medical student?

I know they have the right to test for what they want, but given my scenario above, do they normally test for THC? at my institution residents lose things quite a bit and have to go pee in a cup...its not that anyone exhibited any specific behavior but thats pretty routine when something goes unaccounted for. I know many residents who use marijuana while off and am wondering if it becomes an issue because they deal with narcotics all day in comparison to other specialties
 
southernhospitality12 said:
are you a medical student?

I know they have the right to test for what they want, but given my scenario above, do they normally test for THC? at my institution residents lose things quite a bit and have to go pee in a cup...its not that anyone exhibited any specific behavior but thats pretty routine when something goes unaccounted for. I know many residents who use marijuana while off and am wondering if it becomes an issue because they deal with narcotics all day in comparison to other specialties
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Yes I'm a med student. I suspect your questions are institution specific.

I do know that urine drug dip sticks are cheap and hospitals usually have plenty of them around. I am willing to bet any given hospital will use the cheapest most readily available test for standard situations like you bring up.

Hopefully someone here can give you a better answer.
 
NOsaintsfan said:
Yes I'm a med student. I suspect your questions are institution specific.

I do know that urine drug dip sticks are cheap and hospitals usually have plenty of them around. I am willing to bet any given hospital will use the cheapest most readily available test for standard situations like you bring up.
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There's a difference between drug testing for diagnostic purposes and to guide treatment, and drug testing for legal purposes. Cost, sensitivity/specificity, confirmatory tests, chain of custody, consent ... worlds different.
 
pgg said:
There's a difference between drug testing for diagnostic purposes and to guide treatment, and drug testing for legal purposes. Cost, sensitivity/specificity, confirmatory tests, chain of custody, consent ... worlds different.
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I see.
 
To elaborate a little ...

Here in the military, if someone on active duty comes in to be seen, we can order a urine drug screen if we think it's medically indicated. This might be a cheap urine dipstick or blood test. That data can then be used to guide treatment. If positive, it can't be used as evidence of wrongdoing to prosecute or process the person out of the military. (They can of course confess to drug use to someone and produce legally admissible evidence against them, but the tox screen isn't.)

If someone on active duty is referred to be seen because someone thinks they're intoxicated, a person with appropriate authority can order a drug test. The paperwork is different, the test is different. The sample gets taken in the presence of a witness, the subject witnesses and signs that the sample was put in a tamper-resistant container, and a chain of custody has to be perfectly maintained between that point and the testing company. The test company typically tests the sample using a sensitive but not specific test, and then (if positive) retests it with another method that's extremely specific, like mass spectography.

I had to get drug tested as a condition of employment at a civilian place where I moonlight, and the process was much the same. I went to a test center, peed in a cup with some dude watching, never took my eyes off my pee as it got packaged up and sealed in tamper-resistant packaging, and signed a bunch of release forms.

ERs everywhere routinely do drug screening of patients when medically indicated. These tests have little or no legal strength. If the cops drag someone in handcuffs in, the process is different.

No one in the civilian world is going to get fired on the strength of a cheap urine dipstick with no chain of custody and no confirmatory test ... their lawyers would have a field day with it.
 
southernhospitality12 said:
are you a medical student?

I know they have the right to test for what they want, but given my scenario above, do they normally test for THC? at my institution residents lose things quite a bit and have to go pee in a cup...its not that anyone exhibited any specific behavior but thats pretty routine when something goes unaccounted for. I know many residents who use marijuana while off and am wondering if it becomes an issue because they deal with narcotics all day in comparison to other specialties
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How do residents "lose things quite a bit"? That's ridiculous. At our place this is very high visibility and would be a very high level problem. If you lost things "quite a bit", you wouldn't be peeing in a cup, you'd be on probation and potentially fired.
If it was a regular problem for the residency program, heads would roll there as well and system change would be swift. The last thing a hospital needs is problems with the DEA or any of the other governing and/or licensing bodies.
I can't imagine they would let a regular problem continue. They've tested exactly one person at my place several years ago and that was because they had a problem with the random screening system that just happened to hit that faculty a couple times and flagged them.
 
