1. Introduction
Urine drug testing has repeatedly proven to be an effective monitoring and rehabilitation tool in both managing drug addicted health professionals and assuring the Board that practitioners about whom they may have received concerns regarding self administration, do not abuse prescribed or illicit substances. This Urine Drug Testing (UDT) policy has been developed to inform doctors of the Board's expectations and to ensure maximum consistency in the day-to-day running of the Program.
A doctor participates in the Medical Board's urine drug testing program because a condition to do so has been imposed on his/her registration as the result of a hearing or inquiry.
Overall responsibility for decisions regarding the collection and testing protocol, and progress through the testing groups rests with the Board through the Health Committee.
Doctors must bear the cost of urine drug testing (collection and testing). As a medico-legal investigation, it cannot be funded by Medicare.
The Board is aware that urine drug testing is inconvenient, intrusive and expensive. However, it is the only quantitative means by which the Board can be assured that an impaired doctor is well enough to be maintained in active practice.
Breach of a condition relating to urine drug testing in accordance with the Board's protocol can result in the Board taking disciplinary action against the doctor, as well as directly affecting progress through the Health Program.
Negative tests are the best available evidence that an impaired doctor has their substance abuse problem under control, provided this protocol has been adhered to.
2. Collection and Testing.
Collection and testing must be in accordance with the Australian Standard and meet its chain of custody requirements. The New South Wales Medical Board's provider of urine drug testing services is PaLMS (Pacific Laboratory Medicine Services) Toxicology Unit.
2.1 Collection
Doctors have three options in arranging supervised collection of urine samples:
- Supervised collection at a PaLMS collection facility. A list of locations is contained in the section titled PaLMS Collection Sites on page 5.
- Collection supervised by a supervisor approved by the Board, using postage paid collection kits provided by PaLMS to the approved supervisor. (Supervised collection guidelines can be found on page 6 in the section titled Supervised Collection Guidelines.) Kits can be obtained by contacting PaLMS on telephone (02) 9887 5666. You will be invoiced for the collection kits by PaLMS.
- Collection supervised by another pathology provider approved by the Board. Collection centres of PaLMS's competitors are often prepared to supervise collection, and forward the sample to PaLMS Toxicology Unit for testing. Most pathology providers will have collection kits that satisfy the Asutralian Standard.
2.2 Testing
In accordance with Australian Standard AS/NZS 4308, drugs routinely tested for include cannabis, opiates (morphine and codeine), cocaine amphetimine and benzodiazepines. In addition, specimens are tested for pethidine and tramadol. In certain cases, a doctor's condition may require their urine sample be tested for additional drugs.
3. Testing Protocol
Doctors undertaking urine drug testing are expected to strictly comply with these requirements.
3.1 General Requirements
- Within seven days of the introduction of a condition requiring urine drug testing, the doctor is required to advise the Board of the location of the PaLMS facility to be attended or the name and address of the nominated supervisor or other pathology centre.
- The doctor is required to meet the cost of testing by paying PaLMS directly. The doctor may also incur costs for the collection supervision.
- Urine samples are to be collected under direct supervision according to the protocol detailed in the section titled Supervised Collection Guidelines on page 6.
- Testing results must be forwarded both to the New South Wales Medical Board, the treating medical pratitioners and the Board-nominated practitioners.You may find it helpful to also have the results sent directly to yourself, in order to monitor any difficulties PaLMS Toxicology Unit may be having with your samples.
- Doctors undertaking Urine Drug Testing are prohibited from self administering any drugs detailed in Schedule 1 (of the Drug Misuse and Trafficking Act), Schedule 4 or Schedule 8 (of the Poisons and Therapeutic Goods Act). This includes any narcotic derivatives, non-prescription compound analgesics or cold medications unless prescribed and taken at the direction of a treating practitioner. The participant must notify the Board of any instance of illness requiring the administration of medications described above. In addition, the participant should provide the Board with written confirmation of such treatment from the treating practitioner.
- When consumed in a sufficient quantity, poppy seeds may result in the presence of morphine and codeine metabolites in the participant's urine. Participants subject to a condition that requires them to attend UDT should actively avoid the consumption of any food containing poppy seeds. Tests showing metabolites for a known drug of addiction, for example morphine, may result in the Board either convening an Impaired Registrants Panel to inquire into the matter or referring the matter to the Conduct Committee for formal disciplinary action.
