Pre-Residency Hair Drug Test

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Normnom

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Hello everyone,
I'm starting to freak out a little bit and would like to know if anyone could offer some information to help me.

Here is my situation:

I have to complete a pre-residency drug screen for residency within one month from now, which I believe includes hair follicle test.

Today is 4/20 and my roommate had a bunch of people over smoking pot. When I walked in the house, the room was filled with smoke. I called my landlord and he came over and kicked everyone out of the house.
My total exposure to the second hand smoke was ~5minutes. I did (I think) feel some minor effects from the smoke (dizzy, tachycardia) afterwards, but this could just be due to being anxious/aggravated.

Right now I'm paranoid about testing positive from a hair follicle test. Does anyone know the cutoff values that are commonly used? Is there any possibility I could be positive? If it is positive, will the result be quantitative; showing a low enough level to most likely be from 2nd hand exposure?

I've been searching the internet trying to find answers to these question and I found this http://www.nature.com/articles/srep14906
which makes me even more worried.

Sorry for the long post, but I'm just really worried and would like some information to know what my risk is.

Thank you for any help or information.
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In my completely ignorant, non-medical opinion, I think you'll be fine.

I can't imagine any lab setting a threshold that low for a drug test.

EDIT: One thing I would not do is tell my future PD this story. It will sound like a lame excuse for trying to cover your a$$. If you're really that concerned, find out on the sly which drug testing company your program uses, then follicle test yourself before they do. If it comes back positive, you got some 'splainin to do.
 
Law2Doc said:
That is my gut reaction as well -- nobody is going to buy this.
Click to expand...

I realize this sounds bogus, but I really have no reason to lie on an anonymous board.

I realize that I am probably overreacting and will be fine. Admittedly, I'm a neurotic and anxious person who is just looking for some assurance so that I don't have to spend the next month freaking out.
 
WilliamofOckham said:
How do you know that it's a hair test? Those are significantly more expensive than urine tests, and I haven't heard of any residencies that test anything besides urine.
Click to expand...

Actually, not that long ago there was a thread started by someone who lost their residency spot after a positive hair test.
 
22031 Alum said:
Yeah. It was probably almost a year ago, post-Match. It quickly dropped, as there's not much to pontificate on beyond "That sucks." The Match is binding but you do have to meet whatever requirements the hospital has for new hires.
Click to expand...

I hope it wasn't just pot. IMO, the hassle of trying to fill a vacancy before July isn't worth it for marijuana use.
 
WilliamofOckham said:
I hope it wasn't just pot. IMO, the hassle of trying to fill a vacancy before July isn't worth it for marijuana use.
Click to expand...

Some hospitals might think it's worth it. Or more accurately, might not care- not every hospital that has residents is deeply invested in its residency programs. There are community hospitals out there with a couple of affiliated residencies, where the concerns of a program director aren't even a blip on the administrators ' radar.
 
WilliamofOckham said:
I hope it wasn't just pot. IMO, the hassle of trying to fill a vacancy before July isn't worth it for marijuana use.
Click to expand...
On the flip side, MJ use shouldn't be worth the hassle on the applicants end either. If you are going into a career that drug tests, you stay away from the stuff, period. Legality or your views on safety needn't ever enter into it -- if you are committed to a career that tests for this, you avoid it.
 
I found this site: https://www.omegalabs.net/hair-testing-service/hair-testing-faqs/other-services.cmsx

I would hope that they would be using a service, like this one, that tests for metabolites.


Normnom said:
Hello everyone,
I'm starting to freak out a little bit and would like to know if anyone could offer some information to help me.

Here is my situation:

I have to complete a pre-residency drug screen for residency within one month from now, which I believe includes hair follicle test.

Today is 4/20 and my roommate had a bunch of people over smoking pot. When I walked in the house, the room was filled with smoke. I called my landlord and he came over and kicked everyone out of the house.
My total exposure to the second hand smoke was ~5minutes. I did (I think) feel some minor effects from the smoke (dizzy, tachycardia) afterwards, but this could just be due to being anxious/aggravated.