IlDestriero said:
How do residents "lose things quite a bit"? That's ridiculous. At our place this is very high visibility and would be a very high level problem. If you lost things "quite a bit", you wouldn't be peeing in a cup, you'd be on probation and potentially fired.
If it was a regular problem for the residency program, heads would roll there as well and system change would be swift. The last thing a hospital needs is problems with the DEA or any of the other governing and/or licensing bodies.
I can't imagine they would let a regular problem continue. They've tested exactly one person at my place several years ago and that was because they had a problem with the random screening system that just happened to hit that faculty a couple times and flagged them.
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this is what I was told by one of the residents who said they had to go give a sample. I don't know how much (if any) hyperbole he was using. He handed me some fentanyl and versed early in the day and forgot he had given it to me. When I reminded him he said if I didn't then he would have had to have gone to pee in a cup.

So, there are no real instances in anesthesia where residents would be tested unless there was OBVIOUSLY something going on?

I just think its interesting how a hospital can terminate someone for doing something which can be (and ultimately will be) legal for something way off duty.
 
southernhospitality12 said:
this is what I was told by one of the residents who said they had to go give a sample. I don't know how much (if any) hyperbole he was using. He handed me some fentanyl and versed early in the day and forgot he had given it to me. When I reminded him he said if I didn't then he would have had to have gone to pee in a cup.
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:smack:

That's not normal.
 
southernhospitality12 said:
He handed me some fentanyl and versed early in the day and forgot he had given it to me.
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Say what???

Yeah, I'm just a med student but at the hospital where I rotate this would be a very big deal. As in I imagine the first time that happened would possibly be the last time. Maybe that just here though.
 
NOsaintsfan said:
Say what???

Yeah, I'm just a med student but at the hospital where I rotate this would be a very big deal. As in I imagine the first time that happened would possibly be the last time. Maybe that just here though.
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I don't think it was that big of a deal. we were doing a bunch of blocks and he handed it to me before we started in case any patient needed sedation because he wouldn't have been able to grab it because he would have gloves on and was obviously sterile. At the end of a long day where no one needed sedation it was an honest mistake
 
southernhospitality12 said:
I don't think it was that big of a deal. we were doing a bunch of blocks and he handed it to me before we started in case any patient needed sedation because he wouldn't have been able to grab it because he would have gloves on and was obviously sterile. At the end of a long day where no one needed sedation it was an honest mistake
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OK I see. I was thinking he gave them to you and then later on you saw him in the locker room and was like oh yeah, here's your fentyl back. They keep a pretty good account of that kinda stuff where I am.
 
Just because something is legal doesn't mean that your state board of medicine or nursing or your employer or university can't hold you to a higher standard. For example, A state that I used to be licensed in required me to be compliant with all the laws of that state even when I am not in that jurisdiction.
So...Assuming the state board hasn't changed their rules, if I go on vacation to Colorado and use legal marijuana, extend my vacation to a legal Nevada Brothel, post to social media...I am subject to discipline of my state medical board.

Employers have discharged people for failing drug tests for individuals who were prescribed legal medical marijuana.
 
so I guess my next question is for residents and attendings: under what circumstances and conditions have doctors been drug tested by hospitals for a panel that includes marijuana after the initial pre employment screen? does it happen often at your institutions?
 
southernhospitality12 said:
at my institution residents lose things quite a bit and have to go pee in a cup...
Click to expand...

at many institutions this is reason enough to start drug testing. if you lose something once or twice, okay, maybe it's a mistake. but if residents (or anyone) are losing things "quite a bit" that causes SUSPICION. I wouldn't be surprised if there was a serious problem in the past, ie addiction or death, that involved a resident or attending "losing drugs" and now they've started a policy for people mishandling, losing, etc.

to answer you second question, I'm almost 100% positive that if you have to take a drug test, you get a full screen. if you're at a place that actively screens, it's best to "Pass on the Grass" and keep your job.
 
Doctor4Life1769 said:
Even for medicinal reasons?
That's like saying you can get fired for having an amphetamine in your system, when you've been prescribed adderall for a medical condition.

