Delayed Action
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 profes-
sionals 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 sus-
pension 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 license—or 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 health-
care provider. Healthcare facilities and regulatory boards are sensitive to the
need to maintain confidentiality during the handling of the allegation and sub-
sequent 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 harm-
ful to the substance abuser and violates the ethical responsibilities of the health-
care 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
Drug testing is the most common method used to detect if a person has taken med-
ication 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 immedi-
ate levels found can determine what treatment should occur. Screening to deter-
CHAPTER 4 Substance Abuse^67