Residency Program Drug Testing

[Encephalopathy]

I was just wondering whether any of you residents or former residents were drug tested upon entering your program? If so, was it urine or hair? Just curious because I have, ya know, deeply-held beliefs in civil liberty and privacy issues. Any insight into this subject, and especially California programs, would be greatly appreciated.

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[prominence]

bro, it's just a urine sample before u start residency (though, i don't know anything about cali programs).

they never check again after the first one.

 

[Doc Samson]

No testing at all here in MA. Also don't know about Cali, though.

 

[Someguy2007]

How long does weed show up in urine? :x

 

[maranatha]

How long does weed show up in urine? :x

Occasional use-- 1 to 3 days
Chronic use-- about 30 days

So, you may want to stop for a bit....

 

[Someguy2007]

Teehee, I'm in the clear then. Last use was Nov. 17th, the day of my interview at UTSW

 

[luft]

I'm going to be starting here in California and I just gave a urine sample yesterday. I'm sure it varies from program to program though.

 

[tennreb]

I was just wondering whether any of you residents or former residents were drug tested upon entering your program? If so, was it urine or hair? Just curious because I have, ya know, deeply-held beliefs in civil liberty and privacy issues. Any insight into this subject, and especially California programs, would be greatly appreciated.

I don't use any kind of drugs, but I'm very offended by taking a drug test. We are or will be physicians who have enormous trust placed on us. If the hospital doesn't even trust us enough to let us get by a drug test, how can they trust us to treat patients?

 

[chocomorsel]

I don't use any kind of drugs, but I'm very offended by taking a drug test. We are or will be physicians who have enormous trust placed on us. If the hospital doesn't even trust us enough to let us get by a drug test, how can they trust us to treat patients?

Physicians do have substance abuse issues just in case you weren't aware. I mean, they are human first right. So the whole "trust" thing is overrated when it comes to drug use

 

[Encephalopathy]

It's understandable that they don't want intoxicated doctors to be seeing patients. The problem with drug tests is that they test you not for current intoxication, but for use over a certain time in the past. They are essentially dictating what you can do on your weekends and on vacation.

One might argue that substance use at any time is an employment risk. But alcohol dependence is not assessed and the half-lives of heroin, cocaine, and meth are just a day or two. So the only thing that really ends up being tested for is cannabis, which (from what I've gathered over the course of my medical education) is a relatively benign substance.

 

[OldPsychDoc]

It's understandable that they don't want intoxicated doctors to be seeing patients. The problem with drug tests is that they test you not for current intoxication, but for use over a certain time in the past. They are essentially dictating what you can do on your weekends and on vacation.

One might argue that substance use at any time is an employment risk. But alcohol dependence is not assessed and the half-lives of heroin, cocaine, and meth are just a day or two. So the only thing that really ends up being tested for is cannabis, which (from what I've gathered over the course of my medical education) is a relatively benign substance.

First--I think your medical education is still lacking the depth of exposure to persons who are under the long term influence of THC. Its "benignness" is seriously overrated.

Second--say you're a patient checking in for a walk-in psychiatric assessment. The receptionist says, "We have 2 doctors available to see you today. One is still clearing the metabolites of an illegal substance known to adversely affect subjects' judgment and motivation. The other had a glass of wine last night and a cup of coffee this morning. Which one would you like to discuss your problem with today?"

Finally--the bottom line is impairment. Yes, your weekend ganja might not be impairing you (or threatening your patient) as acutely as the anesthesiologist sleeping off his hangover over there behind the green sheet, but at what point does your professional judgment (or "trust" as it was referred to above) indicate that it is appropriate to ingest illegal substances at all? I've heard plenty of stories from MDs who felt that they were professionally qualified to prescribe opiates and benzos for themselves as well. Face it, if you want to be a physician the bar is set higher for you. Keep the urine and the rap sheet clean.

 

[TheWowEffect]

First--I think your medical education is still lacking the depth of exposure to persons who are under the long term influence of THC. Its "benignness" is seriously overrated.

