Delayed Action - Pharmacology

Drug abuse in the healthcare field can go undetected because of the structure of the healthcare industry. Healthcare providers may be less supervised than in other industries. For example, physicians work independently and come under scrutiny only in a healthcare facility setting. Furthermore, healthcare professionals have the capability to self-diagnose and to self-treat and may not have another provider complete an objective assessment which might reveal substance abuse. Acknowledging substance abuse may put the individual at risk of suspension or revocation of the license to practice.

There can also be a “white wall of silence” among healthcare professionals when it comes to reporting a colleague for substance abuse. Although they want to help their colleague, no one wants to be responsible for a colleague losing his or her licenseor expose themselves to inadvertently making false accusations. Silence is not the right course of action. First, there is an ethical obligation to report suspected abuse to protect patients who are being treated by the healthcare provider. Healthcare facilities and regulatory boards are sensitive to the need to maintain confidentiality during the handling of the allegation and subsequent inquiry. Second, the addicted person actually becomes a patient and should be given the best and most appropriate care. That care includes treatment for the addiction. Keeping silent about suspicion of addiction is actually harmful to the substance abuser and violates the ethical responsibilities of the healthcare provider.

Substance abuse is considered a handicap. Therefore, the healthcare provider who is employed by a healthcare facility may be protected by state and federal employment discrimination laws such as the Rehabilitation Act (29USC, Section 706). This Act requires employers to continue employment of a substance abuser as long as the employee can perform their job function and is not a threat to safety or property. This means that the healthcare provider’s responsibility might be temporarily reassigned until treatment is completed.


Drug testing is the most common method used to detect if a person has taken medication recently. Many businesses, government agencies, and healthcare facilities require prospective employees to be screened for drugs. In addition, employees might be required to undergo random drug testing or drug testing under special circumstances (such as medication unaccounted for in their work area).

Testing for drug overdose or poisoning is best done with blood. The immediate levels found can determine what treatment should occur. Screening to deter- mine if someone is using drugs inappropriately is commonly done with urine testing. Urine testing can detect drugs used days or even a week before the test is performed. As false positive and false negative results can occur, caution should be used when interpreting the results. When asked if they are taking any kind of medication, individuals should include prescription, over-the-counter, and herbal remedies. For example, traces of diphenhydramine (Benadryl)a commonly used antihistamine medicationwill be found in urine and will cause the person to test positive for methadone.

Whenever the result of a urine test is found to be positive for drugs, the person should undergo another test for that specific medication to confirm the results. The second test is used to identify a false positive that might be generated by the first test. Again, urine testing is done but the request is to screen only for the specific drug identified in the first test. Blood levels may also be obtained to determine immediate use of drugs.

Drug testing only gives evidence that the individual has used or been exposed to a drug but does not indicate any pattern of drug use or the degree of dependency. Table (Days substances remain in urine) shows the length of time that traces of popular drugs remain in the body. The most commonly misused and abused drugs are listed in Table (The most commonly misused and abused drugs as reported by the NationalSurveillance Agency Drug Abuse Warning Network (DAWN).) .

Days substances remain in urine.

Table : Days substances remain in urine.

The most commonly misused and abused drugs as reported by the NationalSurveillance Agency Drug Abuse Warning Network (DAWN)

Table: The most commonly misused and abused drugs as reported by the NationalSurveillance Agency Drug Abuse Warning Network (DAWN).

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Pharmacology Topics