:lame:
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This is what I don't get. If you are prescribed adderall (and A LOT of people have scripts for this), medical marijuana, opiates for pain, even xanax or valium, etc, how do you get around this? I know of physicians who have legitimate scripts to all the drugs mentioned (but not in anesthesia and not residents). One of the major reasons I'm applying into anesthesia is because I have a chronic back pain condition and I can't stand for long periods of time (ruling out surgery, but I love the OR). I can't imagine having something like this hanging over my head if my employer reserves the right to terminate me based on a random or unwarranted test.

If the point of doing drug testing is to make sure people are not abusing narcotics used in the hospital, then why include other drugs beyond the pre-employment screening? If they are really concerned about people abusing narcotics, then why include urine marijuana which can be detected for months after use (as opposed to blood testing for it which detects use up to 24 hrs) when the actual drugs we all should be concerned about (opiates, meth, cocaine, benzos) can only be detected for a couple days after use? I have also read of hospitals testing for nicotine as well which is absolutely ridiculous. To me its borderline discriminatory... which is why I'm asking what the real world practice of drug testing with hospitals is like.
 
southernhospitality12 said:
This is what I don't get. If you are prescribed adderall (and A LOT of people have scripts for this), medical marijuana, opiates for pain, even xanax or valium, etc, how do you get around this? I know of physicians who have legitimate scripts to all the drugs mentioned (but not in anesthesia and not residents). One of the major reasons I'm applying into anesthesia is because I have a chronic back pain condition and I can't stand for long periods of time (ruling out surgery, but I love the OR). I can't imagine having something like this hanging over my head if my employer reserves the right to terminate me based on a random or unwarranted test.

If the point of doing drug testing is to make sure people are not abusing narcotics used in the hospital, then why include other drugs beyond the pre-employment screening? If they are really concerned about people abusing narcotics, then why include urine marijuana which can be detected for months after use (as opposed to blood testing for it which detects use up to 24 hrs) when the actual drugs we all should be concerned about (opiates, meth, cocaine, benzos) can only be detected for a couple days after use? I have also read of hospitals testing for nicotine as well which is absolutely ridiculous. To me its borderline discriminatory... which is why I'm asking what the real world practice of drug testing with hospitals is like.
Click to expand...

Depends on the hospital's policy.
I'm sure there's plenty of residents on adderall, some of which are alson likely anesthesia residents.
You tell them straight up that you have a script, provide the pill bottle as proof, and piss away. You're screwed if you are taking a controlled substance without a rx. I'm not sure how the medical marijuana plays into all this
 
I've only ever peed in a cup for life insurance. Never for work.

I don't even drink so it's never been an issue.
 
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southernhospitality12 said:
This is what I don't get. If you are prescribed adderall (and A LOT of people have scripts for this), medical marijuana, opiates for pain, even xanax or valium, etc, how do you get around this? I know of physicians who have legitimate scripts to all the drugs mentioned (but not in anesthesia and not residents). One of the major reasons I'm applying into anesthesia is because I have a chronic back pain condition and I can't stand for long periods of time (ruling out surgery, but I love the OR). I can't imagine having something like this hanging over my head if my employer reserves the right to terminate me based on a random or unwarranted test.
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If you are using any schedule II/III substances, or foresee the need to (based on pain levels), find a different "sitting" specialty (ophthalmology, for example). One shouldn't hire an ex-alcoholic as bartender, regardless how many urine tests are negative.

If the point of doing drug testing is to make sure people are not abusing narcotics used in the hospital, then why include other drugs beyond the pre-employment screening? If they are really concerned about people abusing narcotics, then why include urine marijuana which can be detected for months after use (as opposed to blood testing for it which detects use up to 24 hrs) when the actual drugs we all should be concerned about (opiates, meth, cocaine, benzos) can only be detected for a couple days after use? I have also read of hospitals testing for nicotine as well which is absolutely ridiculous. To me its borderline discriminatory... which is why I'm asking what the real world practice of drug testing with hospitals is like.
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I think they don't want people to be under the influence of illegal drugs at any time (goes to character) and of legal psychotropic drugs during work (goes to safety and liability). I find it acceptable, as long as after a number of negative tests I become a "trusted" individual, and I am excused from accounting for every minor waste, for example.
 