Second--say you're a patient checking in for a walk-in psychiatric assessment. The receptionist says, "We have 2 doctors available to see you today. One is still clearing the metabolites of an illegal substance known to adversely affect subjects' judgment and motivation. The other had a glass of wine last night and a cup of coffee this morning. Which one would you like to discuss your problem with today?"

Finally--the bottom line is impairment. Yes, your weekend ganja might not be impairing you (or threatening your patient) as acutely as the anesthesiologist sleeping off his hangover over there behind the green sheet, but at what point does your professional judgment (or "trust" as it was referred to above) indicate that it is appropriate to ingest illegal substances at all? I've heard plenty of stories from MDs who felt that they were professionally qualified to prescribe opiates and benzos for themselves as well. Face it, if you want to be a physician the bar is set higher for you. Keep the urine and the rap sheet clean.

Great response

 

[Dartos Vader]

I don't use any kind of drugs, but I'm very offended by taking a drug test. We are or will be physicians who have enormous trust placed on us. If the hospital doesn't even trust us enough to let us get by a drug test, how can they trust us to treat patients?

As far as trusting physicians to just be ethical.....that's a little naive. It's obvious from this post that plenty of docs or soon to be docs are partaking in illicit drug use. Docs aren't saints, and we shouldn't have trust instantly placed in us.

As a side note, even though i've never smoked a cigarette, let alone MJ, I still think mariijuana should be legal. I don't think it's nearly as bad as Etoh. Just my two cents.

 

[OldPsychDoc]

It's understandable that they don't want intoxicated doctors to be seeing patients. The problem with drug tests is that they test you not for current intoxication, but for use over a certain time in the past. They are essentially dictating what you can do on your weekends and on vacation.
....

"Hey, I was off duty, man..."

 

[whopper]

Just curious because I have, ya know, deeply-held beliefs in civil liberty and privacy issues

Urine testing goes on in NJ.

Actually the day I did it was wierd. They put me in a bathroom, didn't really tell me what was going on, next thing I knew a hand popped out of a wall like Thing from the Adams Family asking me for urine.

Got no problem with it, last thing I'd want is a doc on drugs. Only problem I'd have is if someone had a false (+) and they didn't give the person a chance to explain.

 

[Chewbacca Jung]

I'm just trying to keep off the poppy seeds for the next couple weeks. It's crazy how much poppy seed-enriched foods keep popping up. Last night I ate 2 slices of an amazing lemon poppy seed cake, before realizing I was doing it again. It's not like I have issues with poppy seeds, and I know the half life isn't that long, but It seems suddenly hard to avoid, and I have to start practicing abstaining now...

Is there any truth to the cross reactivity of poppy seeds with drug testing, or am I denying myself some good muffins for nothing?

 

[zver81]

Is there any truth to the cross reactivity of poppy seeds with drug testing, or am I denying myself some good muffins for nothing?

I am not sure if there is any evidence but I have to be drug tested and it was indicated on the form that I should not eat poppy seeds before the test. They say that one poppy bagel can cause the test to be positive.

 

[Doc Samson]

I'm just trying to keep off the poppy seeds for the next couple weeks. It's crazy how much poppy seed-enriched foods keep popping up. Last night I ate 2 slices of an amazing lemon poppy seed cake, before realizing I was doing it again. It's not like I have issues with poppy seeds, and I know the half life isn't that long, but It seems suddenly hard to avoid, and I have to start practicing abstaining now...

Is there any truth to the cross reactivity of poppy seeds with drug testing, or am I denying myself some good muffins for nothing?

Yes, poppy seeds can produce a positive opiate urine tox. The other issue here, is that the urine toxicology screen is probably one of the least reliable tests in all of medicine. It produces a lot of false postives (I remember an 88 yo woman testing postive for methadone because of her verapamil). Sustiva is more likely to produce a positive urine THC result than occasional marijuana.

