Type and timing of nicotine testing done by residency programs

[GeneticsGoddess]

I've searched the forums but haven't found a clear answer to these questions. What type of nicotine testing do the programs perform (blood, urine...)? When do they test you (before orientation, during orientation, July 1st...)?
Also, someone asked me this question and I didn't know the answer: do they test for anything else like alcohol or illicit drugs?

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[shiftingmirage]

It's program dependent, but I've read on websites, programs use urine to test for nicotine and what sounds like a standard urine tox screen. When they test you will also be program dependent.

 

[GeneticsGoddess]

Thanks! Have you read this on residency-specific websites or just other types of websites?

 

[shiftingmirage]

From specific program websites. Sometimes under "requirements" they will mention drug testing.

 

[Trogghunter]

I think that employer substance testing laws are state regulated, not program dependent.

Furthermore, nicotine is extremely water soluble and lingers in your body for only a few hours, thus smokers need cigs constantly. The metabolite of nicotine is coteine? or something like that, and that is more practically tested for. Urine vs blood? No idea, but hair tests are very expensive and not practical (at least in the clinic for opiate pts).

Finally, nicotine leads to atherosclerosis and HTN even if it's taken in non-smoked forms, so best to avoid.

 

[shopsteward]

Nicotine testing: the answer is "I gave up smoking on 6 March 2014".

Alcohol testing: there is obviously a relatively short time in which alcohol is in the breath or blood, but having alcohol in your system at most places of work is a serious disciplinary offence, and can get you sacked. The signs of drinking are often obvious enough that formal testing is not required. If you binge, remember that you will still have alcohol in your system the next morning.

A med student doing illicit drugs is heading for the shortest medical career in history.

 

[GeneticsGoddess]

Nicotine testing: the answer is "I gave up smoking on 6 March 2014".

Why March 6th?

 

[sanityonleave]

Why March 6th?

... that's today. 4th year really does make you lose track, eh?

It's institution dependent. They're not going to demand you pee in a cup on match day, so once you match look up your department / hospital's policies re: cotinine and illicits testing. You'll have plenty of time to get it all out of your system prior to orientation.

 

[Bacchus]

I was tested for cotinine in my urine. If it was present, mandatory 6-month delayed start for rehab/cessation.

 

[Psychotic]

I was tested for cotinine in my urine. If it was present, mandatory 6-month delayed start for rehab/cessation.

I don't smoke, just curious, but...what if someone is a former smoker and on nicorette gum or any other smoking cessation program that uses nicotine? What level in the urine warrants the conclusion that the person is an active smoker and not a 'victim' of passive smoke?

 

[Bacchus]

I don't smoke, just curious, but...what if someone is a former smoker and on nicorette gum or any other smoking cessation program that uses nicotine? What level in the urine warrants the conclusion that the person is an active smoker and not a 'victim' of passive smoke?

I think there are different levels that are ranges. I don't know the details because I didn't have to worry about it.

 

[BrettSnodgrass]

Some residency programs perform a screening UDS on all applicants. For example they did this when I was a resident at CMC.

Recent changes in the legal landscape of this country may pose interesting new ethical challenges related to marijuana. In the past if someone tested positive for marijuana, they would be identified as having committed at least a misdemeanor and were likely dismissed or reprimanded, or other. Now, should and what are the legal ramifications of dismissing a resident who was off for the weekend, went to WA, smoked marijuana, and then returned to a state such as California where it is illegal. On Monday, the PD, with the underlying aim of firing the resident states they are going to employe the hospital's policy of screening at will. The UDS returns positive for Cannabinoids and the PD states, aha, the resident was engaged in illegal activity and later in the day mails him a formal letter stating they are immediately terminating his contract.

 

[pithecanthropus]

Some residency programs perform a screening UDS on all applicants. For example they did this when I was a resident at CMC.

Recent changes in the legal landscape of this country may pose interesting new ethical challenges related to marijuana. In the past if someone tested positive for marijuana, they would be identified as having committed at least a misdemeanor and were likely dismissed or reprimanded, or other. Now, should and what are the legal ramifications of dismissing a resident who was off for the weekend, went to WA, smoked marijuana, and then returned to a state such as California where it is illegal. On Monday, the PD, with the underlying aim of firing the resident states they are going to employe the hospital's policy of screening at will. The UDS returns positive for Cannabinoids and the PD states, aha, the resident was engaged in illegal activity and later in the day mails him a formal letter stating they are immediately terminating his contract.

That would be one giant ass of a PD. I hope I don't get him/her.

 

[BrettSnodgrass]

I have never heard of any residency program or hospital taking disciplinary action against a physician or trainee based solely on the presence of a nicotine metabolite. Such a statement is most unusual for someone to care about as cigarettes and other tobacco products, are unfortunately sold at alarming rates to those 21& up in all states.

I am interested to hear about why such a test might concern you. If you eat too much fatty food and ice cream are you also afraid your triglycerides might be too elevated to get a residency position 🙂

[email protected]

 

[Smurfette]

Some residency programs perform a screening UDS on all applicants. For example they did this when I was a resident at CMC.

Recent changes in the legal landscape of this country may pose interesting new ethical challenges related to marijuana. In the past if someone tested positive for marijuana, they would be identified as having committed at least a misdemeanor and were likely dismissed or reprimanded, or other. Now, should and what are the legal ramifications of dismissing a resident who was off for the weekend, went to WA, smoked marijuana, and then returned to a state such as California where it is illegal. On Monday, the PD, with the underlying aim of firing the resident states they are going to employe the hospital's policy of screening at will. The UDS returns positive for Cannabinoids and the PD states, aha, the resident was engaged in illegal activity and later in the day mails him a formal letter stating they are immediately terminating his contract.

If the hospital's policy is that you have to test clean, the location where you used is irrelevant. And even if it's legal everywhere, the hospital could still have a policy (like some do for nicotine) that if you test positive for substance x, you're terminated.

 

[gutonc]

Feel free to get your knickers all twisted about this, but since alcohol drinkers, tobacco smokers and drug users aren't legally protected classes, you have exactly 0 legs to stand on if you fail one of these required tests and get canned as a result.

I mean, you can certainly file a lawsuit about it. But you'll still be residency position free when it finally settles out of court 6 years later.

 

[BrettSnodgrass]

If the hospital's policy is that you have to test clean, the location where you used is irrelevant. And even if it's legal everywhere, the hospital could still have a policy (like some do for nicotine) that if you test positive for substance x, you're terminated.

If the hospital's policy is that your triglycerides must be less than 300, and you are at 301, you're terminated.


[email protected]

 

[Raryn]

...since alcohol drinkers, tobacco smokers and drug users aren't legally protected classes....

That actually depends on your state (for tobacco users at least). There's a good two dozen states (including both yours and mine) that make it illegal to discriminate against smokers.

Note: This is regarding smokers on their own time. Obviously it's perfectly fine to make it against the rules for people to smoke at work/on company time.

 

[evilbooyaa]

If the hospital's policy is that your triglycerides must be less than 300, and you are at 301, you're terminated.


[email protected]

Is this actually a thing or are you trying to employ the 'slippery slope' argument?

 

[gutonc]

Is this actually a thing or are you trying to employ the 'slippery slope' argument?

The latter.