Pre-employment Drug Testing

[DarknightX]

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lol, I wish when we hired someone we could know if they went onto the internet and randomly asked about drug testing. Because the only people who ask anonymously about drug testing are drug addicts and people on lots of cross-reacting medications. And no offense personally to people in the latter group, but a lot of them can be hell to work with as colleagues.

Right...because if someone smokes some weed once a week or so, that makes them a drug addict.

By that same logic, someone who has a glass of wine every night is an alcoholic.

 

[JaggerPlate]

The hospital could be a private entity that 'just happens' to have a Medicare funded residency program. There's your loophole.

Hmm, I'm not sure if it works this way. Seems like the gov would be pretty stern about 'if you get our money, you're federally affiliated' and would be recognized as such.

Again though, building this argument up or ripping it down would be the job of JDs, not me and my assumptions.

 

[Rendar5]

lol, I wish when we hired someone we could know if they went onto the internet and randomly asked about drug testing. Because the only people who ask anonymously about drug testing are drug addicts and people on lots of cross-reacting medications. And no offense personally to people in the latter group, but a lot of them can be hell to work with as colleagues.

yeah, those people with seasonal allergies are a pain in the ass to work alongside.

 

[LifetimeDoc]

If they test me for caffeine abuse, I'm so fired!

 

[Law2Doc]

Hmm, I'm not sure if it works this way. Seems like the gov would be pretty stern about 'if you get our money, you're federally affiliated' and would be recognized as such.

Again though, building this argument up or ripping it down would be the job of JDs, not me and my assumptions.

You are right, it doesn't work this way. If you use federal funds, that's pretty much the end of the story.

 

[McGillGrad]

You are right, it doesn't work this way. If you use federal funds, that's pretty much the end of the story.

As much as I respect your background in law, as a doctor, you may not always be current in your legal theory.

The Cleveland Clinic has been rescinding resident contracts since 2007.

To take further steps in preserving and improving the health of all
its employees and patients, Cleveland Clinic has recently
implemented a nonsmoking hiring policy requiring all job
applicants and individuals receiving appointments to take a
cotinine test during their pre-placement physical exam. This is a
pre-employment test only. The cotinine test will detect the
presence of nicotine in all forms of tobacco. Beginning
September 1, 2007, appointments that have been offered to
prospective residents and fellows who test positive will be
rescinded. Individuals who test positive will receive a referral to a
tobacco cessation program paid for by Cleveland Clinic. Those
individuals testing positive who test negative after 90 days may be
reconsidered for appointment at the discretion of the program
director should the residency position remain vacant.

 

[LifetimeDoc]

As much as I respect your background in law, as a doctor, you may not always be current in your legal theory.

The Cleveland Clinic has been rescinding resident contracts since 2007.

http://my.clevelandclinic.org/Documents/Urology/Non-Smoking_Hiring_Statement.pdf

While on the interview trail, I had a residency tell me the same thing. They would test us for cotine and would force us to do smoking cessation for 90 days without pay, and if we failed a second time we would be fired. Not sure if it's legal to do so, but what is a resident to do? Fight it and risk never getting a residency again? Just because you are right and win a legal battle doesn't mean you will ever work again.

 

[235750]

I think you are basing your conclusions on arguments that also aren't defensible...This argument has everything to do with government subsidization, which absolutely includes Medicare subsidization.

Like aPD, I too lack a JD, but this is the internet, so why would ignorance stop me from contributing my thoughts? 🙂

To use aPD's example of PETA again, they are a non-profit, so they avoid millions of dollars in taxes each year. I don't think it's crazy then to claim that we as tax payers all pay for PETA. A tax break is a sort of subsidy, no?

And I can think of other examples where my freedom of choice was restricted in the name of employment, and where my employment was at least partially funded by the government. I worked at a clinic years ago that provided abortions as one of it's many services. All employees had to be pro-choice for obvious reasons. We absolutely received state funds, although not very much. And really, if you think about it, every work force requires you to be 'pro' whatever your business is. I mean, I'm not sure if Jehovah's Witnesses vs. Kwick-y Blood Transfusions Ltd. would end well for said church. So, if you can restrict certain types of thoughts, it would seem you could restrict behaviour as well

Also, I too was tested for cigarette use years ago at a research firm where 100% of our funding came through gov't contracts or grants. What they told us was that tobacco usage led to a lot of morbidity that adversely effected productivity (sick days, etc), and their concern was appropriately using gov't money, so no more ciggies. Kind of reminded me of all those letters you get from your bank saying "go green! get your statement online" when you know in fact they don't give two ****s about the environment, and just want to pocket the money saved without giving anything back to you as a customer.

Still, the loss of productivity made sense to me, but as Jagger points out, that does seem like a great segue into restricting more freedoms.

