1 Drug Abuse & Alcoholism PRESENTED BY: ROBERT SWOTINSKY M D FOR MEDICAL EXAMINER COURSE P
2 Drugs, Drinking, and Driving CMV drivers - more fatalities than any other occupation. ~2/3rds of CMV driver fatalities involve highway crashes. If a CMV driver crashes after taking a sedative or opioid painkiller, or after drinking alcohol, the drugs/drinking will be deemed causative.
3 Drugs, Drinking, and Risk Fitness is about risk. Drug/alcohol risk is about cognitive impairment and/or sudden incapacitation.
4 Learning Objectives 1. Recognize drug or alcohol use that is disqualifying for CMV driver certification 2. Obtain additional information as needed 3. Recognize special considerations of return to duty exams after treatment for drug or alcohol abuse
5 Regulations - Drugs Qualified if: Does not use a controlled substance identified in 21 CFR Schedule I, an amphetamine, a narcotic, or any other habit-forming drug. Exception. A driver may use such a substance or drug if the substance or drug is prescribed by a licensed medical practitioner who: Is familiar with the driver s medical history and assigned duties; and, Has advised the driver that the prescribed substance or drug will not adversely affect the driver s ability to safely operate a commercial motor vehicle. 49 CFR (b)(12)
6 Regulations Drugs. Qualified if: Does not use a controlled substance identified in 21 CFR Schedule I, an amphetamine, a narcotic, or any other habit-forming drug. Exception. A driver may use such a substance or drug if the Medical Examiner decides it s ok.
7 Case #1. Marijuana use per state law. CMV driver uses medical marijuana in accordance with state law. Q. What is the best course of action for the Medical Examiner to take? A. Disqualify the driver. B. Give the driver a 3-month certification which would allow time for records to be received. C. Give the driver a 1-year certificate after verifying his marijuana use is consistent with state law. D. Give the driver a 2-year certificate after verifying his marijuana use is consistent with state law.
8 Regulations - Alcohol Qualified if: Has no current clinical diagnosis of alcoholism. 49 CFR (b)(12) What is current? Individualized assessment. Relapse is common. DSM V defines: early remission = at least 3 months sober. sustained remission = at least 12 months sober.
9 Crash Risk Increases With BAC ~# drinks BAC % Effects Start to see cognitive impairment, e.g., by testing. No measured increased crash risk. - Under DOT rules, at BAC, the driver is sent home for the day Start to see increased crash risk. - Under DOT rules, at.04 BAC, the driver is removed from driving and referred to substance abuse professional = DUI for personal vehicles
10 CMV drivers are also governed by FMCSA s drug/alcohol regulation FMCSA s drug/alcohol rule (49 CFR Part 382) implements DOT drug/alcohol testing procedures. DOT drug/alcohol tests (Part 382) are separate from DOT physicals (Part 391), even though they may be scheduled at the same visit. A test violation e.g., positive drug test, BAC of 0.04 or above -- means removal from driving and referral to a substance abuse professional (SAP).
11 Disqualifying drugs Regulation 1. Methadone Rationale many decades ago: Heroin abusers are unreliable, i.e., a safety risk. Still applies, even when methadone is prescribed for pain. 2. Insulin 3. Seizure medicines for seizures Guidance 1. Varenicline (Chantix) (linked to crash risk due to possible dizziness, seizures, arrhythmia, diabetes) 2. Warfarin (Coumadin) during 1 st month 3. Modafinil (Provigil) during 1 st 6 wks. (Provigil is indicated for treatment of excessive sleepiness due to OSA, shift work sleep disorder, and narcolepsy. If prescribed for narcolepsy, the driver is disqualified based on the disease.) For other prescribed drugs, the ME makes the decision to qualify or disqualify on a case-by-case basis. This includes buprenorphine (Suboxone), fentanyl, hydrocodone, hydromorphone, morphine, and oxycodone.
