Substance Use Disorder Policy

PURPOSE
To outline processes and systems that are in place to ensure a drug-free and safe learning and work environment for all

AUDIENCE
All medical students

LCME STANDARD
3.5 Learning Environment/Professionalism

POLICY

  1. The School strives to provide a safe and healthy learning and work environment for our medical students and staff. All staff (including student employees) and students are encouraged to seek assistance, as appropriate, from employee support programs, health centers and counseling or psychological services available at University locations or through referral. Additionally, the School’s faculty and students must also ensure the safety, health and welfare of the patients who are served by the University of California Health System.
  2. The School is opposed to substance use and prohibits the use, unlawful possession, distribution, and illegal use of drugs and/or alcohol by students. This policy is intended to delineate disciplinary sanctions that the School may impose on students who are suspected, or accused of, being under the influence of alcohol or illegal substances.
  3. In any situation where student responsibility for patients is required, or when interacting with peers and /or instructors, the student may never be under the influence of illicit drugs, including alcohol and cannabis. Of particular concern is the unauthorized use of drugs to which the student may have privileged access. Such drug misuse is a violation of societal trust and is viewed by the profession as an especially grave offense. The student who endangers patients or others through the use of alcohol or drugs, or who violates the trust of the special position granted to them, is subject to disciplinary action through the School, independent of any action which may be taken by other authorities. Students who use drugs that produce physical dependence or students who excessively use alcohol or cannabis may have associated, serious psychological problems requiring additional consultation.
  4. We recognize that medical students may bring with them, or develop, alcohol, cannabis, and other psychoactive drug use patterns and behaviors that may be diagnosed as substance use disorder. The School is committed to a program that will assist impaired students in regaining their health while protecting the well-being of patients as well as classmates, faculty, staff, residents, and fellows.

Routine Alcohol and Drug Testing:

  1. Routine alcohol and drug testing: A critical part of medical education involves learning experiences in hospitals and other health care facilities. Use of these facilities in training is essential, and students must be able to complete their assigned rotations. Many hospitals and health care facilities have policies requiring drug testing and/or criminal background checks for employees, students and volunteers. Facilities that provide instruction to the School’s students may have, or may adopt in the future, drug testing and/or criminal background check policies. Some facilities mandate that students who test positive for drugs, or who have certain types of information in their criminal background checks, are ineligible to work in their facility.

    Students who test positive on a routine drug test will be referred to the Associate Dean for Students, who will review their test results. If a student refuses evaluation or consent to share the results of this evaluation, they may be subject to disciplinary procedures including eligibility of recommendation for dismissal.

    Any questions or concerns about routine drug testing may be shared confidentially with the Associate Dean for Students.

  2. For cause testing: To ensure compliance with institutional policies and to promote a safe and healthy work environment, the School may require students to submit to drug and/or alcohol testing “for cause” based upon reasonable suspicion of problematic substance use, the unauthorized use or possession of alcohol on campus or at a health care setting, or the use of or possession of illicit drugs at any time. Reasonable suspicion of problematic substance use may be based upon, but is not limited to, the following criteria:
    1. Direct observation of drugs or alcohol use or possession and/or demonstration of physical symptoms of the influence of drugs or alcohol
    2. A pattern of abnormal or erratic behavior, consistent with problematic alcohol or drug use
    3. Arrest or conviction for a drug or alcohol related offense; identification as the focus of a criminal investigation into illicit drug use, possession, or trafficking
    4. Evidence that a student has tampered with a previous drug or alcohol test
    5. Possession of drug paraphernalia

Reporting persons must contact the Associate Dean for Students and should document the exact reason why they suspect a violation. Every effort should be made to document the behavior and how the behavior is affecting the student’s performance. The reporting person should make every effort to document the specific facts that would lead a reasonable person to the conclusion that the student was using or was in possession of illicit drugs or unauthorized alcohol. Whenever possible, corroborating statements from other administrators, faculty, employees, or students as well as patients should be obtained. The use of the Observations of a Potentially Impaired Employee form is recommended. (Access through the UC Davis Health Policy Manager online system. Manuals, Administrative and Clinical Policy Attachments, Administrative Policy 2909 – Drug Free Workplace: Suspected Employee Impairment)

If the student’s behavior impacts academic performance or results in professionalism lapses, the Committee on Student Promotions (CSP) will be notified. If, in the judgment of CSP, and/or the Associate Dean for Students, a student is perceived to have had academic or professional difficulties arising from suspected drug and/or alcohol use, CSP can vote to require drug testing for the student. In such instances, the report would come back to the Associate Dean for Students and to CSP.

While awaiting definition of the facts of an alleged or established violation and of its significance, the Associate Dean for Students must notify the student of the charges.

If in the judgment of the Associate Dean for Students, the student represents a clear and present danger to self or others, the Associate Dean for Students may take immediate steps to suspend the student. The Associate Dean may also take additional steps that, in their judgment may be necessary to minimize hazards to the student or to others, including securing emergency professional assistance. The Associate Dean for Students may also notify the School's legal counsel if appropriate.

Problematic Substance Use Self-Identification:

The administration and faculty wish to assist students before they develop academic or legal problems related to alcohol and drugs. When a student is self-referred for treatment or counseling and has no academic or professionalism issues, no official report is made unless specific permission is granted by the student. Patient-physician confidentiality is carefully guarded. Students who wish to receive assistance may be referred to non-UC Davis affiliated providers by the Director of Wellness, the Associate Dean for Students, the Vice Dean for Medical Education, or by individual faculty members.