Law is fascinating stuff, why'd you give it up Law2doc? 🙂

 

[jdh71]

Right...because if someone smokes some weed once a week or so, that makes them a drug addict.

By that same logic, someone who has a glass of wine every night is an alcoholic.

Which is entirely true. Which brings up a question in my mind, could we say the same thing about someone who uses cocaine once a week? But while your point is well taken. It's still illegal and even if it wasn't depending on your state board, they might still not grant you a license if you partake. It's just better to abstain. It's not fair, but you make some choices when you become a doctor. Hell, getting to a bar fight and arrested can be a problem for licensing. It's all a little paternalistic, but you can't fight city hall.

 

[JaggerPlate]

You are right, it doesn't work this way. If you use federal funds, that's pretty much the end of the story.

I should practice a little law on the side ... my shoot from the hip conclusions are 2/2 in this thread.

 

[Law2Doc]

...
And I can think of other examples where my freedom of choice was restricted in the name of employment, and where my employment was at least partially funded by the government. I worked at a clinic years ago that provided abortions as one of it's many services. All employees had to be pro-choice for obvious reasons. We absolutely received state funds, although not very much. And really, if you think about it, every work force requires you to be 'pro' whatever your business is. I mean, I'm not sure if Jehovah's Witnesses vs. Kwick-y Blood Transfusions Ltd. would end well for said church. So, if you can restrict certain types of thoughts, it would seem you could restrict behaviour as well...

You are mixing "at work" behavior and "your own time" behavior. An entity can absolutely put restrictions on what you can do or espouse while at work. They really are going to have a tough time legally dictating what you can do away from work. So you can be anti-abortion on your own time so long as you have no problem doing them at work (if you work for an entity that performs them), or try to talk patients out of them, etc. Or you can refuse blood transfusions for yourself as a Jehovah's Witness but as long as you are willing to encourage and give transfusions at work it won't be a problem. Actually this is a much stronger argument than the one regarding smoking because freedom of religious views is a constitutionally explicit right, so it's going to be a slam dunk that an entity trying to ban these views outside of work in your spare time is going to lose, although in most cases they are able to dictate how you conduct yourself during the hours of your employment.

 

[Law2Doc]

As much as I respect your background in law, as a doctor, you may not always be current in your legal theory.

The Cleveland Clinic has been rescinding resident contracts since 2007.

http://my.clevelandclinic.org/Documents/Urology/Non-Smoking_Hiring_Statement.pdf

Again, I don't doubt that they put this into their contract, or even that they try to follow through with it. I do however doubt that if actually brought to court they would prevail. Lots of people put things into contracts that they have no right to require. That doesn't mean they will win in court if tested. I'm suggesting that this is a good example of something that someone with lots of time and money (something most residents don't have) could prevail on if they were willing to take it through the court system. It will be tested eventually, either for smoking or when some entity chooses to impose additional restrictions that people feel more strongly about (premarital sex, gambling, tattoos, etc.).

 

[LifetimeDoc]

Again, I don't doubt that they put this into their contract, or even that they try to follow through with it. I do however doubt that if actually brought to court they would prevail. Lots of people put things into contracts that they have no right to require. That doesn't mean they will win in court if tested. I'm suggesting that this is a good example of something that someone with lots of time and money (something most residents don't have) could prevail on if they were willing to take it through the court system. It will be tested eventually, either for smoking or when some entity chooses to impose additional restrictions that people feel more strongly about (premarital sex, gambling, tattoos, etc.).

But if you win, will you still want to work at that residency being known as the person that "causes trouble"? What about getting another residency? Your career would be over or at least taken down many notches. No?

 

[gutonc]

But if you win, will you still want to work at that residency being known as the person that "causes trouble"? What about getting another residency? Your career would be over or at least taken down many notches. No?

That's what they're counting on. That we're all so cowed by the risk of having to leave that program and not get another spot that nobody is willing to rock the boat and challenge them on this bull****. The fact that CCF (an IMG-heavy program) is one of the main places pushing this, clinches it for me.

 

[McGillGrad]

That's what they're counting on. That we're all so cowed by the risk of having to leave that program and not get another spot that nobody is willing to rock the boat and challenge them on this bull****. The fact that CCF (an IMG-heavy program) is one of the main places pushing this, clinches it for me.

What kind of fool fights a program that pushes for non-smoking doctors? Alcohol is one thing, but smoking is 100% negative, in every possible way for the person and those whom he surrounds.

You would sound like those inbred yokles that make fun of the first lady for trying to help kids read or eat healthy.

 

[235750]

You are mixing "at work" behavior and "your own time" behavior. An entity can absolutely put restrictions on what you can do or espouse while at work. They really are going to have a tough time legally dictating what you can do away from work.