- Doctors must advise the Board of any surgical procedures that they are required to undergo which may involve the administration of drugs. Where administration of drugs has occurred in an emergency situation, the doctor must advise the Board as soon as practicable in the circumstances. In addition, the doctor must provide the Board with written confirmation of such treatment from the treating practitioner.
3.2 Thrice Weekly Testing
- Testing is conducted on Monday, Wednesday and Friday of each week. It is not acceptable to present on other days in lieu of routine collection days without prior approval.
- The decision to vary testing from thrice weekly to random can only be made with endorsement from the Board. This decision will be made by considering the recommendations from the Board-nominated psychiatrist and the Board Review Interview Panel. The decision will also be affected by aspects of the Healh Program Decision Parameters.
3.3 Random Urine Drug Testing
- Random Urine Drug Testing means a minimum of 15 tests in each consecutive period of six months. The timing of the collection will be determined by the Medical Board secretariat.
- The doctor is required to telephone the free-call 1800 number each day to ascertain whether they are required to attend for testing. The doctor must attend on the specified day.
- The following number must be called Monday to Friday between Midnight & 5pm.
1800 654 068
- Cessation of Urine Drug Testing can only occur with approval of the Medical Board. This decision will be made by considering the recommendations from the Board-nominated practitioner and the Board Review Interview Panel. The decision will also be affected by aspects of the Health Program Decision Paramters.
3.4 Absence from testing
- Doctors are required to advise the Board, in writing, at least five business days before any anticipated absence. [Fax (02) 9816 5307 or E-mail (nswmb@nswmb.org.au) notifications are acceptable]. Only under extraordinary circumstances will permission be given for a doctor to abstain from testing on certain days on a routine basis. In those situations the doctor may be required to undertake urine drug testing on the required days when they are available and also undergo an additional monthly hair drug test.
- Doctors are required to provide evidence of their absence (eg, boarding passes, hotel receipts).
- The doctor is not required to provide a urine sample on a public holiday.
3.5 Missed tests
- If a doctor is aware that he or she has missed a test, he/she must immediately notify the Board in writing and provide an explanation. The doctor may also be contacted by the Board and asked to provide a written explanation. Explanations may be considered by the Health Committee, which may view the matter as a breach of conditions and recommend disciplinary action.
3.6 Positive tests
- Any doctor who returns a positive test will be required to provide a written explanation. That explanation, together with any additional information obtained from the testing laboratory, may be considered by the Health Committee. The Committee may view the matter as a breach of conditions and recommend disciplinary action. If the participant is subjected to random drug testing, the Committee may also resolve to require the participant to return to thrice-weekly urine drug testing.
3.7 Dilute samples
- The Board considers a test to be dilute when the urine creatinine is below 2.0 mmol/Lt. Dilute urine suggests that the doctor has consumed a large volume of water prior to passing the urine, or that there has been adulteration of the sample after collection. This renders the test invalid as drug metabolites may be diluted to concentrations below testing detection levels.
- If dilute samples are received, the doctor will be notified in writing and requested to take the necessary steps to avoid further dilute samples.
- Should further dilute samples be received, the doctor will be notified in writing and required to provide a written explanation. That explanation will be placed before the Health Committee. The Committee may view the matter as a breach of conditions and recommend disciplinary action.
3.8 Sample substitution
- The Board may, at any time conduct any test on a urine sample as may be required to determine whether the sample has been substituted. Any participant who returns a result indicating sample substitution will be notified in writing and required to provide a written explanation. That explanation, together with any additional information obtained from the testing laboratory, will be placed before the Health Committee. The Committee may view the matter as a breach of conditions and recommend disciplinary action.
| Address | Telephone |
Royal North Shore Hospital | Clinic 13, Level 3 Pacific Highway St Leonards | 9926 7557 |
North Shore Private Hospital | Ground Floor PaLMS Collection Suite Westbourne St St Leonards | 8425 3066 |
Hornsby Ku-Ring-Gai Hospital | Near Main Entrance Palmerston Rd Hornsby | 9477 9537 |
Mona Vale Hospital | via Level 2 Coronation Street Mona Vale | 9998 0278 |
Manly Hospital | via West Wing Darley Rd Manly | 9976 9686 |
Ryde Hospital | via Main Entrance Denistone Rd Eastwood | 9858 7542 |
4. Advice to Supervisors
- Supervisors should be familiar with all aspects of the Medical Board's Urine Drug testing Protocol, as well as the medical and behavioural consequences of drug addiction.