Right now I'm paranoid about testing positive from a hair follicle test. Does anyone know the cutoff values that are commonly used? Is there any possibility I could be positive? If it is positive, will the result be quantitative; showing a low enough level to most likely be from 2nd hand exposure?

I've been searching the internet trying to find answers to these question and I found this http://www.nature.com/articles/srep14906
which makes me even more worried.

Sorry for the long post, but I'm just really worried and would like some information to know what my risk is.

Thank you for any help or information.
Click to expand...
 
Thanks.
From what I've read, most labs test the metabolites and have a initial screening ELISA test with a cutoff value of .5-1pg/mg of hair. To test positive would require ingestion of an amount that is greater than can (most likely) be ingested passively. I feel a LOT better now.
 
OP, I would relax. If your story is as you say it is, then you have nothing to worry about. :happy:
 
On a more serious note are are hair follicle tests actually done for incoming residents? What institutions?
 
bob123451 said:
On a more serious note are are hair follicle tests actually done for incoming residents? What institutions?
Click to expand...

I don't know if anyone can give a comprehensive list of institutions. It varies from hospital to hospital. But yes, some places actually do perform hair follicle tests on incoming residents - my boyfriend had to do one.
 
bob123451 said:
On a more serious note are are hair follicle tests actually done for incoming residents? What institutions?
Click to expand...


Yes. It was specifically mentioned by the PD at one of my interviews. Can't remember which one since it's a non-issue for me. I think most test via urine though.

FWIW, most of the programs I interviewed at mentioned that they test for nicotine as well.
 
Law2Doc said:
If I had a nickel for every person who ever blamed their roommate or a poppyseed bagel for their positive drug test...
Click to expand...

While I have no patience for people doing drugs and failing drug tests, the poppyseed bagel bit is *the real deal* and has been demonstrated a number of times.

http://www.nytimes.com/2005/01/11/h...seeds-can-make-you-fail-a-drug-test.html?_r=0

In other words, folks, stay away from the poppyseeds if there's a drug test coming up.

(As an aside: in fact, there can be a lot of morphine/codeine/other alkaloids hanging out on the outside of poppy seeds. The local opioid addicts are now making 'poppyseed tea', which apparently involves buying big bags of unwashed poppyseeds at the local hispanic food stores, mixing them with water and drinking the water.

A colleague admitted a guy to the ICU who ended up hypoxic + brain dead after ODing on this poppyseed tea.)
 
Last edited:
Law2Doc said:
If I had a nickel for every person who ever blamed their roommate or a poppyseed bagel for their positive drug test...
Click to expand...

Older assays definitely cross-react with poppyseeds. Might not be an issue with a few on a bagel, but I've had plenty of cakes with poppyseed filling over the years. There's a ton of other cross-reactive substances out there, including OTC nasal sprays/decongestants that cross-react with the amphetamine assay. The only screen that has no chance of false positives is cocaine, which will only react with cocaine or some other product illegally derived from the coca plant. Marijuana is pretty close.

That said, no residency program should fire you on a + screen. Presumably, any results will be confirmed with a quantitative assay (GCMS).
 
I am not making this up: an acquaintance once called me up asking if the following story would seem credible for a failed drug test (drug testing being required for a job she was applying for).

"I ate two pounds of fudge from Holland and didn't know they were spiked with marijuana. Marijuana is legal in Holland"

I spent about 15 minutes trying to explain how this was total BS and she'd get spotted in a nanosecond, but she was adamant that it was a good cover story. I finally told her' yeah, it seems credible".

I still wonder if she ever got the job?


Law2Doc said:
If I had a nickel for every person who ever blamed their roommate or a poppyseed bagel for their positive drug test...
Click to expand...
 
I think it's total BS that hospitals can test you for nicotine and not hire you
I don't think tobacco should be legal, but it is
I just don't see why smoking cigarettes at home on their own time should be something they are allowed to concern themselves with
I know quite a few great ED docs that smoke... and also some that have quit
it's not like being a smoker is some sort of unalterable characteristic about oneself

I'm confused, they test the follicle, not the shaft? how long do you have to abstain from MJ to test clean then?