Doctor4Life1769 said:
Depends on the hospital's policy.
I'm sure there's plenty of residents on adderall, some of which are alson likely anesthesia residents.
You tell them straight up that you have a script, provide the pill bottle as proof, and piss away. You're screwed if you are taking a controlled substance without a rx. I'm not sure how the medical marijuana plays into all this
Click to expand...
Stimulants are one thing. But I am sure any anesthesia provider (or pharmacist) on prescribed opiates/benzos would enjoy a much higher level of supervision.

You have pain? Use NSAIDs, pain procedures etc. You nervous? Use non-selective beta-blockers. If you need psychotropic agents, just stay away from this specialty. Sooner or later it will bite you in some way.
 
All employee drug panels around here are standard panels. Any drug test your given for whatever reason will turn up THC, whatever the reason for the test.
 
I thought every American's right to smoke weed was also in the second amendment.
 
FFP said:
If you are using any schedule II/III substances, or foresee the need to (based on pain levels), find a different "sitting" specialty (ophthalmology, for example). One shouldn't hire an ex-alcoholic as bartender, regardless how many urine tests are negative.

.
Click to expand...

Or schedule I.

I strongly agree about considering a different specialty if you have a propensity to use these substances. For your own well-being. The access is too easy and frequent. And despite all the systems that are in place, the accounting is so loose that any motivated individual could divert a large amount of drugs without detection.
 
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Yeah, your DEA license is a federal license and they hold you to abide by federal laws. Any state laws are overruled on the federal level.
 
Consigliere said:
Dude.....just stop smoking weed for a little while and pass your damn drug test. Shouldn't be that hard.
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Exactly.

FFP said:
I thought every American's right to smoke weed was also in the second amendment.
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74c6d56995ba5337ee98608c7d9cf9f1.400x300x26.gif
 
Consigliere said:
Dude.....just stop smoking weed for a little while and pass your damn drug test. Shouldn't be that hard.
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pre employment screening is fine and everyone should be able to show they can pass a scheduled test

My concern is if a program tests randomly or does an unscheduled test later in residency, it pops up because the test can be effective after months, and then boom they lay the hammer.

That said, I have strong views on how hospitals or organizations choose to dictate what employees do when they aren't at work. This would apply even when employees are on vacation or somewhere where the use is acceptable
 
southernhospitality12 said:
pre employment screening is fine and everyone should be able to show they can pass a scheduled test

My concern is if a program tests randomly or does an unscheduled test later in residency, it pops up because the test can be effective after months, and then boom they lay the hammer.

That said, I have strong views on how hospitals or organizations choose to dictate what employees do when they aren't at work. This would apply even when employees are on vacation or somewhere where the use is acceptable
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You can have whatever views you want about anything you want.

If you want to work at a hospital and keep your medical lisense don't get cought smoking weed.
 
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southernhospitality12 said:
so I guess my next question is for residents and attendings: under what circumstances and conditions have doctors been drug tested by hospitals for a panel that includes marijuana after the initial pre employment screen? does it happen often at your institutions?
Click to expand...

I had to do a urine drug test for my fellowship at a private hospital. I did not have to do one for my subsequent employment with a private practice group. The screening place was a joke, by the way. They let me take my purse into the bathroom with me and didn't color the toilet bowl water blue or examine it before flushing and the sink wasn't taped off. I had one done for a summer internship years ago that made it difficult to get around the test, apparently there isn't much quality control between screening sites.
 
NOsaintsfan said:
You can have whatever views you want about anything you want.

If you want to work at at hospital and keep your medical lisense don't get cought smoking weed.
Click to expand...

This.....This is America and you can do whatever you want to do, but be ready for the consequence

@southernhospitality12 To sum things up for you, if you really think you need to smoke marijuana then you should ask whoever you're going to work for prior to taking the job what the policy on drug testing is. bear in mind, you asking them may be a red flag for them to not hire you, as most hospitals (and many organizations) are "Drug Free Environments". That doesn't only mean you can't light up on the premises, but also they don't want their employees using. Yes, most just do the initial test and are done with it, but as you and others have stated, this is Anesthesiology, where the most common reason for abuse/addiction is ease of access. (I don't care what policy your pharmacy has in place because you can get around it).

