How those with substance abuse and mental health issues are dealt with would be far better without the profit motive that infects healthcare as a whole. The cozy arrangements that guarantee both referrals and appropriate diagnoses are evidence of the addictions industry gone awry. See the previous post on this Recovery forum that discusses this re: Michigan HPRP. Instead, give people the option of seeing a practitioner of their own choosing and accepting those recommendations without trying to strong arm them into giving a diagnosis that is going to bring the licensee to an affiliated treatment center. Do not force someone to sign a contract.
While I'm at it, stop calling these programs "voluntary". If one has a choice of getting their license disciplined or sign a contract then it is NOT voluntary.
Stop treating those with substance abuse or mental health issues like criminals. They have an illness, help them to get the issues addressed without being punitive and without the "one size fits all" approach. Make the contracts, if they are indicated, truly individualized. Make people aware of what things can potentially cause false positives, but if there is one, GIVE THE NURSE THE BENEFIT OF THE DOUBT and run the test again. Set the cutoff limit in the Etg to a reasonable level and don't try to trip people up. The monitoring contracts are difficult enough without people having caseworkers and medical review officers treating them like they have relapsed before having it double checked. There ARE people that have come out positive and have not relapsed. Do not assume that people who get a "Dilute" or "Abnormal" reading have tried to tamper their specimen. Give them instructions on how they can hydrate themselves appropriately, first, and be nonjudgmental until proven otherwise. Even medical professionals might not know how 12 oz of water might affect a urine sample. I didn't. Most people don't give a second thought to what effect their fluid or food intake might have on a drug test. So stop assuming a person has relapsed until it is confirmed.
Have financial assistance and real advocacy available for those that cannot afford the fees associated with these contracts, fees for drug testing, doctors, counselors, therapists, etc. Remember that the nurse who isn't working because he or she has been ordered not to, might not have another source of income and might not have insurance to cover the costs. Meet people half way.
Have flexible options available for recovery groups. Not all people respond to the AA/NA message. Allow SMART Recovery and other groups.
Don't set up conditions that are impossible for people to reasonably fulfill. The goal with these programs should be to both protect the public AND help the affected person to be treated for their illness, allowing them to practice safely-in a holistic, not punitive, manner.
Set up statutes of limitations where records of discipline on governmental websites can be expunged after a time if the licensee involved has been able to practice without further incident. Once the licensee is eligible for removal, then it is extended to national databases.
Do not make a licensee who has completed monitoring, complied with all the terms required of them by a regulatory agency, and demonstrated safe practice, go through it all again, for the same incident in another state the individual applies for licensure to. If the discipline is similar to what would've happened in one state, then license the individual and give them a chance to actually start over.
Best yet? Have independent audits and review boards with a real grievance process for monitoring programs, licensing boards, etc that will actually listen to the licensee.