Participant procedure: drug screening

This procedure explains to NSW health professionals and students with drug screening conditions imposed on their registration how to participate in drug screening. It does not apply to Psychology. There are separate policy and procedure documents for the Medical Council and the Nursing and Midwifery Council.

Purpose

If you have drug screening conditions on your registration, this procedure explains how to:

• prepare for screening
• give samples at the required times
• get your results
• manage any absences you need to take
• apply to decrease your screening.

Compliance context

You must comply with this procedure and:

• our Drug screening policy
• any drug screening conditions on your registration.

If a condition on your registration is inconsistent with this procedure or the Drug screening policy, the condition prevails.

We will decide all aspects of screening, including how often you need to attend. Our monitoring team will monitor your compliance.

Key information

We use urine drug screening and hair drug screening to monitor NSW health professionals and students where there is a history of or concerns about substance misuse or dependence. We do this to protect the public.

We understand that providing samples can be inconvenient, intrusive and expensive. However, negative drug screening results are an effective way for us to know you are not affected by substances and can continue safely in practice or training.

Responsibilities

Definitions and abbreviations

Preparing for screening

Timing

Start date. If you must attend urine drug screening, you need to start within seven (7) days of the condition being placed on your registration. If you must attend hair drug screening, we will tell you the start date.

Frequency. We will advise how often you must attend drug screening both when the condition is placed on your registration and if your conditions change. The table below outlines the requirements for each type and frequency of screening.

Public holidays. If you must attend three (3) times a week urine drug screening you do not need to attend for screening on public holidays (as defined in the Public Holidays Act 2010 (NSW)). But you must attend the next business day after the holiday. If you must attend random urine drug screening you do not need to call the Council random screening phone number on a public holiday.

Extra screening. We may require you to attend for extra screening if we are concerned you are not complying with this procedure, the related policy or any drug screening conditions on your registration, or believe you may have used a substance. We will advise when you need to attend for extra screening. You may need to attend on a weekend.

What to avoid

Substances. We have all urine and hair samples screened for the substances listed in Appendix A.

Prescribed substances and over-the-counter preparations. Some prescription medicines and over-the-counter preparations may cause positive screening results. It is your responsibility to avoid these while you are attending for screening.

Do not self-administer any of the following unless advised or prescribed, and taken at the direction of a treating practitioner:

• prescribed substances
• narcotic derivatives
• non-prescription compound analgesics
• cold and flu medicines.

If you need to take any of these substances due to an illness, procedure or emergency, you must:

• notify us within five (5) business days, or as soon as practicable in an emergency
• send us written confirmation from the treating practitioner of the event and any substances advised, prescribed or administered.

You must vigilantly check any over-the-counter preparations you take, including supplements and complementary medicines. You must review the ingredient list for any substance that may cause a positive result. If the exact ingredients are not listed or you are unsure, you must avoid the preparation.

Some food and drink. Ingredients in foods and drinks can cause positive results. Before you eat or drink anything, carefully check that it does not include ingredients that may cause a positive result. If you cannot find out its exact ingredients, you must avoid it.

Do not eat food that contains poppy seeds. You cannot use poppy seed consumption to explain a positive screening result.

Do not drink too much water before you attend for urine drug screening, as this can dilute your sample and cause an unsatisfactory result.

Giving samples

Collection centres

You must attend a Council-approved collection centre for screening. Contact your nominated collection centre to confirm their opening hours and the time you need to attend.

Alternative arrangements. We must approve any alternative arrangements, and will only do so in exceptional circumstances. If you cannot attend a Council-approved collection centre, you must:

• write to us explaining why
• propose an alternative collection arrangement
• ensure that we receive this proposal as soon as possible, noting that for urine drug screening you must start screening within seven (7) days of the condition being placed on your registration.

These arrangements must meet all our collection and screening requirements, and can include collection by a local registered medical practitioner, nurse or pathology provider. You are responsible for any additional costs that may be incurred.

Sample collection and handling

Urine. If you are giving a urine sample it must be collected under direct supervision. The collector will stand in front of you and directly observe the urine passing from the urethra into the container. Samples are otherwise collected and handled in line with the Standard.

Hair. If you are giving a hair sample, your hair must be at least 3 cm long and free from hair products. The collector will cut a pencil-width section of hair from as close to your scalp as possible.

All samples. You must not handle your specimen at any time during the collection.

Forms

Drug screening request form. We will provide you with Drug screening request forms. You must complete the participant section of this form at every collection. You must complete this form correctly or the pathology provider may not screen your sample.

On the form, you must write down:

• any substances (prescribed or otherwise) you consumed since your last sample collection
• which parties need your results, including us, your treating practitioner and your Council-appointed practitioner
• whether you want your results sent to you and any relevant group e.g. professional indemnity insurer.

