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Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests (Part 1 of a Blog Series)

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In representing nurses and other licensed health professionals, we constantly discuss positive drug screenings, usually from employer-ordered drug testing, with our clients. These clients include nurses, pharmacists, dental professionals, mental health counselors, therapists, etc. Often these individuals need to remember that if they apply for a job with a new employer or are working for a large corporation or the government, they are subject to employer-ordered drug screenings. Most problems arise when the professional has applied to a hospital or a placement agency for work in a hospital and they must submit to a pre-employment drug test.

The client often contends that the result is a false positive and that some other substance must be responsible for it.

A positive result for any drug for which you do not have a valid prescription from a physician, including marijuana, will cause you to be eliminated from consideration for a new job or terminated from a current position and a complaint against your professional license, which could cause you to lose it. We are routinely called on to defend such situations.

Series of Blogs to Discuss Substances that Can Mimic Prohibited Drugs on Drug Tests.

In the years I have been doing this, I have encountered many cases in which other substances have caused a positive result for a prohibited substance on a drug screening test.

In this series of blogs, I intend to discuss some of the substances scientifically shown to cause false positives on employer-ordered drug screening tests. This is the first in the series.

Over-the-Counter Medications Mimicking Amphetamines on Drug Tests.

Following is a discussion of substances that can cause a false positive for amphetamines on a urinalysis drug test. This material comes from an article in Case Reports in Psychiatry published in 2013. (Ref. 1)

Many prescription pharmaceuticals and over-the-counter (OTC) medications have been previously reported in the literature to cause a false-positive result for amphetamines on urine drug screens. Many OTC medications have been reported in scientific literature to produce false positives for amphetamines on urine drug screenings, chiefly antihistamines.

The OTC medications that have been documented to and are well known as causing false positives for amphetamines on drug tests include nasal decongestants, Vicks inhaler, MDMA (3,4-Methylenedioxy methamphetamine; commonly known as ecstacy, molly, mandy or X), and pseudoephedrine. (Refs. 1-5) Some of these are prohibited medications that cannot be prescribed and are only available as “street drugs” such as MDMA.

Prescription Medications Documented as Mimicking Amphetamines.

Prescription medications known to have mimicked amphetamines on testing include antipsychotics and antidepressants. (Refs. 1 & 2)

The prescription medications known to cause false-positive amphetamine urine drug screen include fluoxetine, selegiline, ranitidine, trazodone, nefazodone, brompheniramine, phenylpropanolamine, chlorpromazine, promethazine, ephedrine, methamphetamine, and labetalol. (Refs. 2-5) However, the fact that the individual taking the drug test might have a prescription for one of these might cause the employer to disqualify the employee or potential employee from consideration for the job.

Bupropion (an atypical antidepressant that inhibits norepinephrine and dopamine re-uptake), is a drug used to treat depression and smoking cessation, but may also be used off-label to treat ADHD. It has also been documented as causing false positive results for amphetamines on drug screenings. (Ref. 6)

The drug atomoxetine has metabolites that are similar to those of amphetamines (phenylpropan-1-amine verses phenyl-propan-2-amine). This could also result in a false positive on a urine drug screen. (Ref. 1)

Other Discussions in Future Blogs.

In future blogs, I intend to discuss false positive claims associated with use of ibuprofen, amoxicillin, coca leaf tea, poppy seeds and other common substances and medications. Stay tuned.

Contact Experienced Health Law Attorneys in Matters Involving PRN or IPN.

The Health Law Firm’s attorneys routinely represent physicians, dentists, nurses and other health professionals in matters involving PRN or IPN. Our attorneys also represent health providers in Department of Health investigations, before professional boards, in licensing matters, and in administrative hearings.

To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.

References:

1. Fenderson JL, Stratton AN, Domingo JS, Matthews GO, Tan CD. Amphetamine positive urine toxicology screen secondary to atomoxetine. Case Rep Psychiatry. 2013;2013:381261. doi: 10.1155/2013/381261. Epub 2013 Jan 30. PMID: 23424703; PMCID: PMC3570929.

(Accessed on May 20, 2023.)

2. Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA. Commonly prescribed medications and potential false-positive urine drug screens. Am J Health Syst Pharm. 2010 Aug 15;67(16):1344-50. doi: 10.2146/ajhp090477. PMID: 20689123.

3. Vincent EC, Zebelman A, Goodwin C, Stephens MM. Clinical inquiries. What common substances can cause false positives on urine screens for drugs of abuse? J Fam Pract. 2006 Oct;55(10):893-4, 897. PMID: 17014756.

4. Rapuri SB, Ramaswamy S, Madaan V, Rasimas JJ, Krahn LE. ‘Weed’ out false-positive urine drug screens. Current Psychiatry. 2006;5(8):107–110. [Google Scholar]

5. Moeller KE, Lee KC, Kissack JC. Urine drug screening: practical guide for clinicians. Mayo Clin Proc. 2008 Jan;83(1):66-76. doi: 10.4065/83.1.66. Erratum in: Mayo Clin Proc. 2008 Jul;83(7):851. PMID: 18174009.

6. Reidy L, Walls HC, Steele BW. Crossreactivity of bupropion metabolite with enzyme-linked immunosorbent assays designed to detect amphetamine in urine. Ther Drug Monit. 2011 Jun;33(3):366-8. doi: 10.1097/FTD.0b013e3182126d08. PMID: 21436763.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.

Finding a Lawyer Who Accepts HPSO Insurance to Defend Healthcare Providers

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Healthcare professionals such as pharmacists, licensed mental health counselors, advanced registered nurse practitioners (ARNPs), and massage therapists often struggle to find experienced lawyers in Florida who will accept their professional liability insurance after receiving complaints from the Department of Health (DOH). Specifically, in this blog, the insurance provider in question is Healthcare Providers Service Organization (HPSO) Insurance.

Advantages of Having HPSO Insurance.

The medical professionals HPSO Insurance covers can give a sigh of relief knowing they have excellent insurance coverage. HPSO Insurance provides professional liability coverage that protects them in the event of a lawsuit or negligence claim.

However, it’s not just the significant cases that HPSO covers. More often than not, healthcare professionals receive a notice of an investigation, a subpoena for a deposition in someone else’s case, a demand because of an allegation of sexual harassment or sexual impropriety, a complaint because of a breach of medical records confidentiality, or a Health Insurance Portability and Accountability Act (HIPAA) Privacy complaint, or some other administrative type of action. These situations can be incredibly stressful and time-consuming, but HPSO provides excellent coverage.

For example, if the individual receives a subpoena for a deposition, HPSO currently reimburses up to $10,000 in legal fees and expenses just for representation at the deposition. This means that the professional can focus on their work and not worry about the legal costs of a deposition. Additionally, the provider receives a notice of investigation or complaint from the DOH or Agency for Health Care Administration (AHCA). HPSO currently reimburses up to $25,000 in legal fees and expenses for their defense. The peace of mind that comes with knowing that they have this kind of coverage can be invaluable.

Finally, suppose a health professional is facing a complaint or investigation regarding a breach of medical confidentiality. In that case, HPSO reimburses up to $25,000 in legal fees and expenses for their legal representation in defense.

Whether you’re a nurse, physician, psychologist, or other healthcare professional, knowledgeable and skilled attorneys can assist you with legal issues.

Free Legal Advice: Get Insurance Right Away.

As a healthcare professional, it is essential to understand the importance of carrying insurance that covers any investigation, complaint, or administrative hearing that may be filed or opened against your license. Many healthcare professionals mistakenly believe their employer will cover them in such situations, but this is not always true.

Suppose you are still determining whether your employer will provide legal defense for any matters arising during employment. In that case, asking for a written statement confirming this is crucial. Without such a statement, you may find yourself without any legal support in the event of a complaint or investigation.

Unfortunately, in many cases, the employer terminates an employee and then files a complaint with the Department of Health (DOH). This can result in the DOH opening an investigation against the healthcare professional, leaving them vulnerable to potential legal action. In such cases, the employer is unlikely to pay for the healthcare professional’s legal defense costs, leaving the professional in a difficult position.

If you find yourself in this situation, you may be out of work, out of money, and facing an investigation and complaint that could result in your professional license and career termination. Taking proactive steps to protect yourself and your career is essential by investing in insurance that covers legal defense costs.