I don't think it's as clear cut as you make it. Like I said, I have no legal background, but I do read the news

What about the teachers who have been fired for having making legal adult films years before they were teachers? Or that woman who was fired for innocent pictures of her drinking alcohol on vacation? And I think some Utah college basketball player (working for his full-ride scholarship) was punished for having premarital sex recently.

And the woman who stated abortornot.com, a website to vote on her decision for her own reproductive choice, was fired for being a "grave threat to the reputation of the company" despite the fact that all her activity took place after work. They also forbid all of their current employees from being friends with her on social networking sites.

This all seems unfair, but it does not seem unprecedented to restrict employee behavior outside of work, at least it seems to be norm right now.

A spokeswoman for the U.S. Equal Employment Opportunity Commission said they saw "no problem" with not hiring smokers from where the federal government is concerned. Now, of course the federal government can be wrong, but the fact that they won't challenge it is an indicator of the current interpretation of the 4th amendment.

Many states have made legislation to specifically protect smokers. Only a handful go so far as to have law that protect people who "engage in lawful activity or use legal products outside the workplace".

The EEOC spokesperson did specify that the testing could only take place after the job offer was made.

http://www.ama-assn.org/amednews/2011/04/04/bisd0405.htm

 

[MrBurns10]

I don't think it's as clear cut as you make it. Like I said, I have no legal background, but I do read the news

What about the teachers who have been fired for having making legal adult films years before they were teachers? Or that woman who was fired for innocent pictures of her drinking alcohol on vacation? And I think some Utah college basketball player (working for his full-ride scholarship) was punished for having premarital sex recently.

And the woman who stated abortornot.com, a website to vote on her decision for her own reproductive choice, was fired for being a "grave threat to the reputation of the company" despite the fact that all her activity took place after work. They also forbid all of their current employees from being friends with her on social networking sites.

This all seems unfair, but it does not seem unprecedented to restrict employee behavior outside of work, at least it seems to be norm right now.

A spokeswoman for the U.S. Equal Employment Opportunity Commission said they saw "no problem" with not hiring smokers from where the federal government is concerned. Now, of course the federal government can be wrong, but the fact that they won't challenge it is an indicator of the current interpretation of the 4th amendment.

Many states have made legislation to specifically protect smokers. Only a handful go so far as to have law that protect people who "engage in lawful activity or use legal products outside the workplace".

The EEOC spokesperson did specify that the testing could only take place after the job offer was made.

http://www.ama-assn.org/amednews/2011/04/04/bisd0405.htm

I'm not familiar with most of your examples, but it seems to me just reading your brief descriptions of them that it was determined their activities were felt to be potential detriments to the companies' reputations. That can almost always be a cause for firing.

As for the BYU basketball player, that's a different situation entirely. He broke the honor code. Granted almost all of us who aren't Mormon would have broken the BYU honor code before we even got to campus, but that's not the point. He signed his name stating he would uphold the code, and he didn't. They had every right to suspend him.

 

[235750]

I'm not familiar with most of your examples, but it seems to me just reading your brief descriptions of them that it was determined their activities were felt to be potential detriments to the companies' reputations. That can almost always be a cause for firing.

Right, and you agree that those activities happened outside of work hours.

 

[MrBurns10]

Right, and you agree that those activities happened outside of work hours.

Ah, you know, I didn't notice the quote to which you were responding, so I didn't quite get your point. I agree with you.

 

[Law2Doc]

I don't think it's as clear cut as you make it. Like I said, I have no legal background, but I do read the news...

Yeah, see the problem is you are reading "the news" and not the law here. Companies can make up "rules" and even fire people based on those rules. That DOESN'T mean these will hold up in court. The examples you cited were news stories about folks being fired, but do not reflect the end result if and when they decided to push the case through our court system. That I am able to fire someone today doesn't mean I'm not going to be liable to them 3 years from now when a high court ultimately determines I had no right to fire them. That a resident won't have the funds to push a case up through the court system any more than a former porn star is what some of these employers are counting on. But that doesn't mean their actions are supportable under the laws of the US.

 

[235750]

Yeah, see the problem is you are reading "the news" and not the law here.

Fair enough!! I take it though that the federal government reads the law, and their opinion seems to carry some weight in how our constitution is upheld.

Your view, that companies cannot regulate private behaviour, doesn't seem to be the view shared by the government or private companies at this moment. But I share your concern that it does seem contrary to our laws (if it's legal, why can't I do it??). All I'm saying is, there seems to be some precedent on this issue

That I am able to fire someone today doesn't mean I'm not going to be liable to them 3 years from now when a high court ultimately determines I had no right to fire them.

For the record, several of those stories were from 5 years ago, and the porn actress for example has lost every appeal since then. But you're right, maybe the tide will turn completely in the years to come.

