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Substance Abuse Evaluations for Impaired Practitioners

72-hour Substance Abuse Evaluation

Most states have laws regarding the mandatory board reporting of medical practitioners who have substance abuse problems. As an exception to this mandatory reporting, several states, including Ohio, offer a one-time exception given proper treatment, monitoring, and continued sobriety. When a practitioner, such as a dentist, medical doctor, nurse, veterinarian or another licensed medical professional, is found to have a substance use issue, they are required to enter into a treatment contract facilitated by various agencies. In Ohio, the organization responsible to assist in this process is the Ohio Physicians Health Program.

A frequent part of this treatment contract is a 72-hour substance abuse evaluation. The duration of this evaluation can vary by state. For example, Kentucky requires a 96-hour evaluation. However, the procedure of this evaluation is the same regardless of the duration. The Ridge is an approved provider recognized by boards in Ohio such as The Ohio State Dental Board, The Ohio Pharmacy Board, The Ohio Veterinary Medical Licensing Board, and other Ohio medical licensing organizations.

The Ridge is an Approved Provider for These Assessments

The Ridge is one of only a handful of providers in Ohio privileged with this recognition. This 72- hour assessment will help referrers, professional organizations and prospective clients make sound clinical decisions for people who are unsure if they need addiction treatment or the level of care they may require. These assessments will evaluate:

  • Substance abuse disorder, including alcohol
  • Co-occurring mental health disorders
  • The need for detox if any
  • The appropriate recommended level of care for the patient

This service is provided in our premier residential facility. This setting has several advantages for the prospective client.

  • The serene location allows for complete immersion for the evaluation time period
  • Comfortable amenities
  • Healthy, hearty meals
  • 16 patient maximum census
  • Non-hospital setting with advanced clinical care
  • 24-hour care including room and board
  • Participation in our daily treatment schedule with other Ridge patients
  • Introduction to support groups and aftercare options

The Ridge’s 72 Hour Substance Abuse Evaluation Procedures and Services Include:

  1. Comprehensive substance abuse evaluation by a licensed counselor.
  2. Comprehensive medical history and physical examination by one of our board-certified physicians.
  3. Point-of-care alcohol breathalyzer, and urine drug testing followed by a comprehensive forensic urine drug testing using liquid chromatography and mass spectrometry at our drug testing lab.
  4. Forensic urine testing detects alcohol glucuronide (EtG) and alcohol sulfate (EtS) which detects alcohol use within the past 3-5- days.
  5. Comprehensive blood testing which includes a complete blood count, comprehensive metabolic profile, pancreatic enzymes if indicated, testing for HIV and or hepatitis A, B, C if indicated. We can also do a phosphatidylethanol (PEth) test on blood, which can detect significant alcohol consumption in the past 21 days.
  6. Hair analysis can be done which will detect most of the major drugs of abuse for up to 90 days.
  7. Comprehensive initial psychiatric evaluation (IPE) by a board-certified psychiatrist.
  8. Comprehensive nursing assessment.
  9. Collection of collateral information (upon written consent from the patient) from significant others in the patient’s life that can shed light on the patient’s substance use/abuse.
  10. 72-hour observation for any signs of physical withdrawal that typically develop in the first 24-72 hours.
  11. Medication that can be administered for withdrawal, if deemed appropriate by the attending physician. Patients usually know if they will have withdrawal if they drink or use heavily.
  12. Participation in The Ridge’s educational program, individual and group counseling program with all other Ridge patients.
  13. Appropriate referrals made for treatment (outpatient, residential, etc.) if indicated at the end of the 72-hour evaluation. This includes any necessary follow-up in the patient’s home environment or no recommendation for treatment if our determination is that the patient doesn’t qualify for a diagnosis of a substance use disorder.
  14. Room and board at The Ridge for 3 nights, which is an upscale, comfortable experience – unlike being in a hospital.
  15. Ability to attend daily 12-step meetings. The patient would attend open meetings so even someone who doesn’t yet qualify for a diagnosis of abuse or dependence can go without embarrassment. At these open public meetings, the patient does not have to talk nor have to say “Hi, I’m John and I’m an alcoholic”.

 

This 72-hour assessment program is often part of Ohio’s “One Bite Rule”. Under this rule, a physician may escape board intervention. The OSMB [Ohio State Medical Board] allows a carve-out that circumvents mandatory reporting of a physician in many circumstances. The physician’s associates and colleagues can be excused from their mandatory reporting duty regarding substance abuse if residential treatment is completed with a board approved treatment provider such as The Ridge. There are other statutory requirements, such as 104 sessions of aftercare, which also must be met. So long as the physician completes these achievable, yet rigorous requirements, the individual can escape board intervention and maintain their licensure.

This “One Bite Rule” is codified by statute for resident physicians, podiatrists, anesthesiology assistants, and physician assistants. Though the law applies to those disciplines, the spirit of the law and the exceptions provided by it have been codified through statute, or board policy statement by many Ohio state medical licensing boards. The following boards all have formally recognized this exception:

 

The Ohio Physicians Health Program [OPHP] facilitates monitoring, documentation of continued sobriety and program participation to support the physicians return to medical practice.

The Ridge can assist by providing a substance abuse evaluation, treatment, and ongoing aftercare which meet the rigorous and fair requirements provided by the OPHP. As a recognized provider we have experience working with OPHP and other boards. We are also a patient advocate and enjoy helping our patients get back on track into a happy, sober lifestyle.

Sources:

https://www.ophp.org/one-bite-rule

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704134/

Ohio Medical Board One Bite Rule Policy Statement