Alcohol Testing

Buprenorphine Post
Posts: 267

Postby peterorrin » Wed Jul 20, 2016 12:08 pm

I practice in a building at a curve of a busy 2 lane State highway in a suburban-exurban community. If someone is intoxicated clinically & by breathalyzer, we take their keys, and ask a friend/relative to pick them up and drive them home. I have actually driven a couple home myself. If they refuse to cooperate, we mention calling the police. That works.

We do not allow intoxicated people to walk from the office either. Year in and out, nationally, about half of pedestrian deaths are found to have alcohol on board.

These policies are for our patient's safety and our liability.

Posts: 183

Postby MChaplin » Wed Jul 20, 2016 12:08 pm

we test- and like Bruni- a positive test leads to a conversation- never to immediate discharge- we also have an onsite breathalyzer so if we think someone is intoxicated we can test- if they test positive they are asked to leave and if we feel they are unsafe to leave we call 911 and have them brought to ER. In our treatment agreement, patients agree not to use alcohol or benzos (unless prescribed and then only exactly as prescribed) due to the real risk of overdose with these combinations....if alcohol use is detected, then we have to weigh the risk benefit of continuing buprenorphine on an individual basis. we are in the process of tailoring our tests so that clients with no history of alcohol use who have had initial negative tests don't continue to get tested. but we don't have a protocol in place so for now it is somewhat arbitrary...

Posts: 49

Postby Bruni » Wed Jul 20, 2016 12:08 pm

I do, and at least the first time the EtG is positive I ask for confirmation, which gets me a report of EtS. More importantly, what to do with repeatedly positive tests. Wave them in the patient's face, calmly ask the patient how much they drink (AUDIT, DAST, MAST, etc) or just comment? I can't put them back at risk of heroin overdose or imprisonment for heroin possession for one tiny binge. If it repeats, I ask about their plans for the medium range and long range future - do you want to stop using drugs? do you think you can continue to drink this much and remain abstinent from opioids? how does that work?

Posts: 104

Postby jmosby1469 » Wed Jul 20, 2016 12:08 pm

We do. I understand that, for one, it can be a risky combination with buprenorphine on board. In addition, many addiction recovery plans strongly advise against its use. Obviously, it would be unwise in those for whom it has been a problem.

Posts: 1404

Postby drpasser » Wed Jul 20, 2016 12:08 pm

Most screens just detect very recent use. It otherwise wouldn't be a bad idea. I just never routinely for etoh. I do have some strips in office which are supposed to detect in saliva etoh levels above 0.02 (I think). So, without accurate screening, routine testing pts may prove ineffectual.
I do occasionally have a pt who has been drinking and usually a fm member rats them out. I do have pts sign a contract agreeing not to drink. If a pt drinks, it could be easily concealed. Of course, they are only hurting themselves if they do.

Good question.

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