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Workshop - Drug Testing: Best Practices

Workshop - Drug Testing: Best Practices. Greg Skipper, MD Michael Kaufmann, MD. At the end of today’s workshop:. We will have a shared understanding of the concept of a “Best Practices” in PHP drug testing document;

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Workshop - Drug Testing: Best Practices

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  1. Workshop - Drug Testing: Best Practices Greg Skipper, MD Michael Kaufmann, MD

  2. At the end of today’s workshop: • We will have a shared understanding of the concept of a “Best Practices” in PHP drug testing document; • We will have blueprint suggestions for the categorical content of the document; • We will have suggestions for specific content for the document; • We will have good ideas regarding the format and stewardship of such a document; • We will have direction for next steps in the production of this document.

  3. Consider: • Elements of a “best practices” document must include: • Elements that ought to be included • Elements that don’t need to be included • Where further information or research is required before a decision regarding inclusion can be made • Content not discussed today that you think ought to be included

  4. Drug Test Panels • Components – • Fixed vs Variable Panels? • Based on DOC? • How and when to vary? • Naltrexone – Other therapeutic meds, (Psych etc.) • Alternative substrates • Hair, nails – for security? How often? Saliva? • Dipsticks? Use in the “field” or office? • Cutoffs – arbitrary, as low as possible?

  5. Collection • Supervised? • Witnessed? • Observed? To what degree? • DOT protocol? (empty pockets, remove jacket and outer clothing, have no access to water in bathroom, etc..) • Enforced and if so how? • QA?

  6. Frequency & Duration of Testing • What type of random testing? Define • When to suspend? Vacation? Evidence? • Should the pattern change after relapse and if so how? • Duration of testing? • Who should decide frequency, duration, change after relapse? PHP, Evaluator, Tx Provider?

  7. TPAs • Is having the TPA provide the PHP management software a good idea? • Is it a conflict of interest for programs to mark-up the price for a drug test and take profits? • Registry for TPAs • FSPHP authorized? Accredited?

  8. Ethanol Monitoring • EtG,EtS, pEth – (i.e. cutoffs, EtG immunoassay, normalization to creatinine 100, warning regarding products to avoid, confirmation of drinking with PEth, • Protocol for use with EtG that “proves drinking?” • SCRAM/TAD – transcutaneous monitors • Home/work photo/voice recognition breathalyser

  9. Interpretation Issues • Dilute urine • Missed check-in • Missed tests • False positives and negatives • Second hand exposure • Out of range: temp, pH • Invalid test • Consequences for each?

  10. Best Practices “Document” • What should this document be called? • Best Practices, guidelines, other? • What will be the format for this “document”? • Published paper • Pamphlet • Digital • Web-based • Some form of Wiki document • other • How will this document be produced? • How will this document be maintained? • How will this document be distributed? • Who will oversee validity?

  11. Participants on Prescribed Drugs • How to designate test (positive, negative, other) when on legitimate prescription • How to certify legitimacy • Valid prescription from any licensed MD • Require evaluation by PHP authorized MD • Never allow • Other

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