I agree with @L2D you enter a field you make sacrifices
but it's a little too big brother for my taste, testing for nictotine and hair test for MJ

granted owing to Federal law smoking MJ is illegal period, but I sort of resent the idea that because I'm a doctor that means I can't have a joint on my two week vacation in a state where it is legal, but now I'm getting into a states vs federal rights sorta debate there

to my knowledge, there is still no way to test for acute MJ intoxication?
that would be fair
also if there was a way to quantify usage, understandably a joint on your vacay is a different story than your doc smoking daily at home, as that can have longer term cognitive effects
 
Crayola227 said:
granted owing to Federal law smoking MJ is illegal period, but I sort of resent the idea that because I'm a doctor that means I can't have a joint on my two week vacation in a state where it is legal, but now I'm getting into a states vs federal rights sorta debate there
Click to expand...

If a VA hospital is involved, there go your states rights.
 
Crayola227 said:
I think it's total BS that hospitals can test you for nicotine and not hire you
I don't think tobacco should be legal, but it is
I just don't see why smoking cigarettes at home on their own time should be something they are allowed to concern themselves with
I know quite a few great ED docs that smoke... and also some that have quit
it's not like being a smoker is some sort of unalterable characteristic about oneself

I'm confused, they test the follicle, not the shaft? how long do you have to abstain from MJ to test clean then?

I agree with @L2D you enter a field you make sacrifices
but it's a little too big brother for my taste, testing for nictotine and hair test for MJ

granted owing to Federal law smoking MJ is illegal period, but I sort of resent the idea that because I'm a doctor that means I can't have a joint on my two week vacation in a state where it is legal, but now I'm getting into a states vs federal rights sorta debate there

to my knowledge, there is still no way to test for acute MJ intoxication?
that would be fair
also if there was a way to quantify usage, understandably a joint on your vacay is a different story than your doc smoking daily at home, as that can have longer term cognitive effects
Click to expand...

Totally agree.
 
Crayola227 said:
I think it's total BS that hospitals can test you for nicotine and not hire you
I don't think tobacco should be legal, but it is
I just don't see why smoking cigarettes at home on their own time should be something they are allowed to concern themselves with
I know quite a few great ED docs that smoke... and also some that have quit
it's not like being a smoker is some sort of unalterable characteristic about oneself

I'm confused, they test the follicle, not the shaft? how long do you have to abstain from MJ to test clean then?

I agree with @L2D you enter a field you make sacrifices
but it's a little too big brother for my taste, testing for nictotine and hair test for MJ

granted owing to Federal law smoking MJ is illegal period, but I sort of resent the idea that because I'm a doctor that means I can't have a joint on my two week vacation in a state where it is legal, but now I'm getting into a states vs federal rights sorta debate there

to my knowledge, there is still no way to test for acute MJ intoxication?
that would be fair
also if there was a way to quantify usage, understandably a joint on your vacay is a different story than your doc smoking daily at home, as that can have longer term cognitive effects
Click to expand...
you don't have to work at a place that does testing...and on the interview day they tell you if they test and what they test for...if its that big an issue (and if you as a physician don't understand the financial cost of smoking, well..) then don't rank that place.
 
rokshana said:
you don't have to work at a place that does testing...and on the interview day they tell you if they test and what they test for...if its that big an issue (and if you as a physician don't understand the financial cost of smoking, well..) then don't rank that place.
Click to expand...

well, if it was that big of a deal then you might not even want to interview there, usually there's not insubstantial expenses with interviewing

luckily thanks to SDN anyone reading this now knows this is something some places do and can steer accordingly
I don't see why you couldn't pre-ERAS call a site's HR and ask about drug testing policy, I would call from a blocked number, disguise my voice, and not tell them who I really was or what I was applying for if I were to do that tho, I imagine many places would just tell you

doesn't change my management as they say, just expressing the opinion I think it's atrocious some of the information that the healthcare system as a workplace feels entitled to have about you
 
Crayola227 said:
luckily thanks to SDN anyone reading this now knows this is something some places do and can steer accordingly
I don't see why you couldn't pre-ERAS call a site's HR and ask about drug testing policy, I would call from a blocked number, disguise my voice, and not tell them who I really was or what I was applying for if I were to do that tho, I imagine many places would just tell you
Click to expand...