- Supervisors should maintain a purely doctor-patient relationship with the doctor undertaking urine drug testing.
- Supervisors should generally be available to supervise collection, and ensure that in their absence, an alternative supervisor is available and informed of the Board's requirements. The responsibility of actually securing an alternative supervisor is that of the participant.
- Payment for supervised collection is to be directly negotiated between the supervisor and the doctor concerned.
- The Board is appreciative of the service supervisors provide, but supervisors should be aware that failure to comply with the supervised collection guidelines may be viewed unfavourably by the Board. Supervisors are strongly advised not to cut any corners.
- Supervisors should contact the Medical Board on (02) 9879 2200 and speak to the Board's Monitoring Corodinator if there are any queries or concerns.
5. Supervised Collection Guidelines
Supervisors must maintain a permanent record of specimen collection. The record is to comprise of the date of the specimen, the nature of the specimen, the serial number on the specimen seal and the supervisor's signature. Copies of this record, or part thereof, must be made available to the New South Wales Medical Board on request. It may also be pertinent for the participant to maintain their own diary that he/she has signed by the supervisor on each occasion.
If the collection protocol is adhered to correctly, including the collection procedure and preparation for dispatch set out below, there can not be an opportunity for the urine specimen to be adulterated, substituted or diluted by the participant. Similarly, the urine container and the request form will be correctly completed if the protocol is adhered to. The information recorded on the request form must be identical to that recorded on the urine container.
5.1 Collection procedure
The following procedures will ensure that unadulterated specimens are obtained and correctly identified. Every effort should be made to minimise the number of persons handling specimens.
a) After washing hands, the participant shall remain in the presence of the supervisor and not have access to any water fountain, tap, soap dispenser, cleaning agent or any other materials that might be used to adulterate the specimen.
b) The participant shall provide the specimen under direct supervision. Direct supervision means the supervisor must witness the passing of the urine from the urethra to the container. This may include video supervision, where such facilities are available.
c) Upon receiving the specimen, the supervisor shall determine that there is a sufficient sample to enable all required testing to be performed. A sample of at least 20mL must be collected for a full drug screen to be undertaken. In the event that an insufficient amount is provided, an additional sample must be collected. PaLMS Toxicology Unit recommends that two specimens are taken for medico-legal drug testing.
d) Immediately after the specimen is collected, the supervisor shall inspect the urine specimen to determine its colour and look for any indication of adulterants or diluents. Any unusual finding should be noted in the supervisor's record.
e) If the validity of the sample cannot be established, or if it is suspected that the specimen may have been adulterated or substituted, then another specimen shall be collected as soon as possible and both forwarded to the laboratory for testing. These specimens shall be labelled and documented appropriately.
f) Both the supervisor and the participant shall keep the specimen in view at all times prior to it being sealed and labelled.
g) The supervisor shall request that the participant observe the transfer of the specimen and the placement of the tamper-proof seals over the bottle cap and down the sides of the bottles. The donor shall sign the seals.
h) After the specimen has been provided and submitted to the supervisor, the participant shall be allowed to wash his/her hands.
5.2 Preparation for dispatch by the Supervisor
The supervisor and the participant shall be present during the steps (a) to (e) of the following preparation for dispatch procedures.
a) The supervisor shall securely place labels on the bottle. The label should list the date of collection and a minimum of two identifiers for the participant. One of these must be the name, and the second an ID which may be the participant's date of birth.
b) The supervisor shall enter the date and time of supervised collection into their record and sign the record.
c) The participant shall be asked to read and counter-sign the record.
d) The supervisor shall complete the request form. The supervisor must record the participant's name, and ID, as well as the date and time when the sample was collected. The name and ID must appear identical to the entries on the urine container.
e) The urine bottles and the request form are now ready for shipment by the supervisor. If the specimens are not immediately prepared for transport, they shall be appropriately safeguarded and refrigerated during temporary storage. Postage should occur as soon as possible. At no stage should the specimen be in the custody of the participant.
f) While any part of the above chain-of-custody procedures is being performed, it is essential that the urine specimen(s) and request form are under the control of the supervisor.
5.3 Transportation to the Laboratory
a) The supervisor shall place the specimen(s) and request form in the containers provided.
b) The containers shall be securely sealed to eliminate the possibility of undetected tampering.
c) The supervisor shall arrange postage to the laboratory.