Chain of custody. Every sample must have an accompanying chain of custody form, completed in line with the Standard.

For a urine sample, this must state:

• how the sample collection was supervised
• the sample temperature, recorded within 4 minutes of collection
• the urine creatinine result.

For a hair sample, this must state whether your hair is chemically treated (permed, dyed or bleached) and free from hair products.

You must ensure the collector completes this form, and you must sign it when the sample is collected. We recommend you also keep your own sample collection records and ask the collector to sign them each time.

Costs, identification and privacy

Payment. You are responsible for all collection and screening costs, including any confirmatory testing. You must pay the collection centre when you attend for screening. If you cannot pay when you attend, the centre cannot collect a sample. We will consider this a missed screen. Screening is not eligible for a Medicare rebate.

Proof of identity. You must show government-issued photo identification, such as a valid driver licence, identity card or passport, to the collector each time you give a sample.

Pseudonyms. If we approve, you can use a pseudonym for screening. You must write to us and provide your:

• proposed pseudonym
• real name and photo identification
• consent to provide the pseudonym to all treating practitioners and Council-appointed practitioners who may receive your screening results.

The collector must verify your real identity each time you give a sample.

Getting your results

Recipients

The pathology provider will send your results to the parties nominated on your Drug screening request form. You can also request a copy for yourself and any relevant group e.g. professional indemnity insurer.

Positive or unsatisfactory results

Positive urine drug screening result. A urine drug screening result is positive if both of the following apply:

• it shows your sample contains a substance listed in Appendix A
• a treating practitioner has not confirmed they advised, prescribed or administered that substance.

In some cases your sample may be tested again to confirm the result. You are responsible for the cost of any confirmatory testing.

Positive hair drug screening result. A hair drug screening result is positive if both of the following apply:

• it shows your sample contains a substance listed in Appendix A
• a treating practitioner has not confirmed they advised, prescribed or administered that substance.

Dilute urine samples. A dilute urine sample has a creatinine level below 1.76 mmol/L. If your urine drug screening result shows you provided a dilute sample, we will notify you and ask you to take the necessary steps to avoid further dilute samples.

Unsatisfactory results. The following table lists unsatisfactory results for each type of screening.

If you receive an unsatisfactory result, we will ask you for a written explanation, and use your explanation and information from the pathology provider to decide whether to take further action.

Managing absences and operational issues

Absences from screening

All absences. You must follow these procedures when taking leave from practice. If you take leave, we may also require your employer or accreditor to confirm your leave period, and verify your absence from practice with Medicare.

You must continue to screen during absences from practice, except in the circumstances specified below. If you are absent and do not follow these procedures we may take further action, particularly if your absences follow a pattern.

Planned absences. If you intend to take a planned absence from practice, you must:

• complete our Leave from screening form
• ensure we receive this at least five (5) business days before your planned absence.

If you are undergoing urine drug screening, you must meet the following requirements:

If you are undergoing hair drug screening and plan to be absent on the date you must attend for screening by, you must attend before you leave. We will use the date you attend to recalculate your next screening date.

Unplanned absences. If you have an unplanned absence from urine or hair drug screening, you must meet the following requirements:

Operational issues

Random screening phone number issues. If the random screening phone number is not working when you call, you must note the time you called and tell us immediately. We will tell you whether you need to attend for screening that day. The next day, call the random screening phone number as usual. If we don’t expect the issue to be fixed by the next day, we will tell you what to do.

Pathology provider issues. If the Council-approved collection centre cannot collect your sample, you must:

• tell us immediately
• attend for screening no later than the next business day
• send us the pathology provider’s written explanation for why they could not collect the sample, within five (5) business days.

Ending your screening

Decreases

Decreasing your screening. We will decide when you need less frequent screening or a different type of screening.

Requirements. We will only consider decreasing your screening if you meet the requirements below. Unless there is a material change to your circumstances, you must meet the minimum time periods.

Reviews. You can request a review of your screening requirements by writing to us and providing evidence to support this request.

Considerations. We will decide whether to decrease your screening based on factors such as:

• your request and the evidence you provide
• your drug screening results and other information from the pathology provider
• reports from your Council-appointed practitioner, treating practitioner and any interview or hearing with us
• your compliance with the conditions on your registration
• your engagement with treatment
• your health
• any other information about your progress.

Contacts and further information

Legislation and references

We have a range of fact sheets providing information about drug screening.

Related policies

Drug screening policy

Appendix A – Substances to be screened

Adapted from AHPRA – Drug and Alcohol Screening Protocol – Registrant Information (October 2017). 

_{* Will require further expert advice in each case. QML routinely screen for a range of other substances – the full list of substances screened can be found on their website for urine and hair.}