But in the mean time, it does appear that the Cleveland clinic is in very good company.

Also thanks LAw2Doc for responding to me, I apologize if I come off rude. I just enjoy the stimulating conversation; it is also fun to talk to a lawyer without paying the big $$$ 🙂

 

[Law2Doc]

...
For the record, several of those stories were from 5 years ago, and the porn actress for example has lost every appeal since then. ...

Um no. If you google it, she opted not to appeal. That's hardly the same as losing every appeal.

In fact her story is still to be determined because according to wiki, instead of pursuing her rights in court, she simply moved to a new state, got another teaching job, and only just got fired again last month.

 

[NotAProgDirector]

I realize this is only one case:

http://www.masslive.com/news/index.ssf/2009/08/federal_judge_tosses_suit_of_m.html

.... and is woefully lacking in details. Still, it appears that the guy was fired for smoking off hours, sued, and lost. It appears that he sued mainly as a privacy issue. This has nothing to do with a gov't position, so perhaps the rules would be different.

 

[235750]

Um no. If you google it, she opted not to appeal. That's hardly the same as losing every appeal.

In fact her story is still to be determined because according to wiki, instead of pursuing her rights in court, she simply moved to a new state, got another teaching job, and only just got fired again last month.

Ok. According to foxnews they said she did appeal, but lost. Maybe she withdrew then, or maybe fox is full of it. I know I trust wiki over fox news any day!

But if she got fired again...in another state too...that would seem to be congruent with the trend I was describing, and with official view of the federal gov't.

I sense some hostility so I'll leave it at that. No offense intended. Thanks again for the interesting back and forth

 

[Apollyon]

but smoking is 100% negative, in every possible way for the person

Not 100% - ulcerative colitis is improved with smoking.

It's just that you make it black letter, but it isn't.

 

[McGillGrad]

Not 100% - ulcerative colitis is improved with smoking.

It's just that you make it black letter, but it isn't.

Yes, 100%. SMOKING is 100% negative. Nicotine is the word you are searching for. Nicotine (which is found in cigarette smoke but is easily found in other forms) improves UC.

It's like saying automotive exhaust is helpful to trees because it contains Carbon Dioxide.

 

[Apollyon]

Yes, 100%. SMOKING is 100% negative. Nicotine is the word you are searching for. Nicotine (which is found in cigarette smoke but is easily found in other forms) improves UC.

It's like saying automotive exhaust is helpful to trees because it contains Carbon Dioxide.

No, not 100%. Ipso facto. 99%+? Yes. However, your black-letter statement is incorrect. That is all. You are quibbling. Alternatively, these unfortunate people can chew the gum or use the inhaler delivery systems. However, your strident 100% statement is factually incorrect.

You support your point by your example. Again, it's not 100% - internal combustion exhaust products are polluting, but the CO2 does benefit the trees.

 

[McGillGrad]

No, not 100%. Ipso facto. 99%+? Yes. However, your black-letter statement is incorrect. That is all. You are quibbling. Alternatively, these unfortunate people can chew the gum or use the inhaler delivery systems. However, your strident 100% statement is factually incorrect.

You support your point by your example. Again, it's not 100% - internal combustion exhaust products are polluting, but the CO2 does benefit the trees.

I find it amusing that 99.99% is okay but 100% is patently false.

As an aside, nothing in the universe is factually 100% true. Even [fill in Latin legal phrase to look spiffy on the internet].😉

 

[Apollyon]

I find it amusing that 99.99% is okay but 100% is patently false.

As an aside, nothing in the universe is factually 100% true.

What about death? I tell patients that not even taxes are 100% - some US states have no income tax, and some tiny European nations have no taxes at all, but 100% of people will die sometime in their lives.

In the universe, as things stand now, we can only prove that human life exists while biologically living in a corporeal, physical body. And, to this date, no human has been born that hasn't yet died; that is not to say that it is happening right now, but hasn't been detected up to this time. There are hydras and cancer cells that appear immortal, but humans - all have died that were ever born, excluding those currently living.

My only point is you stated 100%, invariably, stridently, and unwavering. My response is a well-known point; it is not some miracle or fluke or nonreproducible finding.

 

[LifetimeDoc]

I find it amusing that 99.99% is okay but 100% is patently false.

As an aside, nothing in the universe is factually 100% true. Even [fill in Latin legal phrase to look spiffy on the internet].😉

Maybe he's including those extremely rare, few people that are lucky and don't suffer the diseases associated with smoking. Take my mom for example, 70 years old, 120+ pack years, clear chest x-ray, no health problems other than some age related osteoarthritis. Good genes, she got very lucky.