 

[Encephalopathy]

First--I think your medical education is still lacking the depth of exposure to persons who are under the long term influence of THC. Its "benignness" is seriously overrated.

Second--say you're a patient checking in for a walk-in psychiatric assessment. The receptionist says, "We have 2 doctors available to see you today. One is still clearing the metabolites of an illegal substance known to adversely affect subjects' judgment and motivation. The other had a glass of wine last night and a cup of coffee this morning. Which one would you like to discuss your problem with today?"

Finally--the bottom line is impairment. Yes, your weekend ganja might not be impairing you (or threatening your patient) as acutely as the anesthesiologist sleeping off his hangover over there behind the green sheet, but at what point does your professional judgment (or "trust" as it was referred to above) indicate that it is appropriate to ingest illegal substances at all? I've heard plenty of stories from MDs who felt that they were professionally qualified to prescribe opiates and benzos for themselves as well. Face it, if you want to be a physician the bar is set higher for you. Keep the urine and the rap sheet clean.

OPD - I've lurked on this board for a while and have always appreciated your posts. I agree that, in a perfect world, physicians would be the perfect specimens of health that we encourage our patients to be and shouldn't be breaking any laws. But as a practical matter, we all have vices, and I have yet to see a "perfect doctor" who practices what he preaches 100% and sacrifices the simple pleasures in his life to conform to the ideal perception of what a doctor should be. I think you'd be surprised at how many competent doctors like to light up every once in a while, you just wouldn't know it because they have to stay deep under cover.

You're right, the bottom line is impairment. When given the option of a doctor who had a glass of wine or smoked a joint the night before, I would have no problem with either as long there was no current intoxication.

I'm not trying to get into a debate here, but I would be interested to know what long-term effects you've observed in your practice - e.g. amotivational syndrome, memory problems, general dependency behavior...? - because this is a subject of great interest to me. I actually have had a great deal of exposure to chronic THC users - it's just that they're my friends, not my patients.

 

[Dartos Vader]

I'm just trying to keep off the poppy seeds for the next couple weeks. It's crazy how much poppy seed-enriched foods keep popping up. Last night I ate 2 slices of an amazing lemon poppy seed cake, before realizing I was doing it again. It's not like I have issues with poppy seeds, and I know the half life isn't that long, but It seems suddenly hard to avoid, and I have to start practicing abstaining now...

Is there any truth to the cross reactivity of poppy seeds with drug testing, or am I denying myself some good muffins for nothing?

Isn't it funny how stuff like that happens? The second you're not supposed to eat/do something you rarely ever eat/do it keeps popping up everywhere.

 

[OldPsychDoc]

...I'm not trying to get into a debate here, but I would be interested to know what long-term effects you've observed in your practice - e.g. amotivational syndrome, memory problems, general dependency behavior...? ....

All of the above...
Just a few examples:
Middle aged man, underachieving, calling it "depression", not responding to multiple antidepressant trials, finally admits he's smoking a joint every night "to help me relax and sleep".
Hardly a month goes by that I don't admit a person under 25 with a first psychotic break and a THC+ urine.
Mood swings, irritability, anxiety, insomnia? Turns out pt stopped weed 2 weeks ago in order to "prep" for a job interview/drug test.
And of course, depressed 20 y/o, hx ADHD, parents can't get him out of the house to get a job, has dropped out of community college, smokes weed incessantly.

The more you read about the cannabinoid receptors and how widely distributed they are in the brain, apparently in a neuromodulatory capacity, the more you appreciate the havoc a high potency agonist can unleash when administered chronically.

 

[Dartos Vader]

On a tangent here. I will state again, I have never done drugs and don't intend to. But what I don't understand is why we have more opioid (sp?) products than I can list here, yet the medical use of marijuana is illegal. It seems to me that opium is worse than marijuana. Very few prescription drugs are even close to opioids for abuse and addiction potential. If marijuana can provide relief to cancer patients, then toke away I say. I would gladly trade in one patient on soma, vics and valium for three potheads any day! We use stimulants to treat ADHD as well, and there are definite issues there that you all know much more about than I do.