The more you ask on SDN, you're just going to get 100 different opinions from many people who A) don't use B) work in places where they don't randomly screen
 
southernhospitality12 said:
pre employment screening is fine and everyone should be able to show they can pass a scheduled test

My concern is if a program tests randomly or does an unscheduled test later in residency, it pops up because the test can be effective after months, and then boom they lay the hammer.

That said, I have strong views on how hospitals or organizations choose to dictate what employees do when they aren't at work. This would apply even when employees are on vacation or somewhere where the use is acceptable
Click to expand...

I just wanted to add that I'm not judging you or anyone else for what you do when you're not working. It's just that the current reality is if you fail a drug test for THC its gonna be an issue pretty much with any hospital or employer. That's just the world we live in. Nobody said it was fair.

If you want to spear head the issue of getting marijuana accepted similarly to EtOH in regard to off duty use then go for it. If you are successful then I think many will applaud you if not publicly then privately for sure.
 
southernhospitality12 said:
That said, I have strong views on how hospitals or organizations choose to dictate what employees do when they aren't at work. This would apply even when employees are on vacation or somewhere where the use is acceptable
Click to expand...

You seem unable to grasp some things that are obvious or apparent to those of us who have been in the field even a fairly short period of time.

Anesthesiology, in general, for better or worse, has a relatively high incidence of impaired providers from any number of legal or illegal substances. In my many years of practice, I have known a number of anesthesia providers of all types that have either A) become addicted to a variety of readily-available anesthesia drugs, usually fentanyl or more recently propofol, or B) died from a drug overdose, again, usually fentanyl or propofol.

Your apparent view that smoking marijuana is somehow your right will raise huge red flags from an employer or potential residency, even in states where use of marijuana may be legal from some dubious standpoint. You would not be worth the potential risk IMHO. Just calling it like I see it...
 
jwk said:
You seem unable to grasp some things that are obvious or apparent to those of us who have been in the field even a fairly short period of time.

Anesthesiology, in general, for better or worse, has a relatively high incidence of impaired providers from any number of legal or illegal substances. In my many years of practice, I have known a number of anesthesia providers of all types that have either A) become addicted to a variety of readily-available anesthesia drugs, usually fentanyl or more recently propofol, or B) died from a drug overdose, again, usually fentanyl or propofol.

Your apparent view that smoking marijuana is somehow your right will raise huge red flags from an employer or potential residency, even in states where use of marijuana may be legal from some dubious standpoint. You would not be worth the potential risk IMHO. Just calling it like I see it...
Click to expand...
nobody is talking about taking fentanyl or propofol or taking any drug that can be found in a hospital or pharmacy...if you genuinely think that marijuana use predisposes people to narcotic drug use (i.e. gateway theory), then I can happily pm you some studies and literature on the subject. Alcohol is actually THE gateway drug that you describe and that idea of marijuana being a gateway drug has been disproven over and over again, but I digress...

I did not want the thread to be an opinion of who thinks what is right etc. I have a card for it and that should be enough just like any other prescription. I do not want to disclose this to residency programs before the match so I am in a tough spot. If I show signs of being a drug user or people suspect I am stealing drugs at the hospital, ok test me, but is this what programs do? All I want to know is under what circumstances programs will ask for a piss test based on what people have experienced? thats all.
 
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southernhospitality12 said:
nobody is talking about taking fentanyl or propofol or taking any drug that can be found in a hospital or pharmacy...if you genuinely think that marijuana use predisposes people to narcotic drug use (i.e. gateway theory), then I can happily pm you some studies and literature on the subject. Alcohol is actually THE gateway drug that you describe and that idea of marijuana being a gateway drug has been disproven over and over again, but I digress...