12 Guidelines for decisionmaking If the prescribing doctor responds unsafe, the ME should disqualify. If the prescribing doctor responds safe, the ME still makes the final decision qualified or unqualified. This is the current practice and expectation of MEs. (The regulation has yet to be updated.) Be strategic and efficient. Don t ask for the prescribing doctor s opinion if you ve already decided to disqualify. The ME can do a (non-dot) drug and/or alcohol test as part of the exam. Any drug test should include confirmatory tests of screenpositive results. If ME identifies current drug/alcohol use, ME should refer the driver to a substance abuse professional (addictionologist) for treatment.
13 Evaluating drugs and driving Consider the underlying disease/injury. Drugs are prescribed to improve function. Use of amphetamines generally improves driving ability. Evidence of increased crash risk with initial dosing of certain short-acting Schedule II painkillers. Evidence does not identify crash risk from long-term use of painkillers. Evidence of crash risk with benzodiazepines, too.
14 Case #2 What 3 prescription drugs/types of drugs are, by regulation, disqualifying?
15 Yes - Regular, frequent alcohol use Does the driver: Have a consumption pattern that indicates need for additional evaluation? Pass standardized screening questions, e.g., CAGE? Have a history of driver and/or family alcohol-related medical and/or behavioral problems? Have exam findings of alcoholism/problem drinking? Overall appearance and demeanor Tremor Enlarged liver Is the driver taking other medications that may interact with alcohol?
16 CAGE questionnaire Two yes responses indicate that the possibility of alcoholism should be investigated further. 1. Have you ever felt you needed to cut down on your drinking? 2. Have people annoyed you by criticizing your drinking? 3. Have you ever felt guilty about drinking? 4. Have you ever felt you needed a drink first think in the morning (eye-opener) to steady your nerves or get rid of a hangover?
17 Yes - Regular, frequent alcohol use Does the driver: Have a consumption pattern that indicates need for additional evaluation? Pass standardized screening questions, e.g., CAGE? Have a history of driver and/or family alcoholrelated medical and/or behavioral problems? Rehab, AA meetings DUIs Alcohol-related arrests
18 Yes - Regular, frequent alcohol use Exam findings suggestive of alcoholism/problem drinking: Overall appearance and demeanor Odor Tremor Enlarged liver
19 Yes Narcotic or other habit-forming drug use Is the drug use for: Therapeutic or habitual need? To alter mood, affect, or state of consciousness? To extend physical limits by use of stimulants? Does the driver have a history of drug rehabilitation? As a matter of health promotion, even if not disqualifying, the medical examiner should discuss with the driver: Risks associated with OTC diet, energy, and sleep aids Prescription and OTC pain medications Risks associated with combining medications and alcohol
20 Additional information sources 1. Past records of DOT physicals 2. Records from treating provider(s) 3. Discussion with treating provider(s) 4. Substance abuse specialists (distinguish from SAPs)
21 Case #3. Driver in treatment for alcoholism. CMV driver presents for self-pay DOT physical with alcohol on his breath. The ME learns from treating provider that the driver is struggling with alcoholism. 6 weeks later, the driver presents the ME with letter from alcohol rehab center stating he completed IOP treatment and has good prognosis for continued sobriety. What is the best course of action for the medical examiner to take? A. Disqualify the driver. B. Give the driver a 3-month certification which would allow time for records to be received. C. Give the driver a 1-year certificate. D. Give the driver a 2-year certificate.
22 Mental status exam Mini mental status exam Comprehensive and interaction Cognitive impairment Abnormal affect or behavior (depressed, paranoia, antagonistic, aggressiveness)
23 Diagnostic tests and/or referrals (non-)dot drug or alcohol tests, e.g., rapid urine test, breath alcohol test Use of Schedule I drug or use of any non-prescribed controlled substance is disqualifying Breath alcohol concentration >0.04 is disqualifying. But, any detectable BAC at the clinic raises questions. Blood tests for liver-related enzyme levels, e.g., GGT Referral for mental/emotional health assessment, e.g., for co-morbid mental illness
24 History of positive drug/alcohol tests? Breath alcohol technician Designated employer representative, e.g,. for record of past positive drug tests Medical review officer Substance abuse professional
25 Contact treating provider(s) Better for the ME to contact the treatment provider directly. Don t have the driver serve as intermediary. The toughest specialty from which to get information. A signed release is de regueur. Ask for copies of notes, including recent drug/alcohol test results.