Is this just a political issue? What's the deal?

 

[sga430]

on a side note the recent Time or Newsweek has an article on research regarding ectasy, ketamine and psilocybin on various psych conditions. should be interesting to see what the results r. i believe the research is done by nimh and harvard.

 

[jjbmsiv]

On a tangent here. I will state again, I have never done drugs and don't intend to. But what I don't understand is why we have more opioid (sp?) products than I can list here, yet the medical use of marijuana is illegal. It seems to me that opium is worse than marijuana. Very few prescription drugs are even close to opioids for abuse and addiction potential. If marijuana can provide relief to cancer patients, then toke away I say. I would gladly trade in one patient on soma, vics and valium for three potheads any day! We use stimulants to treat ADHD as well, and there are definite issues there that you all know much more about than I do.

Is this just a political issue? What's the deal?

Have you even READ the studies about the efficacy of marijuana? It's about as effective as Tylenol III with all the slap-happy side effects. That's it. I mean, why is this then such a big deal? It's no miracle. Would you rather grow and toke away or just swallow a pill? *shakes head*

Disclaimer: I'm a libertarian, and for the end of the "drug war" and legalization of most of this stuff. At the same time, all this medical marijuana crap is just silly.

 

[Dartos Vader]

Have you even READ the studies about the efficacy of marijuana? It's about as effective as Tylenol III with all the slap-happy side effects. That's it. I mean, why is this then such a big deal? It's no miracle. Would you rather grow and toke away or just swallow a pill? *shakes head*

Disclaimer: I'm a libertarian, and for the end of the "drug war" and legalization of most of this stuff. At the same time, all this medical marijuana crap is just silly.

Where might I find the source you are using? I would like to read it. Plus I'm sure that when opium was prescribed en masse it probably wasn't as
"effective" as it is today after being tinkered with by pharma. And in a different light, if you're dying of cancer and you want to burn one down, why shouldn't you be able to? You're dying, what's the harm?

 

[jjbmsiv]

I'm trying to find it on OVID/Medline right now, but so far no luck. My info comes from a study I read in an Addictions Psychiatry weekly or monthly newsletter that contains summaries of recent and pertinent studies. It's blue and black, if that helps. *laughs* I'll continue to look for it (since I don't recall which journal the study was originally published it anyhow), and post back. If anyone else is into Addictions and knows what this newsletter is called (or has read this article themselves), that'd be helpful!

Again, I'm for the legalization of marijuana for recreational purposes. I've never used the stuff, but I'm not for my tax dollars locking up folks who have. At the same time, from a medical perspective I sure do prefer a pill in the form of Tylenol III that has been well studied with a much superior side effect profile to that of some home-grown weed.

 

[Dartos Vader]

I'm trying to find it on OVID/Medline right now, but so far no luck. My info comes from a study I read in an Addictions Psychiatry weekly or monthly newsletter that contains summaries of recent and pertinent studies. It's blue and black, if that helps. *laughs* I'll continue to look for it (since I don't recall which journal the study was originally published it anyhow), and post back. If anyone else is into Addictions and knows what this newsletter is called (or has read this article themselves), that'd be helpful!

Again, I'm for the legalization of marijuana for recreational purposes. I've never used the stuff, but I'm not for my tax dollars locking up folks who have. At the same time, from a medical perspective I sure do prefer a pill in the form of Tylenol III that has been well studied with a much superior side effect profile to that of some home-grown weed.

A pill is easier for sure, but patient compliance might be enhanced with the chronic ! Plus I hope if something like this gained legal approval the prescription wouldn't be for a bag of seeds and a hot lamp!