I did not want the thread to be an opinion of who thinks what is right etc. I have a card for it and that should be enough just like any other prescription. I do not want to disclose this to residency programs before the match so I am in a tough spot. If I show signs of being a drug user or people suspect I am stealing drugs at the hospital, ok test me, but is this what programs do? All I want to know is under what circumstances programs will ask for a piss test based on what people have experienced? thats all.
Click to expand...

Some programs test. Some don't. That's the answer.

Many do pre-employment testing. If you give a program a reason to test, then you will be tested.
 
southernhospitality12 said:
nobody is talking about taking fentanyl or propofol or taking any drug that can be found in a hospital or pharmacy...if you genuinely think that marijuana use predisposes people to narcotic drug use (i.e. gateway theory), then I can happily pm you some studies and literature on the subject. Alcohol is actually THE gateway drug that you describe and that idea of marijuana being a gateway drug has been disproven over and over again, but I digress...

I did not want the thread to be an opinion of who thinks what is right etc. I have a card for it and that should be enough just like any other prescription. I do not want to disclose this to residency programs before the match so I am in a tough spot. All I want to know is under what circumstances programs will ask for a piss test based on what people have experienced, thats all.
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Your question was answered in the first few posts, yet you continue to want more and more specific details. Again, speaking as someone who has done this for a long time, those kinds of questions raise red flags for us older farts, the kind that you are likely to meet along the way that can determine your future. If I had a new employee or a new doc coming into our practice, and he's all over wanting to know specifics about when or how he can be drug tested, do you not see why that might be a concern?

We do a drug screen upon hiring. When you come to the office and fill out your employment paperwork, we hand you the lab request and tell you to get it done in the next few days. At ANY time during your period of employment with our practice, with reasonable concern by a physician partner in the group, any employee or physician is subject to an immediate drug screen. Refusal is grounds for immediate termination. Before you worry about your rights (as an employee-at-will, and absent a contract to the contrary, you have none anyway), I can tell you that this is a rare event - it's been done perhaps three times in the 20+ years I've been here, all three times for cause.

I'm not up-to-speed on drug screens because I don't dabble in anything that would cause me concern. I have no idea how quickly any substances that might be tested for will clear from your system - again, just not something I have need to worry about. If THC takes "months" to clear, then likely your drug screen will show up positive, and you're going to have to explain that to someone. I doubt that is something you can keep from disclosing, at least with the person who will make the decision if they hire/keep you.

I'm just telling you the perspective from the employer/administrative side of things. We don't want even a HINT of an impaired provider, for whatever reason, under any circumstances, for any drug, legal or illegal.
 
jwk said:
We do a drug screen upon hiring. When you come to the office and fill out your employment paperwork, we hand you the lab request and tell you to get it done in the next few days. At ANY time during your period of employment with our practice, with reasonable concern by a physician partner in the group, any employee or physician is subject to an immediate drug screen. Refusal is grounds for immediate termination. Before you worry about your rights (as an employee-at-will, and absent a contract to the contrary, you have none anyway), I can tell you that this is a rare event - it's been done perhaps three times in the 20+ years I've been here, all three times for cause.
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This is the exact type of answer I was looking for

Thank you
 
southernhospitality12 said:
This is the exact type of answer I was looking for

Thank you
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If what jwk wrote wasnt common sense to you then that's a red flag.

No one should have to tell you that.

Anyone who has ever been employed anywhere in the USA should know that. That isn't specific to the medical field.

Just sayin.
 
southernhospitality12 said:
nobody is talking about taking fentanyl or propofol or taking any drug that can be found in a hospital or pharmacy...if you genuinely think that marijuana use predisposes people to narcotic drug use (i.e. gateway theory), then I can happily pm you some studies and literature on the subject. Alcohol is actually THE gateway drug that you describe and that idea of marijuana being a gateway drug has been disproven over and over again, but I digress...
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Actually the most abused drug that gives (physiologic) dependence is sugar. People who cannot abstain even from it will have a very hard time with anything else.
 
NOsaintsfan said:
If what jwk wrote wasnt common sense to you then that's a red flag.

No one should have to tell you that.

Anyone who has ever been employed anywhere in the USA should know that. That isn't specific to the medical field.

Just sayin.
Click to expand...
The land of the free is anything but free. 😉
 
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