26 Case #4. History of alcoholism. CMV driver reports history of alcohol abuse, goes to AA, takes naltrexone, and says he is sober. What is the best course of action for the medical examiner to take? (May select more than 1.) A. Disqualify the driver. B. Withhold determination pending old records. C. Withhold determination pending additional test results. D. Give the driver a 2-year certificate
27 Case #5. Driver on oxycodone and Fentanyl. CMV driver reports taking oxycodone and Fentanyl patches. Should the ME ask for prescribing physician s opinion? Yes If the prescribing physician says he is aware the patient operates a CMV and believes the patient safe to drive, must the ME qualify the driver? No Yes No
28 Treatment and assessment required after a drug and alcohol testing rule violation Separate from any medical assessment (DOT physical) the employer may require, the drug/alcohol testing rule allows the worker to return to driving after a rule violation only if he/she has completed treatment recommended by a substance abuse professional (SAP). The rule violation may be a positive drug or alcohol test, or it may be a refusal to take a required drug or alcohol test.
29 Substance abuse professional (SAP) two roles 1. Gatekeeper for treatment Evaluates drivers who have positive drug/alcohol tests or other violation(s) of DOT s drug and alcohol rule. Refers drivers to treatment; monitors treatment. Recommends type and duration of follow-up testing. 2. Treatment provider Per FMCSA, the medical examiner refers the examinee to a SAP for treatment if a drug/alcohol abuse problem is identified during the DOT physical.
30 SAP as gatekeeper for treatment after drug/alcohol test violation Drug or alcohol test violation 1. Removal from safety-sensitive duty 2. SAP referral SAP initial evaluation of worker SAP recommends treatment Worker gets treatment If SAP determines treatment not complete SAP follow-up evaluation of worker Fail SAP determines treatment is complete RTD subject to 1-5 yrs of follow-up tests, LCA Pass Return-to-duty drug/alcohol test Yes Employer takes worker back SAP letter re: 1. Compliance 2. Follow-up testing No (This refers to the DOT drug/alcohol testing programs, not to DOT physicals.)
31 Fitness-for-duty DOT Physical, e.g., b/o issues of substance abuse Types Return to duty DOT physical after absence, e.g., for drug/alcohol treatment. Fitness for duty DOT physical triggered by information the medical review officer receives whiel interviewing a donor about a positive drug test. Fitness for duty DOT physical triggered by employer concern, Standard forms and exam, but ME should be informed of, and focus on, the issue at hand. As always, can include necessary ancillary testing, e.g, non-dot drug and/or alcohol test. A DOT drug test looks only for amphetamines, cocaine, marijuana, opiates (targeted at heroin), and PCP.
ACOEM Commercial Driver Medical Examiner Training Program Module 8: Drug Abuse & Alcoholism, Medication Use Drug Abuse - 49 CFR 391.41(b)(12)i)(ii)(A)(B) "A person is physically qualified to drive a commercial
CITY OF ESSEXVILLE SUBSTANCE ABUSE POLICY Department of Transportation Regulated Employees (Original Adoption November 29, 1995, Latest Revision November 17, 2008) I. PURPOSE The City of Essexville ( Employer
City of Lincoln Non-DOT Anti-Drug Plan & Non-DOT Alcohol Misuse Plan A. DRUGS I. POLICY OVERVIEW ANTI-DRUG PLAN SUMMARY City of Lincoln (hereinafter referred to as the City) has a vital interest in maintaining
MEDWAY SCHOOL BOARD POLICY DRUG AND ALCOHOL TESTING OF SCHOOL BUS DRIVERS NEPN/NSBA CODE: EEAEAA The safety of our students, employees and the general public requires that our drivers perform their duties
D.O.T. (DEPARTMENT OF TRANSPORTATION) DRUG AND ALCOHOL TESTING POLICY Purpose: Anoka-Hennepin School District #11 realizes the importance of providing a safe and healthy work place and minimizing the risks
Karla Ramirez, LCSW Director, Outpatient Services Laurel Ridge Treatment Center 1 in 4 Americans will have an alcohol or drug problems at some point in their lives. The number of alcohol abusers and addicts
opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 ed #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380 effects of alcohol in the brain 100 Top 30 698 heroin addiction 100
Interview Date: Community Treatment Center 1215 Lake Drive Cocoa, Florida 32922 Phone: 321-632-5958 Fax: 321-632-2533 Do you have a substance abuse problem? Yes No Do you have a mental health diagnosis?
Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction Frequently asked questions What is Naltrexone? Naltrexone is a prescription drug that completely blocks the effects of all opioid drugs
Drug Court EPIDEMIC In the 10 years (1997 2007) the per capita retail purchases of Methadone, Hydrocodone and Oxycodone in the United States increased 13-fold, 4-fold and 9-fold, respectively. 4.6 % OF
8.13 FEDERAL HIGHWAY ADMINISTRATION (FHWA) REGULATIONS ON DRUG USE This policy is adopted in order to comply with federal requirements concerning drug and alcohol testing of employees who hold positions
C o n s u m e r Q & A 1 California Society of Addiction Medicine (CSAM) Consumer Q&As Q: Is addiction a disease? A: Addiction is a chronic disorder, like heart disease or diabetes. A chronic disorder is
EL PASO COUNTY DEPARTMENT OF HUMAN RESOURCES Program for Testing for Alcohol Misuse and Use of Controlled Substance by Drivers of Commercial Motor Vehicles Adopted Date: May 15, 1995 I. Policy- The County
Increasing Issues of Polypharmacy and Off-Label Drug Use in Psychiatric Care Stefan P. Kruszewski, MD Board Certified in Adult, Geriatric, Adolescent and Addiction Psychiatry, and Addiction Medicine Speaker
Drug and Alcohol Testing for Bus Drivers School bus drivers who operate a motor vehicle requiring a commercial driver's license are subject to a drug and alcohol testing program that fulfills the requirements
Drug and Alcohol Abuse Prevention Information Fine Mortuary College (FMC) is committed to providing a drug-free environment for all college students and employees. Under the Drug-free Workplace Act and
Death in the Suburbs: How Prescription Painkillers and Heroin Have Changed Treatment and Recovery Marvin D. Seppala, MD Chief Medical Officer Hazelden Betty Ford Foundation This product is supported by
Drug and Alcohol Use Asset Marketing Services, Inc. Drug and Alcohol Testing Policy (MN) Illegal drug use in the workplace is against the law and highly detrimental to the safety and productivity of our
Drug-Free Workplace Policy and Procedures July 16, 2015 Regional Transit Authority of Southeast Michigan Drug-Free Workplace Policy and Procedures Purpose In compliance with regulations governing anti-drug
Petrol, paint and other Polydrug inhalants use 237 11 Polydrug use Overview What is polydrug use? Reasons for polydrug use What are the harms of polydrug use? How to assess a person who uses several drugs
DRUG TESTING FOR SCHOOL BUS DRIVERS General 1. It is the policy of the Board to establish a program which is designed to aid in the prevention of accidents and injuries resulting from the misuse of alcohol
Facts About Opioid Overdose How Does an Overdose Occur? Opioid overdose can occur when a patient misunderstands the directions for use, accidentally takes an extra dose, or deliberately misuses a prescription
LINCOLN UNIVERSITY Procedure: Confirmatory Testing for Substance Abuse Procedure Number: HRM 113p Effective Date: October 2008 Revisions: Review Officer: Chief Human Resources Officer 1. Purpose 1.1. It
[Minor revision posted 3/7/14 (replaces 1/27/12 edition)] Operating Policy and Procedure : Drug and Alcohol Testing for Safety- and Security-sensitive Positions DATE: March 7, 2014 PURPOSE: The purpose
Opioid Treatment Agreement 1. I understand that my provider and I will work together to find the most appropriate treatment for my chronic pain. I understand the goals of treatment are not to eliminate
NORTHEAST COMMUNITY COLLEGE ADMINISTRATIVE PROCEDURE NUMBER: AP-3237.0 FOR POLICY NUMBER: BP 3237 ALCOHOL AND CONTROLLED SUBSTANCE TEST PROCEDURES FOR COMMERCIAL DRIVER S LICENSE PROCEDURES 1. PROCEDURE
Chapter 18 Driving Under the Influence 18-1 ALCOHOL AND OTHER DRUGS A. Select the word or phrase that best completes each of the following sentences and write the letter in the space provided. 1. 2. 3.
Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction Frequently Asked Questions What is Naltrexone? Naltrexone is a prescription drug that effectively blocks the effects of heroin, alcohol,
X. SUBSTANCE ABUSE/DRUG-FREE WORKPLACE POLICY GENERAL POLICY It is the policy of Scott County to provide safe, dependable and efficient services to the public which it serves. Scott County is committed
guideline for identification and treatment of alcohol abuse/dependence in primary care This guideline is informational in nature and is not intended to be a substitute for professional clinical judgment.
PATIENT TREATMENT AGREEMENT Patient Name: : As a participant in buprenorphine treatment for opioid misuse and dependence, I freely and voluntarily agree to accept this treatment agreement as follows: I
Screening Patients for Substance Use in Your Practice Setting Learning Objectives By the end of this session, participants will Understand the rationale for universal screening. Identify potential health
Kanawha Valley Fellowship Home Client Assessment Form Date: Time: Assessment Taken Caller s Name: Agency (if applicable) Address: County: Relationship to Patient: Phone # Client s Name: Age: D.O.B.: Current
Chapter 16 DRUG & ALCOHOL TESTING Chapter 16 Table of Contents Chapter 16 DRUG & ALCOHOL TESTING... 16-1 DRUG AND ALCOHOL TESTING... 16-3 Testing Program... 16-3 Guidelines and Procedures for Drug/Alcohol
DRUG AND ALCOHOL TESTING OF SCHOOL BUS DRIVERS ADMINISTRATIVE PROCEDURE The RSU 83/M.S.A.D. #13 School Board, hereinafter referred to as the Board, is committed to the establishment of an alcohol and controlled
2.08 DRUG FREE WORKPLACE Cabinet Approval: CHAPTER 2 Board of Trustees Approval: 06/14/89 POLICY 2.08 Revised: 03/12/97 I. PURPOSE To provide: (1) an alcohol / drug free workplace for all employees, (2)
Substance-Related Disorders DSM-V Many people use words like alcoholism, drug dependence and addiction as general descriptive terms without a clear understanding of their meaning. What does it really mean
F 416 Willmar Public Schools ISD 347 ATTACHMENTS TO DRUG AND ALCOHOL TESTING POLICY Attachments A through C are to be used in conjunction with the drug and alcohol testing of bus drivers and driver applicants.
visited on Page 1 of 5 LEARN MORE (HTTP://WWW.NAMI.ORG/LEARN-MORE) FIND SUPPORT (HTTP://WWW.NAMI.ORG/FIND-SUPPORT) GET INVOLVED (HTTP://WWW.NAMI.ORG/GET-INVOLVED) DONATE (HTTPS://NAMI360.NAMI.ORG/EWEB/DYNAMICPAGE.ASPX?