Besides, back to the original topic, tobacco use (and OTC nicotine products) are perfectly legal in this country. I don't see how a company that is public can get away with, if tested in court, arbitrarily making selection rules. This person smokes, they are too fat, they have a beard, they're gay, they're a woman, they're black, this person drinks socially.

Anyways, we are focusing on a special population, residents. We've gone through the match, we've followed the law, we don't have any DUIs, arrests, drug abuse, records that indicate we've cheated or are a person that is not to be trusted. Then they slap on a test and say, oh wait...we don't like smokers, you'll be fired if we find out you are doing something legal that we don't want, and then you'll never get another residency again. Mmmm, something not right there.

 

[lipomas]

Right...because if someone smokes some weed once a week or so, that makes them a drug addict.

By that same logic, someone who has a glass of wine every night is an alcoholic.

It makes them a drug addict if they are willing to risk their future to get high. If they are willing to risk this or unable to see the consequences, then that puts you at high risk for future problems with drug or alcohol abuse. Just ask a malpractice company if you doubt this. And there are certain professions where if you have a glass of wine every night you are considered an alcoholic.

That is the point. If you can't lay off the dope for a year while you're working hard to get a job, then you are a drug addict, plain and simple. I don't care whether you "technically" are or not. I have zero sympathy for you if you fail a pre-employment drug test because of pot, unless you have a truly legitimate reason which is unlikely. What a joke.

The seasonal allergy argument is a non-starter and a distractor.

 

[jdh71]

It makes them a drug addict if they are willing to risk their future to get high. If they are willing to risk this or unable to see the consequences, then that puts you at high risk for future problems with drug or alcohol abuse. Just ask a malpractice company if you doubt this. And there are certain professions where if you have a glass of wine every night you are considered an alcoholic.

That is the point. If you can't lay off the dope for a year while you're working hard to get a job, then you are a drug addict, plain and simple. I don't care whether you "technically" are or not. I have zero sympathy for you if you fail a pre-employment drug test because of pot, unless you have a truly legitimate reason which is unlikely. What a joke.

The seasonal allergy argument is a non-starter and a distractor.

DarknightX,

See? Your question is irrelevant as long as people like lipomas exist and sit on medical boards.

Though he does have a point, if you can't lay off for awhile, it might be a good idea to consider it more of a problem than anything else.

 

[DarknightX]

It makes them a drug addict if they are willing to risk their future to get high. If they are willing to risk this or unable to see the consequences, then that puts you at high risk for future problems with drug or alcohol abuse. Just ask a malpractice company if you doubt this. And there are certain professions where if you have a glass of wine every night you are considered an alcoholic.

That is the point. If you can't lay off the dope for a year while you're working hard to get a job, then you are a drug addict, plain and simple. I don't care whether you "technically" are or not. I have zero sympathy for you if you fail a pre-employment drug test because of pot, unless you have a truly legitimate reason which is unlikely. What a joke.

The seasonal allergy argument is a non-starter and a distractor.

Dude that stick is far up your ***** it's coming out of your mouth.

I'm going on vacation the month before I start residency, and wanted to know how much "fun" I could actually have without endangering my employment. I just wanted to know if programs can drug test without explicitly telling you beforehand, which Law2Doc graciously answered.

Obviously, I'm not willing to risk my future to get high, which is why I'm here asking. I have no idea how that makes me a drug addict. Now that I know whats going on, I'll make sure not to touch anything.

 

[Rendar5]

.

 

[lipomas]

Dude that stick is far up your ***** it's coming out of your mouth.

I'm going on vacation the month before I start residency, and wanted to know how much "fun" I could actually have without endangering my employment. I just wanted to know if programs can drug test without explicitly telling you beforehand, which Law2Doc graciously answered.

I don't get high regularly and I don't drink, period. Alcohol just isn't my thing...I'd much rather smoke some weed. Obviously, I'm not willing to risk my future to get high, which is why I'm here asking. I have no idea how that makes me a drug addict. Now that I know whats going on, I'll make sure not to touch anything.

That's all well and good - but you are still at a much higher risk of committing malpractice than I am. Because you do drugs. And I am capable of having "fun" without subjecting my body to crap like pot. Maybe you can limit your drug use to occasional pot. But many can't. What if you then decide it isn't hurting anyone if you start doing opioids? The fact that you don't drink is good for you but doesn't really matter either. And forget the mental issues that come with doing drugs - what about the legal issues? What if you get arrested? Cited? Is it worth it to you to deal with licensing because of that?

