positive drug screens for illicit substances
in january 2003, the board issued an interpretative statement on the ability of the nurse to deliver safe care while using controlled or illicit substances. the statement recognizes that any controlled substance found in an individual’s system may impair that individual’s ability to safely and competently practice nursing.
beginning may 1, 2003, the board began a pilot project for dealing with individuals who test positive for an illicit substance. for purposes of the project, an illicit substance was defined as any drug contained in schedule i or schedule vi of the controlled substances act of north carolina, or any drug for which the nurse cannot provide a legitimate prescription.
during the pilot project, all positive drug screens (except pre-employment) for illicit substances were reported to the board. all specimens had to have a chain of custody and a medical review officer review (mro). if the specimen was determined to be positive, the nurse was given the opportunity to admit to a problem and enter the alternative program for chemical dependency; or to have an evaluation by an addictionologist to determine whether or not a problem exists; or to follow the formal discipline process and be issued a letter of charges. the board developed a specific sanction for those individuals that tested positive for an illicit substance. (see attached illicit drug sanction).
in may 2004, based on the results of the pilot project the board adopted the project as a permanent program. the data from the project clearly illustrated that earlier intervention for those individuals with a substance abuse problem was occurring. of the 51 individuals in the pilot project, 37 of them entered the alternative program. of those 37, 6 admitted they were already diverting substances in the workplace but had not been detected.
beginning july 1, 2004, all positive, chain of custody drug screens including pre-employment must be reported to the board of nursing. a copy of the drug screen report should be submitted with the name and certificate number or social security number of the nurse. additionally, attached to the drug screen should be a copy of the chain of custody and the mro report.
- when the board receives the report and all relevant documentation is present, the licensee will be contacted and offered the option of entering the alternative program (if the licensee admits to a chemical dependency problem). if the licensee denies a problem, but still wishes to attempt resolution of this matter, the licensee may voluntarily surrender their license pending an evaluation by an addictionologist. if the addictionologist diagnoses a problem with substance abuse, the licensee must enter the alternative program or the license will be suspended for a minimum of 1 year or until the guidelines for 1 year of sobriety are met.
if substance abuse is not diagnosed, the licensee will be reinstated with the illicit drug sanction. successful completion of the program occurs when the licensee has practiced for 1 year without additional positive drug screens.
- if the licensee denies a chemical dependency problem, contests the integrity of the drug screen submitted from the agency, and/or declines the offer to enter the alternative program/cddp, a letter of charges will be issued with the following offer:
- the license is suspended until such time as he/she has an evaluation by a board approved addictionist. if the licensee is diagnosed with chemical dependency, the licensee will be monitored consistent with the requirements for cddp/alternative program for 3 years.
- the licensee must comply with all recommendations of the evaluator. the results of the evaluation must be submitted to the director of compliance for appropriate action(s).
- the licensee must immediately enroll in ncps (the board’s body fluid and screening program).
- following receipt of the evaluation with no diagnosis of cd and evidence of complying with any recommendations, the licensee will be reinstated with standard probationary conditions for one (1) year.
- full compliance occurs for the licensee with no diagnosis of chemical dependency when the licensee successfully completes one year of probationary conditions.
- a licensee may self-report at any time for participation in this process, if they test positive for an illicit substance.
faqs1. should all drug screens be reported?
yes, the board will conduct the investigation to determine if further action is warranted. this includes, but may not be limited to: pre-employment, for cause, random, post accident, etc.
2. if the agency has its own program for employees that test positive for drugs, must they be reported?
yes, this is both an employer issue and a licensure issue. each case will be carefully evaluated to determine appropriate action, but all cases must be reported.
3. who is a medical review officer?
a professional mro is a licensed physician who is an expert in drug and alcohol testing and the application of federal regulations to the process.
4. what is a chain of custody specimen?
a chain of custody is a legal designation that defines the circumstances under which the specimen was collected and insures no tampering occurred.
(for specific information on how to collect a chain of custody specimen, contact the reference laboratory used by your agency.)
5.is it public information if an individual is reported for positive drug screens?
if the nurse admits a problem and enters the board’s alternative program for chemical dependency, the information will not be published unless the nurse violates the contract for participation.
if the nurse is issued the illicit drug sanction prior to a letter of charges, the information will not be published unless the nurse violates the contract for participation.
if a nurse denies a problem, is issued a letter of charges and is subsequently found in violation of the nursing practice act, this is considered a formal action and will be reported.
6. who pays for the addictionist evaluation and the drug screens?
the nurse is responsible for the cost of the evaluation and drug screens.
7. how does this affect me if i am a “recreational drug user” and not a substance abuser?
this policy does not discriminate between these two individuals. the interpretative statement states the use of any controlled substance may impair one’s ability to safely practice nursing. in issuing this statement, the board is stating they believe in zero tolerance for the presence of illicit substances in a licensed nurse’s system while delivering care.
keep in mind it is illegal to use or possess drugs in schedules i and vi of the north carolina controlled substances act (g.s. 90-89 and g.s. 90-94). additionally, remember it is illegal to use a prescription medication not prescribed for you.
8. what if i have a legitimate prescription for a controlled substance and it shows on a drug screen?
the mro report will distinguish the legitimate positive screens.
9. can i take my legitimate prescription for a controlled substance and work?
that is a decision for the nurse, their physician and the employer. however, the nurse cannot work if the substance impairs the nurse’s ability to function.