WARNING: SIDE EFFECTS MAY INCLUDE NEW ONSET GROWTH OF SOUL PATCH, SUDDEN INTEREST IN HACKEY SACK, HYPERTROPHY OF DREADLOCKS, DESIRE TO LISTEN TO PHISH ON REPEAT, AND FONDNESS FOR PATCHIOLI OIL. CAUTION: SIDE EFFECTS MAY INCLUDE BLOWING YOUR MIND.

 

[Encephalopathy]

At the same time, from a medical perspective I sure do prefer a pill in the form of Tylenol III that has been well studied with a much superior side effect profile to that of some home-grown weed.

The medicinal potential of cannabis lies not solely in analgesia - those wacky side effects can decrease nausea, stimulate appetite and sleep, and elevate mood, among other things. It is not a panacea, of course, but it may in certain cases be the most effective treatment to palliate symptoms and increase the quality of life.

 

[sistermike]

I'm kind of trolling here -- however, I thought I would comment. Those of you who say marijuana causes less harm than cigarettes and alcohol -- well the DEA agrees with you! I've researched marijuana a great deal after my younger brother had a psychotic break linked to chronic drug use, including marijuana. After reading a great deal of information published by the DEA, they have reported that they agree that marijuana is in fact less harmful to the body compared to alcohol and cigarettes. However, it is classified as a Type I drug (meaning it is in the same category as heroin, meth, etc.) because it is classified as "socially destructive".

Also, the other week I was watching CNN and they reported on how a few 18 year old seniors in high school were caught on school grounds smoking marijuana. When confronted by school police, the students were able to show proof that they were prescribed "medical marijuana" (I think they were in California), but because public schools fall under federal laws, the students medical marijuana was confiscated and they were cited.

 

[i61164]

So does that mean that alcohol and cigarettes are not "socially destructive?"

 

[Dartos Vader]

The medicinal potential of cannabis lies not solely in analgesia - those wacky side effects can decrease nausea, stimulate appetite and sleep, and elevate mood, among other things. It is not a panacea, of course, but it may in certain cases be the most effective treatment to palliate symptoms and increase the quality of life.

Yeah! What he said. Seriously though, when my mother was undergoing chemo she said the worst part by far was the nausea. Nothing alleviated it (no she didn't try pot, but she would have done so gladly had it been available).

 

[Dramkinola]

first off... I agree drug testing is valid... whatever your views... illegal is illegal.
THC is illegal, and if you smoke it, you're breaking the law.

second, OldPsychdoc, in my limited experience of two years of psychiatry, I have noticed that MOST first psychotic breaks using THC, upon detailed questioning appear to be using increased THC to self-medicate. Marijuana DOES have a calming/sedating effect, perhaps even mood-stabilizing quality. Not saying ALL of the first breaks on THC are mood-stabilizing... I have seen a couple of cases of THC-induced psychosis (paranoia and auditory hallucinations), which cleared on hospitalization and NO meds (yes, we do that occaissionally)...

and although MOST people are not retested after the initial drug test, there was one psych resident i know of who WAS retested due to suspicion and came out positive for THC...

 

[duneclimber]

Regarding allowing ill or appetite-suppressed cancer patients the relief of marijuana, I believe that marinol, a drug which contains the active compound present in THC, has been prescribed legally for cancer patients in the US for at least a decade. There are other similar prescription meds as well...which makes me wonder why the argument to allow patients to smoke pot is so incessant (if we already allow them to ingest it in pill form...which can be a more potent long-term route). Confused...

 

[Encephalopathy]

Regarding allowing ill or appetite-suppressed cancer patients the relief of marijuana, I believe that marinol, a drug which contains the active compound present in THC, has been prescribed legally for cancer patients in the US for at least a decade. There are other similar prescription meds as well...which makes me wonder why the argument to allow patients to smoke pot is so incessant (if we already allow them to ingest it in pill form...which can be a more potent long-term route). Confused...

Most patients who've tried both prefer cannabis over marinol. Something to do with the modulatory effects of the other cannabinoids on THC. Plus there's the first-pass metabolism and a delayed onset of action.