HPSO Insurance is both inexpensive and reliable. By purchasing this insurance, while you can afford it, you can rest assured that you will have the legal support you need in case of a complaint or investigation.

We Recommend That You Seek the Services of an Experienced Attorney in the Event of Any Notice of an Investigation.

If you work in the healthcare industry, you must be aware of the potential legal issues that could arise. One such issue is disciplinary action or licensure investigations. If you find yourself in this situation, seeking an experienced health law attorney is crucial. Don’t speak with investigators or provide documents or statements without seeking legal advice.

It’s important to remember that investigators and other professionals involved in the investigation are not on your side. They are looking for evidence against you, so don’t take any advice from them. Instead, rely on the guidance of a skilled attorney who can protect your rights and interests.

Another important consideration is insurance coverage. If you have good insurance, it can help cover the costs of legal expenses from the outset. However, not all insurance policies cover disciplinary complaints and licensure investigations. Be sure to check your policy carefully and ensure this type of coverage is included. If not, consider purchasing a separate policy that provides this coverage. It may cost extra, but it’s worth protecting yourself in case of a legal issue. It is worth it! Please do it!

Contact Experienced Health Law Attorneys Who Represent Healthcare Professionals and Providers.

Our firm specializes in providing legal representation to a wide range of healthcare professionals, including pharmacists, massage therapists, mental health counselors, registered nurses, and more. We offer a variety of services, such as representing clients before their professional board, handling DOH investigations, conducting administrative hearings, defending against malpractice claims, assisting with professional licensing matters, and addressing allegations related to HIPAA privacy violations and medical record breaches.

We also handle DEA actions and other legal matters. Our team frequently defends physicians, dentists, nurse practitioners, and others against malpractice claims, civil lawsuits, administrative complaints, peer review actions, and audits by Medicare and Medicaid. If a healthcare professional has liability insurance that covers these types of claims, we will work to obtain coverage and seek reimbursement for legal fees. In some cases, we may accept an assignment of insurance policy proceeds to directly submit our bills to the insurance company.

We also defend health professionals and health facilities in general litigation matters and business litigation matters.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law; he is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 George F. Indest III. All rights reserved.

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Walmart Increases Pay For Thousands of Pharmacists and Opticians

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On May 31, 2023, Walmart announced it is raising wages for 7,700 U.S. pharmacists and opticians in a nationwide plan to expand healthcare services. The retailer said about 3,700 pharmacists would get a bump in pay, bringing their total average pay to more than $140,000 annually. Additionally, more than 4,000 opticians will receive pay raises, with their average hourly pay rising to more than $22.50. The company also said it plans to start a program in which associates who work in its Vision Center could receive certification and licensing to move into higher-paying positions.

Currently, Walmart employs 16,000 pharmacists and 12,000 opticians overall.

Competitive Pay in a Competitive Market.

According to the Bureau of Labor Statistics, the mean annual wage for a pharmacist in the United States is $129,410 (https://www.bls.gov/oes/current/oes291051.htm), and the mean hourly wage for opticians is $21.58 (https://www.bls.gov/oes/current/oes292081.htm).

The retail giant’s decision to increase wages for workers across its business is a way to compete for talent in a competitive market.

In 2022, the company also increased wages for 36,000 Pharmacy technicians. “As our Health & Wellness business continues to grow, we’re serious about being an employer of choice for talented individuals in these fields,” said Kevin Host, Senior Vice President of Walmart Health & Wellness, Pharmacy, in a press release.

To read the press release on Walmart’s website and learn more, click here.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes pharmacists, optometrists, physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. We represent facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing physicians in investigations and at Board of Medicine and Board of Osteopathic Medicine hearings. We represent physicians accused of wrongdoing, in patient complaints and in Department of Health investigations.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.

Sources:

Holman, Jordan. “Walmart Raises Wages for Some Pharmacists and Opticians.” The New York Times. (May 31, 2023). Web.

“Walmart announces raise for pharmacists and opticians, new optician training program.” 5NewsOnline. (May 31, 2023). Web.