Drug & Alcohol Policy RELIABLE TRUCKING, INC. COMMERCIAL DRIVER PROGRAM 1 2 I. Purpose Statement The purpose of Reliable Trucking, Inc. s Drug & Alcohol Policy is to create, encourage and enforce a safe
SUBOXONE /VIVITROL WEBINAR Educational Training tool concerning the Non-Methadone Medication Assisted Treatment Policy that is Effective on 1/1/12 WEBINAR INTRODUCTIONS Cynthia Parsons- Program Manager
Appendix to Tennessee Department of Health: Tennessee Clinical Practice Guidelines for Outpatient Management of Chronic Non- Malignant Pain Division of Workers Compensation 04.01.2015 Background Opioids
WOOD COUNTY BOARD OF EDUCATION Policy 5160.3 Transportation Employees Alcohol and Controlled Substance Policy Last Reviewed: November 25, 2014 Next Review: November 25, 2016 Section 1.0 Introduction The
Update and Review of Medication Assisted Treatments for Opiate and Alcohol Use Disorders Richard N. Whitney, MD Medical Director Addiction Services Shepherd Hill Newark, Ohio Medication Assisted Treatment
Teen Misuse and Abuse of Alcohol and Prescription Drugs Information for Parents Terminology Misuse: Using a drug in a way in which it was not intended Example: Using a higher dose of medication than was
ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;/13;06/14;07/15 WRITTEN BY Jim Johnson Page 1 REVISED BY AUTHORIZED BY Jessica Moeller Debra Johnson I. APPLICATION: THUMB
Burr Ridge Community Consolidated School District #180 Policy Manual 5:285 Educational Support Personnel Drug and Alcohol Testing for School Bus and Commercial Vehicle Drivers 1 The District shall adhere
Chapter 7 Screening and Assessment Screening And Assessment Starting the dialogue and begin relationship Each are sizing each other up Information gathering Listening to their story Asking the questions
Ever wish you could... Quit using heroin? Protect yourself from HIV infection? Get healthier? Good News: Medical treatments called opioid (oh-pee-oyd) maintenance can help you! Injecting heroin puts you
ALCOHOLISM, ALCOHOL DEPENDENCE AND THE EFFECTS ON YOUR HEALTH. Alcoholism also known as alcohol dependence is a disabling ADDICTIVE DISORDER. It is characterized by compulsive and uncontrolled consumption
9.3 Alcohol and Drug-free Workplace (Corporate Policy) Purpose Xcel Energy has a commitment to its employees, customers, shareholders and the public to promote a safe work environment and to provide energy
Triage, Assessment & Treatment Methadone 101/Hospitalist Workshop Launette Rieb, MSc, MD, CCFP, FCFP Clinical Associate Professor, Dept. Family Practice UBC American Board of Addiction Medicine Certified
Published on OpioidRisk (http://www.opioidrisk.com) Home > Urine Drug Testing Urine Drug Testing This guide provides: Download Entire Guide  Appropriate use of Urine Drug Testing (UDT) to improve patient
Page 1 of 7 700 Kipling Street, Suite 1000 Lakewood, CO 80215 SUBSTANCE ABUSE POLICY AND PROCEDURAL DIRECTIVE PURPOSE To maintain a safe, healthful, and efficient work environment for the Colorado Department
Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence Information for Family Members Family members of patients who have been prescribed buprenorphine/naloxone for treatment of opioid addiction
Driver DOT Drug Free Guidelines Mackay School District #182 In recognition of the harmful effects that the use of illegal drugs and the misuse of the alcohol can have on drivers engaged in the transportation
CLACKAMAS COUNTY EMPLOYMENT POLICY & PRACTICE (EPP) EPP # 51 Implemented: 1/29/08 Revised: 9/1/14; 9/1/15 PRE-EMPLOYMENT DRUG TESTING POLICY PURPOSE: The purposes of this policy are to provide a safe and
COMMERCIAL DRIVER S LICENSE DRUG AND ALCOHOL TESTING POLICY and IMPLEMENTATION PROCEDURES I PURPOSE The Purpose of this policy is to establish programs designed to help prevent accidents and injuries resulting
Appendices to Interim Report on the Baltimore Buprenorphine Initiative Appendix A Managed Care Organization Information Pages Appendix B Buprenorphine Online Physician Training Information Packet Appendix
National Institute on Drug Abuse SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK U.S. Department of Health and Human National Institutes of Health SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK The goal
ALCOHOL AND DRUG-FREE WORKPLACE 6.65 I. Legislative Intent It is the intent of the School Board of Seminole County, Florida (SBSB) to establish a policy that ensures all employees remain drug free as a
Medication Assisted Treatment for Opioid Addiction Tanya Hiser, MS, LPC Premier Care of Wisconsin, LLC October 21, 2015 How Did We Get Here? Civil War veterans and women 19th Century physicians cautious
Planning, Design and Construction 14528 S Outer Forty Suite 100 Chesterfield, MO 63017 (314) 628-3494 (314) 628-3715 Substance Abuse Prevention Program REFERENCES: In an effort to create a safe workplace,
FAQ' s on Alcohol Abuse and Alcoholism It is important to understand that these answers are not meant to provide specific medical advice, but to provide information to better understand the health consequences
DOUGLAS COUNTY GOVERNMENT POLICY FORM SUBJECT DRUG-FREE WORKPLACE TITLE DRUG-FREE WORKPLACE POLICY NO. HR.6.10 APPROVAL DATE 1/1/11 REVISION DATE 9/1/12 PURPOSE: DEPARTMENT RESPONSIBLE: DEPARTMENT(S) AFFECTED:
CITY OF WICHITA SUBSTANCE ABUSE POLICY PURPOSE The City of Wichita has a public trust to provide a variety of services to the community. An efficient and productive workforce is vital to fulfill that responsibility.