This is way easier (and less crazy) than just not doing illegal drugs amirite?? 😀
 
Crayola227 said:
I think it's total BS that hospitals can test you for nicotine and not hire you
I don't think tobacco should be legal, but it is
I just don't see why smoking cigarettes at home on their own time should be something they are allowed to concern themselves with
I know quite a few great ED docs that smoke... and also some that have quit
it's not like being a smoker is some sort of unalterable characteristic about oneself

I'm confused, they test the follicle, not the shaft? how long do you have to abstain from MJ to test clean then?

I agree with @L2D you enter a field you make sacrifices
but it's a little too big brother for my taste, testing for nictotine and hair test for MJ

granted owing to Federal law smoking MJ is illegal period, but I sort of resent the idea that because I'm a doctor that means I can't have a joint on my two week vacation in a state where it is legal, but now I'm getting into a states vs federal rights sorta debate there

to my knowledge, there is still no way to test for acute MJ intoxication?
that would be fair
also if there was a way to quantify usage, understandably a joint on your vacay is a different story than your doc smoking daily at home, as that can have longer term cognitive effects
Click to expand...
A lot of people agree with you, hence why in ~30 states it is expressly forbidden to discriminate against tobacco smokers. That activity is legal.

No state protects people who (ab)use illegal drugs.
 
Raryn said:
A lot of people agree with you, hence why in ~30 states it is expressly forbidden to discriminate against tobacco smokers. That activity is legal.

No state protects people who (ab)use illegal drugs.
Click to expand...
Nothing like tobacco users forcing everyone else at a company to pay higher rates to cover their future COPD and lung cancer. Yes, tobacco users pay a higher premium, but it's not high enough to cover the actual risk that smoking poses.
 
Siggy said:
Nothing like tobacco users forcing everyone else at a company to pay higher rates to cover their future COPD and lung cancer. Yes, tobacco users pay a higher premium, but it's not high enough to cover the actual risk that smoking poses.
Click to expand...
*shrug*. I enjoyed a bacon cheeseburger yesterday, also a perfectly legal activity that is probably not particularly good for my health. Doesn't mean that the hospital should threaten to fire me over it.
 
Crayola227 said:
I think it's total BS that hospitals can test you for nicotine and not hire you
I don't think tobacco should be legal, but it is
I just don't see why smoking cigarettes at home on their own time should be something they are allowed to concern themselves with
I know quite a few great ED docs that smoke... and also some that have quit
it's not like being a smoker is some sort of unalterable characteristic about oneself

I'm confused, they test the follicle, not the shaft? how long do you have to abstain from MJ to test clean then?

I agree with @L2D you enter a field you make sacrifices
but it's a little too big brother for my taste, testing for nictotine and hair test for MJ

granted owing to Federal law smoking MJ is illegal period, but I sort of resent the idea that because I'm a doctor that means I can't have a joint on my two week vacation in a state where it is legal, but now I'm getting into a states vs federal rights sorta debate there

to my knowledge, there is still no way to test for acute MJ intoxication?
that would be fair
also if there was a way to quantify usage, understandably a joint on your vacay is a different story than your doc smoking daily at home, as that can have longer term cognitive effects
Click to expand...

 
22031 Alum said:
This is way easier (and less crazy) than just not doing illegal drugs amirite?? 😀
Click to expand...

... Except that some "illegal" drugs are either decriminalized or in the process of becoming so in a number of states.
 
WilliamofOckham said:
... Except that some "illegal" drugs are either decriminalized or in the process of becoming so in a number of states.
Click to expand...

That's true, but has zero to do with the rules at individual hospitals, especially federal facilities. Is the beginning of your career really the time to try and prove a point over that?
 
22031 Alum said:
That's true, but has zero to do with the rules at individual hospitals, especially federal facilities. Is the beginning of your career really the time to try and prove a point over that?
Click to expand...

No, but that's not really the point.
 
I've always wondered...
1. When cocaine is used for ENT procedures, does it produce positive drug tests?
2. What happens if you test positive for cocaine at an employment test if you had cocaine during a procedure?
 
I wouldn't be surprised if it did...