The truth of the matter is that I don't really care what you do in your personal life. But that isn't important to anyone else. Having these rules out there is not to prevent people from having fun. It's to prevent people from harming patients. You can present me with all the anecdotes you want about successful physicians who have a drug habit and have never harmed anyone, but there will always be more anecdotes about physicians who accidentally harmed someone either directly or indirectly because of drugs. Just think about that before you consider how wonderful it is to get high. We all have our demons and challenges in life. I'm sure I do things or have done things that you don't like. Heck, I have a one year old at home and sometimes it makes it harder to focus on work because of something going on. Maybe parents shouldn't be doctors either!

 

[Rendar5]

...wow, another successful graduate of D.A.R.E.

 

[Neuronix]

 

[DarknightX]

That's all well and good - but you are still at a much higher risk of committing malpractice than I am. Because you do drugs. !

Really? On what basis? Do you drink alcohol? Smoke cigarrettes? Take any over the counter prescriptions regularly? Drink caffeine? Those all are drugs and all have side effects and can affect cognitive function.

I guess studying, training, intelligence, where you went to school, and overall capacity go out the window. If you smoke a joint, your automatically incompetent as a physician.

And I am capable of having "fun" without subjecting my body to crap like pot.

Good for you. It's my body, and I can subject it to what I like. Do you eat fast food? Processed foods? Any preservatives or artificial colors? Cause that has crap which is probably more harmful to your body than taking a puff of weed once in awhile.

Maybe you can limit your drug use to occasional pot. But many can't.

And many cannot limit their drinking. Or their gambling. Or their appetite. Or their sexual promiscuity. All of these behaviors are legal, yet all of them can be addictive with debilitating consequences. That's why there is alcoholics anoynmous, gambling anonymous, sex addicts anonymous, etc.

What if you then decide it isn't hurting anyone if you start doing opioids? The fact that you don't drink is good for you but doesn't really matter either.

Yes, that's just my point. Why is it ok to drink alcohol, which is more damaging to the body and the mind, yet it's soooo horrible to smoke weed?

And forget the mental issues that come with doing drugs - what about the legal issues? What if you get arrested? Cited? Is it worth it to you to deal with licensing because of that?.

What if I have a prescription and I live in California?

The truth of the matter is that I don't really care what you do in your personal life. But that isn't important to anyone else. Having these rules out there is not to prevent people from having fun. It's to prevent people from harming patients. You can present me with all the anecdotes you want about successful physicians who have a drug habit and have never harmed anyone, but there will always be more anecdotes about physicians who accidentally harmed someone either directly or indirectly because of drugs..

Which is why they are called anecdotes. You're not only drinking the kool aid, you're swimming in it.

So by your logic, it's ok to use alcohol because it's legal (even though it is much more damaging than marijuana) and that won't affect your ability as a doctor, but you can't smoke marijuana because it's illegal, so therefore that makes you a bad doctor. Riiiight.

Just think about that before you consider how wonderful it is to get high. We all have our demons and challenges in life. I'm sure I do things or have done things that you don't like. Heck, I have a one year old at home and sometimes it makes it harder to focus on work because of something going on. Maybe parents shouldn't be doctors either!

Lame, bro.

 

[lipomas]

Really? On what basis? Do you drink alcohol? Smoke cigarrettes? Take any over the counter prescriptions regularly? Drink caffeine? Those all are drugs and all have side effects and can affect cognitive function.

None of those, but that isn't relevant, like I said. "over the counter prescription" is an oxymoron, I assume you just meant prescriptions - if you do have certain prescriptions that interfere with your performance of your duties, then that is a problem.

I guess studying, training, intelligence, where you went to school, and overall capacity go out the window. If you smoke a joint, your automatically incompetent as a physician.

Not what I said either. I said if you can't avoid smoking a joint then you are at increased risk from a malpractice perspective. And I question someone's overall capacity if they prioritize getting high over their career (which you are doing if you are risking a positive test).

And many cannot limit their drinking. Or their gambling. Or their appetite. Or their sexual promiscuity. All of these behaviors are legal, yet all of them can be addictive with debilitating consequences. That's why there is alcoholics anoynmous, gambling anonymous, sex addicts anonymous, etc.

Hence why they ask about most of these things on licensing and credentialling applications. If you drink such that you have had legal problems or have been impaired, then you are a risk. If you gamble too much, you are a risk in other areas. I don't think appetite is relevant unless you're morbidly obese. And they do not ask about sexual promiscuity as far as I know but again, if it's caused legal or work performance problems then it is relevant.

Yes, that's just my point. Why is it ok to drink alcohol, which is more damaging to the body and the mind, yet it's soooo horrible to smoke weed?

The pot smoker's favorite internet gambit is to shift the discussion to alcohol as if they able to convince the other person that alcohol has bad effects, pot must be ok since alcohol is legal. Alcohol is legal but not if it interferes with your life. You can't show up to work drunk and expect people to look the other way. Pot is currently illegal - thus, if you are willing to risk legal consequences to smoke it then you are a higher risk. Just like if you are willing to risk using alcohol in a fashion that is illegal, you are at a higher risk. Alcohol is probably worse than pot. I don't precisely know. Pot doesn't seem to have that many serious effects from what I know about it (and I haven't studied it that much). But it's an illegal drug. Sorry. Change the rules if you don't like it, don't blame me.