Table of Contents I. Introduction... 2 II. Summary... 3 III. Charts A. Total Drug Intoxication Deaths... 5 B. Opioid-Related Deaths... 9 C. Heroin-Related Deaths... 11 D. Prescription Opioid-Related Deaths...
Alcohol Overuse and Abuse ACLI Medical Section CME Meeting February 23, 2015 Daniel Z. Lieberman, MD Professor and Vice Chair Department of Psychiatry George Washington University Alcohol OVERVIEW Definitions
SAMPLE DRUG AND ALCOHOL POLICY (MISSISSIPPI) DRUG AND ALCOHOL POLICY DISCLAIMER WARNING!!! The attached Drug and Alcohol Policy is being furnished to you as a courtesy. Stonetrust Management Services highly
Federal Motor Carrier Safety Administration Mandated Drug and Alcohol Testing Program Definitions: Accident, for purposes of this policy, is as an incident involving an employee whose job responsibilities
Non medical use of prescription medicines existing WHO advice Nicolas Clark Management of Substance Abuse Team WHO, Geneva Vienna, June 2010 firstname.lastname@example.org Medical and Pharmaceutical role Recommendations
Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A Disclaimer: This speaker has no financial disclaimers to report.
CAGE In the past have you ever: C tried to Cut down or Change your pattern of drinking or drug use? A been Annoyed or Angry because of others concern about your drinking or drug use? G felt Guilty about
DEPARTMENT OF PSYCHIATRY 1153 Centre Street Boston, MA 02130 Who We Are Brigham and Women s Faulkner Hospital (BWFH) Department of Psychiatry is the largest clinical psychiatry site in the Brigham / Faulkner
Pain and problem drug use Information for patients Prepared by the British Pain Society in consultation with the Royal College of Psychiatrists, the Royal College of General Practitioners and the Advisory
CHARLES & SUE S SCHOOL OF HAIR DESIGN DRUG AND ALCOHOL POLICY DRUG AND ALCOHOL POLICY; SUBSTANCE ABUSE RESOURCES: At Charles & Sue s School of Hair Design, the illicit use of drugs and/or alcohol by staff
The ABCs of Medication Assisted Treatment J E F F R E Y Q U A M M E, E X E C U T I V E D I R E C T O R C O N N E C T I C U T C E R T I F I C A T I O N B O A R D The ABCs of Medication Assisted Treatment
DRUG TESTING & BACKGROUND CHECK Pfizer s Drug Testing and Background Check Requirements for Contingent Workers and Suppliers, Including Criminal and MVR Record Checks, FDA Debarment Database and DEA Controlled
Washington University is committed to maintaining a safe and healthful environment for members of the University community by promoting a drug-free environment as well as one free of the abuse of alcohol.
Office-based Treatment of Opioid Dependence with Buprenorphine David A. Fiellin, M.D Professor of Medicine, Investigative Medicine and Public Health Yale University School of Medicine Dr. Fiellin s Disclosures
Contractor compliance with the Alcohol & Drug Program Rigorous. Respectful. Ready. Table of contents Cenovus s commitment 1 Expectations of our contractors 2 Prevention 5 Impaired driving 6 Testing and
PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications Primary Care & Specialist Prescribing Guidelines Introduction Partnership HealthPlan is a County Organized Health System covering
Urine Drug Testing Methadone 101 Methadone for hospitalists Dr. Patricia Mark MB, BCh LEARNING OBJECTIVES Clarify the purpose of urine drug testing Distinguish between UDT for detection of illicit drug