It is reasonable to avoid ordering tests if they will not change a patient’s management. If you wouldn’t change their medication treatment plan, then don’t order the test. <\/p>\n\n\n\n
When to Test for Nacotics in the Nursing Home?<\/h2>\n\n\n\n
Drug testing may be of importance in the management of patients:<\/p>\n\n\n\n
- With known or suspected diversion of medication for substance use disorders.<\/li>
- Who present in-person to a treatment facility with symptoms and signs of intoxication or withdrawal.<\/li>
- With a self-reported or otherwise identified overdose.<\/li>
- With significantly unstable opioid and\/or other substance use disorders.<\/li><\/ul>\n\n\n\n
Testing for confirmation is important when you have a patient not responding to treatment or concerned about diversion. <\/p>\n\n\n\n
According to SAMSA, drug testing for routine purposes is not recommended at this point.<\/em><\/p>\n\n\n\n
What to Test<\/strong><\/h2>\n\n\n\n
Testing patients can include the following:<\/p>\n\n\n\n
- Amphetamines<\/li>
- Barbiturates <\/li>
- Benzodiazepines<\/li>
- Opiates<\/li>
- Marijuana<\/li>
- Codeine <\/li>
- Cocaine<\/li>
- Carisoprodol<\/li>
- Fentanyl analogues<\/li>
- Methadone<\/li>
- Meperidine<\/li><\/ol>\n\n\n\n
Testing for the presence of alcohol can be conducted by breath, saliva, blood, or other accepted testing methodology. To check out a list of common medications in the nursing home read this article (What are the commonly used medications in the nursing home?<\/a>). <\/p>\n\n\n\n
Discrimination<\/strong><\/h2>\n\n\n\n
Federal law prohibits skilled nursing facilities from discriminating against protected classes. Show caution when deciding who you drug screen and never base it on their race, color, religion, age, sex, or other protected characteristic. <\/p>\n\n\n\n
In other words, do not decide whether you drug screen people based on their race, color, religion, age, sex, or any other protected characteristic.<\/p>\n\n\n\n
Nursing home residents have a right to be treated with dignity and respect.<\/p>\n\n\n\n
Consent to Test<\/strong><\/h2>\n\n\n\n
Usually, a medical provider does not ask a patient to consent before sending urine or blood for testing.<\/p>\n\n\n\n
In most cases, it may be a good idea to let your patient know ahead of time that you will be testing them for controlled substances. This is done in hopes of maintaining trust and a solid patient\/provider relationship.<\/p>\n\n\n\n
There will be times when you are unable to review the reasons for the drug testing. In times like this, it will be vital that you discuss the results with them in a confidential manner and explain your reasoning.<\/p>\n\n\n\n
Some insurances may not cover random drug screens, leaving the patient with a bill for the testing. If there is concern about diversion, abuse, or misuse, the prospect of a bill should not deter you from testing. <\/p>\n\n\n\n
If a patient doesn’t consent to drug testing, use this as an opportunity to discuss addiction, treatment options, and coming up with an alternative treatment that doesn’t involve controlled substances. <\/p>\n\n\n\n\n
<\/div>\n\n\n\n\nCommon Terms<\/strong><\/h2>\n\n\n\n
Controlled Substance<\/em>: A drug or other substance that the government controls because it may be abused or cause addiction. Controlled substances are regulated under the Controlled Substances Act.<\/p>\n\n\n\n
Impairment<\/em>: signs and symptoms of impairment include<\/p>\n\n\n\n
-Physical: poor appearance\/hygiene, sweating, headaches, tremors, diarrhea, restlessness, slurred speech, unsteady gait, etc.<\/p>\n\n\n\n
-Psychosocial: mood fluctuations, inappropriate verbal or emotional responses, irritability, confusion, memory lapses, isolation, lack of focus, lying, etc.<\/p>\n\n\n\n
-Performance: feeling sick frequently, errors in judgment, deterioration in performance, non-compliance.<\/p>\n\n\n\n
Consent to Testing:<\/em> The patient gives verbal or written consent for drug testing. They are not required in all states. <\/p>\n\n\n\n
Federal Protections<\/strong><\/h2>\n\n\n\n
Patients sometimes quote federal regulations, “Confidentiality of Alcohol and Drug Abuse Patient Records.” to prevent medical providers from ordering drug screens. These regulations were meant to protect patients in drug rehab programs, not nursing homes and medical offices. <\/p>\n\n\n\n
In 1995, DHHS revised the definition of the kinds of “programs” subject to the regulations, making it clear that the regulations do not usually apply to a general medical care facility unless that facility (or person) “holds itself out as providing, and provides, alcohol or drug abuse diagnosis, treatment or referral for treatment” (42 CFR \u00a72.11). <\/p>\n\n\n\n
In most primary care settings, these federal protections regarding drug screening do not apply but consult an attorney. These rules cross into a gray area if a health care practice includes someone whose primary function is to provide substance abuse assessment or treatment and if the practice benefits from “Federal assistance.” In this case, the facility must comply with Federal law and regulations and implement special rules for handling information about patients who may have substance abuse problems.<\/p>\n\n\n\n
False Positive Drug Test in Nursing Home<\/strong><\/h2>\n\n\n\n
Practitioners need to be aware of false-positive drug screens when testing the patients in the nursing home. Sometimes the drug screen can pick up the substances that are part of the drug, triggering a false positive. <\/p>\n\n\n\n
San Diego-based “Biosite,” the company that makes the widely used screening test, confirmed Protonix is one of two medications that their test can mistake for marijuana.<\/p>\n\n\n\n
Even eating poppy seeds can cause a positive morphine or codeine test when using older testing methods. What out for all those poppy seed bagels. However, results usually only last for a day after eating poppy seeds in high enough quantity. Phentermine could raise a false red flag in your drug screen if you don\u2019t have a medical reason for taking amphetamines. WebMD<\/a><\/p>\n\n\n\n
Other drugs that may cause false-positive results to include but are not limited to:<\/p>\n\n\n\n
- Rifampin<\/li>
- Sertraline (Zoloft)<\/li>
- Cannabidiol (CBD)<\/li>
- Diphenhydramine<\/li>
- Efavirenz (Sustiva)<\/li>
- Quetiapine (Seroquel, Seroquel XR)<\/li>
- Chlorpromazine <\/li>
- amantadine (Osmolex ER)<\/li>
- bupropion (Wellbutrin XL)<\/li>
- ibuprofen, naproxen, tolmetin (NSAIDs)<\/li>
- Labetalol and Verapamil <\/li>
- Promethazine (Phenadoz, Promethegan)<\/li>
- trazodone (Desyrel)<\/li><\/ol>\n\n\n\n
Medical providers should be aware that specific metabolites of drugs can be misinterpreted as another controlled or illicit substance. <\/p>\n\n\n\n
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