If you have a prescription, as you say, I have no idea how that effects the issues. Maybe that makes it ok for you to flunk a drug test as long as you are not high at work. I tend to doubt it, but I may be wrong. Maybe it depends on what kind of doctor you are.

I can only say it so many times man. I don't care if you smoke pot. It really shouldn't matter to you what my vices are or what I do. I really don't think it's that harmful. But the law is the law and policies are what they are. I didn't write them, and I don't sit on boards or enforce them.

 

[Law2Doc]

...
If you have a prescription, as you say, I have no idea how that effects the issues. Maybe that makes it ok for you to flunk a drug test as long as you are not high at work. I tend to doubt it, but I may be wrong. Maybe it depends on what kind of doctor you are. ...

The person with a prescription won't get arrested under state law. But that doesn't mean he will be allowed to prescribe drugs under a DEA license which isn't a matter of California law. Best to stay the straight and narrow.

I wouldn't say alcohol is safer than marijuana - it's far more dangerous to your health. But it's legal both statewide and federally (and even in our Constitution thanks to the repeal of prohibition). From a career move point of view you are far better off getting trashed on tequila every night for a month than smoking one joint. And that's all there is to it. The borderline alcoholic keeps his job if he can keep his blood alcohol levels down during the work day, but the infrequent recreational pot user runs a real risk.

 

[Giemsa]

I guess studying, training, intelligence, where you went to school, and overall capacity go out the window. If you smoke a joint, your automatically incompetent as a physician.

You're not necessarily incompetent; however, you are committing a drug-related offense under the laws of your country.

That's where the line is. What's legal and what's not.

 

[235750]

The pot smoker's favorite internet gambit is to shift the discussion to alcohol as if they able to convince the other person that alcohol has bad effects, pot must be ok since alcohol is legal.

That's a bit of a strawman. Let me help you.

We would like to think that a thing (or action) is outlawed because it represent excess harm to the individual or society as a whole. Therefore, cannabis must be more harmful than legal substances. If you're a fan of evidence based medicine you'll find that cannabis, for example, does not cause as much harm as ethanol [1]. The fact that is it easier and more dangerous to become addicted to ETOH are very salient facts. So, a legitimate question would be: why the distinction? Legally, what is the sense in ranking cannabis as more dangerous than things like ETOH?

What you dismiss as a 'gambit' is actually a coherent and straightforward argument backed by years of research. Do you know of any peer reviewed evidence that contradicts any of this?

If you drink such that you have had legal problems or have been impaired, then you are a risk. If you gamble too much, you are a risk in other areas.

Right, so I think what Darknight was pointing out was that you can still drink and gamble in a regulated fashion. So, it is inconsistent to have an all or nothing approach to a less harmful substance, such as pot. Again, the evidence shows that it is much more difficult to cause harm with smoking pot.

There's a really famous psychologist and ethicist named Kohlberg who you should look up. He described stages of moral development such that one could gauge ethical maturity based upon how one made decisions, not by judging the decisions themselves. Post-conventional thinking is where one does not simply follow the rules because they are there, but rather applies critical thought and questions their existence, not seeing them as rigid edicts, but rather as general guidelines. So, while you may think Darkknight is being immoral for not following the law, there is a solid theory that says his questioning of unjust laws shows maturity and insight, as opposed to Giemsa who seems to be stuck on the pre-conventional.

Lipomas, you seem to oscillate between acknowledging the benign nature of cannabis, and then reverting back to "law is law, and you can't do anything about it". Are you saying laws should be followed blindly as a sort of social contract a la Kant? You may have a point, but it's not being stated clearly.

 

[lipomas]

I'm saying if you are a physician and expect to get licensed you have to follow the law. There are all kinds of laws which don't make sense or cause more problems than they prevent. I really don't know if illegal pot is one of them. It's not a huge issue to me because I have no personal use for it. I voted for the medical legalization bill when it popped up in my state. I think the state spends far too many resources on trying to stop it. If you find a law unjust or problematic there are mechanisms to register your displeasure or suggestions. Internet forums are rarely that mechanism.

I'm fascinated that you think I think he is being immoral. He is being irresponsible because he is potentially risking his future for a drug high. Immorality doesn't have that much to do with it unless he plans to get high before taking care of patients. Your psychologic analysis is quite lacking.

