failed drug test by First Lab

allnurses Guide · Dec 28, 2009

I think that is something you'd have to discuss with your BON. Did they not explain what the process would be for a positive test?

jackstem · Dec 30, 2009

Depending on the cutoff level for the lab, there are numerous household products as well as other things that can cause a positive test for Etg (Ethyl Glucuronide).

No laboratory test is ever 100% accurate. Since labs hire human beings, and humans are known to make mistakes every now and then, there is always room for error. Other factors can change the EtG results. The excerpt below is from the Medical Laboratory Observer.

"Using regression analysis, this study shows that age, gender, marijuana use, kidney disease, and total grams of alcohol consumed 30 days before sample collection are the variables that most significantly influenced EtG levels. Another recent report warns that urinary-tract infections may lead to false-negative EtG results.31 Regarding sample storage, when urine is stored at 4°C in airtight tubes, EtG concentrations remain relatively constant, but storage of ventilated vials at room temperature for five weeks results in an average of 37% increase in EtG.32"

Also, the Alabama Medical community received this advisory when dealing with EtG positive results...

"The following updated advisory has been developed in response to questions from monitoring programs and regulatory boards regarding EtG testing:
- No laboratory test is 100% accurate. Clinical correlation is always important.
- Some individuals appear to produce more EtG for a given exposure to ethanol than others. This is probably associated with a known genetic polymorphism in the human UDP-glucuronyl transferase enzyme system. The exact limits of this variation are not known.
- A positive EtG is not necessarily proof of intentional alcoholic beverage consumption. Low level positive tests are known to occur due to incidental exposure. The cutoff for possible incidental exposure vs. intentional use has not been accurately established, due to many factors including; amount of "incidental" exposure, individual metabolism, hydration, kidney function, etc..
For the above reasons it is advisable, whenever possible, to refrain from taking action against an employee or licensee based on urine EtG testing alone. When a positive EtG test is reported, if alcohol use is denied, we encourage the use of clinical evaluation by a Medical Review Officer and Addiction Medicine specialists to more fully assess the meaning of a positive test. We encourage Boards, Courts, and/or Employers to include expert opinion involving thorough clinical evaluation to help interpret positive test results."

SAMHSA (Substance Abuse and Mental Health Services Administration) has produced an Advisory regarding this issue. You can read it hear and download the PDF file as well. Here is a quote from the advisory:

Currently, the use of an EtG test in determining abstinence lacks sufficient proven specificity for use as primary or sole evidence that an individual prohibited from drinking, in a criminal justice or a regulatory compliance context, has truly been drinking. Legal or disciplinary action based solely on a positive EtG, or other test discussed in this Advisory, is inappropriate and scientifically unsupportable at this time. These tests should currently be considered as potential valuable clinical tools, but their use in forensic settings is premature.

There are also some class action lawsuits going on with numerous health care professionals involved.

As part of a monitoring program for recovering health care professionals, drug screening is an important component. However, if the test being utilized has significant concerns about it's accuracy, there MUST be additional methods of monitoring which either support or refute the test for ETG. Basing serious legal consequences on one single lab test has some very real concerns.

Here is a list of products to avoid (it's by no means a complete list):

http://ethylglucuronide.homestead.com/IncidentalExposure.pdf

PM me if you have questions.

Jack

MizChelleRN · Dec 31, 2009

WOW. As usual, Jack, you have left me scratching my head and saying, WOW. You are truly a fountain of knowledge. I wish I was for my community what you are for yours.

That being said, I remember during my ALternative program rules interview she advised me against some of these products, especially hygeine and household products. But of course all that was a blur of anxiety from what I remember. Now I know why. I'm so so so SO sorry brownimr that you are going through this. I have an example of a story where in my program I was accused of something I didn't do, and had to pay the consequences as if I had done it, but I'll tell that story when I have a little more time. (wait, did I pretty much just tell it? I'll elaborate later, plus what I have learned from it might help you too)

I guess I would say try not to come off as accusatory, like YOUR test is bogus, etc. or overly defensive I guess is what I meant. It may look like you are hiding something. Surely your level was really low. Call your case worker or whoever is your contact person with the board and let them know you are confused about this, what needs to be done, let them know you HAVEN'T been drinking. I guess try to come off pro-active rather than wait for them to call you and confront you about it. Surely you aren't the only one they've seen, who really isn't drinking, whose levels were just as low(probably minute) and they might shrug it off once or give you some benefit of the doubt (I hope that didn't come across too Molly Sunshine, no I'm not that jaded, I know the board tends to be a little more steadfast and strict than that) Have you been in their program long and have a long standing of clean time?

Best of luck to you. Please let us know what happens next. But know that you have really helped ME (and probably lots of others today) by letting us know what to be careful of. I know I will re-evaluate my products. Heck, I knew from rehab not to use Listerine and started using it again. I figured they didn't want to trigger me with the alcohol and I thought that sounded silly. (alcoholic mind thinking!)

Gotta run, will check back later. Thanks again Jack. xo

jackstem · Dec 31, 2009

WOW. As usual, Jack, you have left me scratching my head and saying, WOW. You are truly a fountain of knowledge. I wish I was for my community what you are for yours.

HAH! There are those in this community who would (and have) disagree with you on my "knowledge". But what the heck...you can't please everyone. My guess is you are an excellent resource and role model for your community. (Local community? Work community? ) The way I see it, we could be bitter about the twists and turns of our lives, or we can use those twists and turns to help others following behind us. Sharing our experience, strength, and hope are what our time on this rock in space is for, isn't it?

Prayers for everyone in this community and all the other communities out there!

Let's make 2010 one of the best years in recovery!