The School encourages students who have developed problematic substance use problems to voluntarily identify themselves and to seek immediate treatment.

  1. A student who voluntarily self-identifies as having a substance use disorder may be permitted to continue their current course of study without suspension, provided:
    1. This self-identification occurs PRIOR to any incident that is grounds for suspension or dismissal under institutional policy.
    2. The student immediately enters and satisfactorily participates in an approved treatment program for problematic drug or alcohol use. The student will agree to engage in a contract with the School that allows monitoring of participation in an approved treatment program.
    3. The student’s conduct and academic performance remain consistent with the demands of the curriculum and profession.
  2. A student who voluntarily self-identifies as having a substance use disorder and who, by their own admission, by the testimony of an approved substance use counselor, or by the determination of institutional authority is no longer capable of acceptable academic and professional conduct will be required to take a medical leave of absence from the School. Nothing in this paragraph will preclude the School from suspending, dismissing, or taking other appropriate action against the student for unacceptable academic performance or lack of professional conduct.

Notification of Arrests/Convictions

Students must notify the School of any drug or alcohol related arrests or convictions within 72 hours after charge of an offense. Failure to do so and subsequent notification during a required background check may result in disciplinary action including dismissal.

PROCEDURE

  1. Testing: When the determination to test for cause has been made, the student will be given instructions on how to obtain their drug screening for collection of urine sample to test for drugs and/or alcohol. Testing cost will be borne by the School. Testing will be done according to standard procedure for these settings. The School will direct the Drug Screening Report to be sent to the Associate Dean of Students (and Chair of the CSP should the CSP mandate the drug/alcohol screening). Prior to making a final decision to confirm a positive test, the student will have the opportunity to discuss the test results and provide any documentation for a legitimate medical explanation for the positive test result.
  2. Appeal and Retesting: Positive tests may be appealed by submitting a written request to the Associate Dean for Students (and Chair of the CSP should CSP have mandated the screening) within three (3) business days after being informed of the positive test results. The student has the right to have a second test performed on the original specimen for qualitative presence only at a certified laboratory of their choice and all expenses of such retest will be the responsibility of the student. The specimen transfer between laboratories will follow standard protocol.
  3. Disciplinary Sanction or Actions: Any student who fails an alcohol or drug test will be subject to disciplinary sanctions and a disciplinary hearing before CSP. These sanctions could result in dismissal. An individual’s participation in, and successful completion of, an approved drug and alcohol treatment program coupled with their consent to random testing may be considered in the disciplinary process but does not ensure that dismissal will not occur.

    Any student who is given the option to participate in a drug and alcohol treatment program will comply with the treatment and rehabilitation requirements set forth below:
    1. Satisfactorily participate in a drug and alcohol treatment program approved by the Associate Dean for Students for this purpose.
    2. Provide evidence satisfactory to the Associate Dean for Students of continued outpatient therapy in an approved program appropriate to the treatment recommendation.
    3. Remain substance-free after completing a drug and alcohol treatment program for substance use disorder and participate in random drug and/or alcohol screening during treatment and for the duration of their medical education at the School.
    4. Failure to comply with these requirements may result in a recommendation for dismissal.
  4. Refusal to Consent to Testing: Any student who refuses to consent to an alcohol or drug test for cause or fails to provide an adequate specimen will be subject to discipline (as per c. above), up to and including recommendation for dismissal.
  5. Confidentiality: Every effort will be made to keep the results of alcohol and drug testing confidential. Students should be aware that test results may be used for administrative hearings and court cases and may be sent to state and/or federal agencies as required by applicable law.

        RESPONSIBILITY
        Associate Dean for Students

        REFERENCES

        1. UC Office of the President Policies (https://policy.ucop.edu/index.html)
          1. University of California Policy on Substance Abuse
          2. Implementing Guidelines for the University of California Policy for Substance Abuse 
        2. UC Davis Administration of Student Discipline (http://sja.ucdavis.edu/disciplinary-process.html).
        3. UC Davis Policy & Procedure Manual (http://manuals.ucdavis.edu)
          1. Section 270-21, Sales, Service and Consumption of Alcoholic Beverages.
          2. Section 290-70, Controlled Substances. 
          3. Section 380-22, Drug and Alcohol Testing of Transportation Employees. 
          4. Section 390-30, Disruptive Behavior in the Workplace.
        4. University of California Davis Health, Administrative Policies, Personnel - 2909: Drug-Free Workplace: Supected Employee Impairment (https://ucdavishealth.ellucid.com/)
        5. United States Code (https://uscode.house.gov/) 
          1. Drug-Free Schools and Communities Act, 20 U.S. Code 1011i. 
          2. Drug-Free Workplace Act, 41 U.S. Code Sections 701-707
          3. Schedule of Controlled Substances Act, 21 U.S. Code Section 812. 
        6. California law
          1. Drug-Free Workplace Act of 1990, Government Code Section 8350-8357. 
          2. Uniform Controlled Substances Act, Health and Safety Code, Division 10, Section 11000 et seq.

        RELATED POLICIES
        Technical, Non-Academic, Standards
        Background Check Policy
        Professionalism Policy

        POLICY OWNER
        Associate Dean for Students

        REVIEWED BY
        Associate Dean for Students*
        Director of Wellness
        Committee on Student Promotions

        REVIEWED DATE and REVIEW CYCLE
        September 2023; Annual review cycle

        * Indicates the policy owner