The reason I posted about the pot smoker's gambit is because usually it is a response to someone criticizing them for smoking pot and breaking the law and risking consequences. They shift the discussion to alcohol. In some cases this is appropriate, but in other cases like this one it really isn't. In the "pot should be legal" discussion, it is a useful comparison although still a bit distracting. The conclusions a rational impartial observer should draw is not that pot should be legalized because alcohol is legal, but that alcohol should be illegal because pot is also. These discussions also generally seem to ignore the fact that alcohol is something of a controlled substance. You can only buy it if you are over 21, and you can't use it if you are performing a task where it will impair you and it might cause harm to others. Thus, alcohol use IS illegal in many circumstances!

My criticism is that in this case it is used because someone criticized him for smoking pot (where it is far less relevant). In this case it has peripheral relevance but is not really pertinent to the topic at hand. Thus, it's a distractor. It doesn't matter whether alcohol is more dangerous. It is legal. But like I said you can probably get in a LOT more trouble with alcohol use as a physician than you can with pot use. I saw some study this morning about surgeon abilities the morning after drinking and it raised the possibility that lingering impairement exists. Alcohol is legal but it is legal within certain use restrictions. So is pot, increasingly.

 

[235750]

I'm fascinated that you think I think he is being immoral..Your psychologic analysis is quite lacking.

You called Darknight a 'drug addict' which is a rather loaded term that many would say involves judgment. The public tend to squish their face in disgust whilst using that phrase. Maybe you didn't mean to judge Darknight when you gave him/her that label, but you didn't really flesh out your view either.

Along the same lines, I thought you maybe had an interesting viewpoint that could lead to a meaningful discussion about the social contract, or something else that would be thought provoking. Instead, you were stating the obvious: "I'm saying if you are a physician and expect to get licensed you have to follow the law." We all know this, and in fact that's why this thread exists.

If you find a law unjust or problematic there are mechanisms to register your displeasure or suggestions. Internet forums are rarely that mechanism.

Again, we realize the obvious; that is to say, no-one here is in a position of power who has the ability to change current drug laws. I am not here to change society. Instead, many of us come to SDN to share ideas and to discuss intellectually stimulating topics. In short, I post to have a good time. Why did you initially post about Darknight being a 'drug addict'? What did you hope to accomplish? Did you think stating a fact like "obey the law or get in trouble" was going to be bring about a lifestyle change? If the 'gimme' points for step 1 have taught me anything, it's that the harsh approach does not work 🙂

Thus, alcohol use IS illegal in many circumstances!

I don't understand why you keep reiterating that legal substances have boundaries. No one is disagreeing with you. Looking at the peer reviewed evidence that is available, from an ethical standpoint (the thing that fascinates and entertains me) I see no reason why cannabis shouldn't be counted among the restricted-but-legal-drugs that you described. Like any legal recreational drug, it seems cannabis should also be regulated. You are right, outlawing ETOH and tobacco is one option, but I don't hear you pushing for that. Instead your view is simple: it's illegal, so don't do it. Which is correct, it's just not at all interesting.

 

[jdh71]

I'm saying if you are a physician and expect to get licensed you have to follow the law.

You may not care for his contemptuous attitude, but lipomas ENDS the discussion right here. None of the arguments matter when the rubber hits the road. If you decide to be a physician, you have decided to not smoke pot as well for all practical purposes. Attitudes may chaneg over the course of time, but as they stand now, don't toke.

 

[Ilovewaiting]

You may not care for his contemptuous attitude, but lipomas ENDS the discussion right here. None of the arguments matter when the rubber hits the road. If you decide to be a physician, you have decided to not smoke pot as well for all practical purposes. Attitudes may chaneg over the course of time, but as they stand now, don't toke.

On a different note, do you all think all these drug tests use the standard recommended cutoff levels?

 

[jdh71]

On a different note, do you all think all these drug tests use the standard recommended cutoff levels?

Probably because they are screens, almost all of them will be a dipstick I imagine with GC confirm if anything looks funny.

 

[Apollyon]

On a different note, do you all think all these drug tests use the standard recommended cutoff levels?

What you get is just the same as the truck driver with the CDL with his random tests. It depends on which assay is used, but, at any given facility, everyone is painted with the same brush. There are some standards, though, to which manufacturers try to adhere (such as the 2000ng/mL for opiates - which won't pick up the poppy seed rolls, whereas the 400ng/mL will get the false-positive from the rolls - the 400 and 2000 are standards, but your shop may do the first, or the second - that's the individual assay).

 

[cosine]

I'm surprised that a program would perform a hair test to screen for drugs considering how expensive it is. I would assume that the urine screen is usually done at most residencies. What exactly is the difference between these 2? I believe hair test can detect drugs after a longer period but are they accurate? Also does the frequency of drug use matter with a hair test vs urine test?

It just seems like the urine test is the tried and true method.