I imagine that's the one time an excuse flies... I mean, you can get an actual ENT doc to call and say, "yep, it was me, I totally shoved cocaine up their nose!!"

cocaine gets out of your system so quick not mention most of the time you have a window on when you take usually take pre-employment screens usually and get to pick the exact time....
I don't ever remember it even being mentioned to the patients that we were gonna use cocaine on them.... but we did! granted, they're usually sent home with a script at least for opiates.... patients "forget" all the time but just seems dumb to pick 3-4 days after surgery where you get sent home with narcs to decide to take a *drug* test. that's either a rookie move or a genius level manuvuer

when I did mine there was a questionnaire beforehand the nurse goes over in detail asking about meds or any recent medical treatment, probably just for what you mentioned
 
WilliamofOckham said:
... Except that some "illegal" drugs are either decriminalized or in the process of becoming so in a number of states.
Click to expand...
"Federal" law trumps "state" law. (The quotes are for your "illegal".) It's not cost-effective to send a US Marshal to write a ticket for a joint, though (just like I said at work about not illuminating the US flag after dark - the US Marshal is going to come and write a ticket for that, too!). But, no matter what Colorado or Oregon or Florida or whichever state, but MJ is still DEA Schedule I, and, therefore, illegal.
 
Crayola227 said:
I think it's total BS that hospitals can test you for nicotine and not hire you
I don't think tobacco should be legal, but it is
I just don't see why smoking cigarettes at home on their own time should be something they are allowed to concern themselves with
I know quite a few great ED docs that smoke... and also some that have quit
it's not like being a smoker is some sort of unalterable characteristic about oneself

I'm confused, they test the follicle, not the shaft? how long do you have to abstain from MJ to test clean then?

I agree with @L2D you enter a field you make sacrifices
but it's a little too big brother for my taste, testing for nictotine and hair test for MJ

granted owing to Federal law smoking MJ is illegal period, but I sort of resent the idea that because I'm a doctor that means I can't have a joint on my two week vacation in a state where it is legal, but now I'm getting into a states vs federal rights sorta debate there

to my knowledge, there is still no way to test for acute MJ intoxication?
that would be fair
also if there was a way to quantify usage, understandably a joint on your vacay is a different story than your doc smoking daily at home, as that can have longer term cognitive effects
Click to expand...

Employers can still maintain "drug-free" workplaces even if the drugs are legalized. Intoxication would obviously be indisputable impairment. But, occ-med folks dealing across state borders aren't currently differentiating whether or not the substance is legal in the state of the site / employee. It still, likely, violates their company's drug-free policy. I haven't come across anyone getting canned for nicotine, other than issues related to their health plans or healthy employee incentives.
 
Siggy said:
I've always wondered...
1. When cocaine is used for ENT procedures, does it produce positive drug tests?
2. What happens if you test positive for cocaine at an employment test if you had cocaine during a procedure?
Click to expand...
Usually, any positive tests are reviewed by medical review officers (MRO), and usually verification tests are done (which sometimes pick up metabolites). Broad screening panels pick up lots of things, including commonly prescribed drugs (benzos and stimulants of course, but can even pick up most antidepressants).
 
Re: screening for cotinine.

My program does it. You have a positive screen? You don't start on time. You must do mandatory cessation counseling and pass a second screen.

I'd say it's the hospital's right to whatever they want when they're paying us a generous resident salary and nearly 8k in benefits. Meh.
 
itscomplicated said:
Employers can still maintain "drug-free" workplaces even if the drugs are legalized. Intoxication would obviously be indisputable impairment. But, occ-med folks dealing across state borders aren't currently differentiating whether or not the substance is legal in the state of the site / employee. It still, likely, violates their company's drug-free policy. I haven't come across anyone getting canned for nicotine, other than issues related to their health plans or healthy employee incentives.
Click to expand...

I just think with smoking you can still maintain a "drug free" workplace, I mean you won't test negative after you morning cigaretee but you're hardly intoxicated and the half life is so short anyway. Many of the smokers I know in healthcare don't bring their cigarettes to work or smoke on campus (smoke free campus).

Could be my ignorance, how long do you have to abstain from smoking to test negative?
 
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