Jack

RecoveringRN · Jan 1, 2010

A close friend of mine is a diabetic and would show positive for alcohol.

foraneman · Jan 2, 2010

Do we know whether this was an EtG positive or an actual alcohol positive? I agree with Jack regarding EtG. Many BONs have stopped using it because of the myriad of false positive issues. If this WAS EtG, (and even a regular alcohol screen) and you were not drinking, I would fight tooth and nail, and LOUDLY proclaim my innocence. If the BON takes action demand an evidentiary hearing rather than sign off on any new/additional penalties AND bring an attorney experienced in defending nurse before the BON. Depending on the state you are in, and the mode of the BON, your license could well be REVOKED (don't mean to scare you, but you have to take this VERY seriously and be aggressive in your defense.) BONs have little interest in determining anything beyond the fact that you have been reported as positive for alcohol. YOU are the ONLY on who will be working to clear your name.

moonmaid50 · Jan 3, 2010

my license is suspended and i call into first lab daily for random screening. i recently showed up positive for alcohol. not that i have to convince anyone, but i have not consumed any alcohol in over a year. anyhow, does anyone know what will happen now. am i going to permanently lose my license?

ask for a confirmation test to include etg. it's your right to get another test on the same urine. that's why the split samples are done. contact the testing company now & get your request moving. there are such things as false positives and by doing an etg it will do a breakdown on the metabolites of ethyl alcohol. bear in mind it's going to cost you but the peace of mind is priceless.

low levels(

foraneman · Jan 4, 2010

My license is suspended and I call into First Lab daily for random screening. I recently showed up positive for alcohol. Not that I have to convince anyone, but I have not consumed any alcohol in over a year. Anyhow, does anyone know what will happen now. Am I going to permanently lose my license?

Again, was this an EtG, or was it a regular alcohol screen. Big difference.

murseb · Jan 30, 2010

I recently lost a nursing job due to cut backs and reorganzation of the schedule. Being stressed out due to no work, a new child, and accumulating bills my Ulcerative Colitis flared up badly. Normally if i was working i wouldnt do this because of the random testing; but i used some MJ to help relieve my symptoms (dont care what some of u might think, it does help with abd. pain, N&V, lowers anxiety, helps with BMs). That being said, im not trying to be an advocate for MJ being legal and all that. Personally dont care whether it is or not, but it sure would be better than the synthetic drugs they give me for my UC (that have numerous side effects). My point to this post is i went to apply for a new job and they gave me a preemployment drug screen on the spot at the first interview. I really didnt even want this job as i had another one in mind all ready. But thinking i may have wanted this one for PRN or a backup plan, i submitted my urine for the test. It was 2 weeks prior that i used the MJ and of course my luck there were traces of THC found in my urine. It was a mistake on my part i know, but im not a routine user so thought nothing of it at the time. Well i didnt get that job, but even worse they submitted those results to Ohio Board of Nursing. Now they sent me a letter questioning this positive drug screen and want me to complete this narrative paper explaining what happened. Just dont get it though, i went for the next job preemployment approx a week later and i passed the drug screen and got the job. Additionally my RN school gave all the students a mouth swab at the start of term in January and i passed that as well. Im really worried whether i will lose my license over this even though it was a one time usage. I dont plan on using it again because i do want to succeed as a nurse and its more important to me.

exnursie · Jan 31, 2010

I recently lost a nursing job due to cut backs and reorganzation of the schedule. Being stressed out due to no work, a new child, and accumulating bills my Ulcerative Colitis flared up badly. Normally if i was working i wouldnt do this because of the random testing; but i used some MJ to help relieve my symptoms (dont care what some of u might think, it does help with abd. pain, N&V, lowers anxiety, helps with BMs). That being said, im not trying to be an advocate for MJ being legal and all that. Personally dont care whether it is or not, but it sure would be better than the synthetic drugs they give me for my UC (that have numerous side effects). My point to this post is i went to apply for a new job and they gave me a preemployment drug screen on the spot at the first interview. I really didnt even want this job as i had another one in mind all ready. But thinking i may have wanted this one for PRN or a backup plan, i submitted my urine for the test. It was 2 weeks prior that i used the MJ and of course my luck there were traces of THC found in my urine. It was a mistake on my part i know, but im not a routine user so thought nothing of it at the time. Well i didnt get that job, but even worse they submitted those results to Ohio Board of Nursing. Now they sent me a letter questioning this positive drug screen and want me to complete this narrative paper explaining what happened. Just dont get it though, i went for the next job preemployment approx a week later and i passed the drug screen and got the job. Additionally my RN school gave all the students a mouth swab at the start of term in January and i passed that as well. Im really worried whether i will lose my license over this even though it was a one time usage. I dont plan on using it again because i do want to succeed as a nurse and its more important to me.

I STRONGLY encourage you to consult with a healthcare lawyer, IMMEDIATELY IF you want to avoid BON monitoing and possible permanant dicipline hx on your license.

As much as you want to minimize this, it is illegal to smoke pot, and your reason will not fly with them. I am guessing that they will require an evaluation for addiction, and go from there. OH is one state that does not let things slide, and they also tend to report this to the legal system, leading to criminal drug charges also.

MizChelleRN · Jan 31, 2010

Hi mursb...I'm from Ohio myself, and am with the Alternative program. So ask me anything about that process if you like. I'm having a really positive experience, for what that's worth. Plus, I was more than guilty with what I was doing, but anyways. It can be a really stressful experience, but what exnursie said, it is still illegal and they are pretty much a no-tolerance state. Keep us posted about what happens. Good luck!!!

Oh and I assume you should probably fill in your current employer, how unfortunate the timing there, but you really don't want them to find out from the board first. Hugs to you. xo