Diaz, Naomi. “Walmart Health to add 28 new clinics by 2024.” Becker’s Hospital Review. (March 2, 2023). Web.

Cavale, Siddharth. “Walmart is raising wages for pharmacists, opticians in healthcare push.” Reuters. (May 31, 2023). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law Firm. All rights reserved.

Florida Governor Signs New Controlled Substance Telemedicine Prescribing Law

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On April 6, 2022, Florida’s Governor signed into law legislation to remove the state’s prior restrictions on telemedicine prescribing of controlled substances. The new law in Florida allows healthcare providers to prescribe many controlled substances via telemedicine.

Florida Senate Bill (SB) 312, signed into law, eliminates the prior ban that had existed prohibiting the prescription of Schedule II controlled drugs (with certain exceptions). Schedule II drugs can now be prescribed in Florida via telemedicine if the clinical situation meets one of four exceptions.

A Big Win For Patients Whose Treatment Requires Controlled Substances.

The prescribing of controlled substances is a heavily regulated medical service. Healthcare providers must usually meet specific criteria to prescribe controlled substances via telemedicine, including conducting an in-person examination of the patient before moving to telehealth examinations.

The new law will allow Florida clinicians to prescribe refills in connection with their ongoing care management more efficiently. For example, the clinician can periodically conduct patient examinations via telemedicine instead of requiring in-person exams.

SB312 was seen to be a big win for Florida patients with medical conditions requiring controlled substances as part of the treatment regimen. This includes, for example, endocrinology or substance use disorder (both of which use Schedule III medications now permitted under the new law), allowing these patients to obtain better access to more care. This is especially so for patients whose medical conditions may have limited their travel or mobility.

The allowance is limited for Schedule II drugs. It is now allowed but only for the treatment of psychiatric disorders, inpatient treatment at a licensed hospital, hospice services, and treatment for residents in a nursing home.

The Florida Law Doesn’t Supersede Federal Law.

It is important to remember that Florida law doesn’t supersede federal law. Therefore, providers should be certain that they meet the requirements of both federal and state law.

In this context, the telemedicine prescribing of controlled substances is governed by the federal Ryan Haight Act, as well. This means prescribers still need to meet one of seven conditions that would allow them to prescribe a controlled substance via telemedicine without first having an in-person exam. Florida law must be read in harmony with the federal Ryan Haight Act requirements and a prescriber must comply with both.

Learn more about the Ryan Haight Act and the federal requirements.

To view SB312 in full, click here.

Contact Health Law Attorneys Experienced in Handling Medicare Audits, Investigations and other Legal Proceedings.

The attorneys of The Health Law Firm represent healthcare providers in defending audits and investigations by the Department of Health and Human Services, the Department of Justice, The Drug Enforcement Administration (DEA), the Florida Department of Health (DOH), the Colorado Department of Regulatory Agencies, Medicaid Fraud Control Unit (MFCU), state boards of medicine, state boards of pharmacy, and state boards of nursing. They also represent health professionals and providers in administrative litigation (state and federal) and civil litigation (state and federal). They represent physicians, nurses, medical groups, nursing homes, home health agencies, pharmacies, dentists, pharmacies, assisted living facilities, and other healthcare providers and institutions in recovery actions and termination from Medicare and Medicaid Programs.

To contact The Health Law Firm please call (407) 331-6620 or (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Wicklund, Erik. “NEW FLORIDA LAW OKS PRESCRIBING MOST CONTROLLED SUBSTANCES BY TELEMEDICINE.” Healthleaders Media. (April 11, 2022).Web.

“New Florida Law Allows Telemedicine Prescribing of Controlled Substances.” National Law Review.” (April 7, 2022). Web.

Lacktman, Nathaniel. “New Florida Law Allows Telemedicine Prescribing of Controlled Substances.” Foley & Lardner. (April 7, 2022). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

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Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests (Part 1 of a Blog Series)

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In representing nurses and other licensed health professionals, we constantly discuss positive drug screenings, usually from employer-ordered drug testing, with our clients. These clients include nurses, pharmacists, dental professionals, mental health counselors, therapists, etc. Often these individuals need to remember that if they apply for a job with a new employer or are working for a large corporation or the government, they are subject to employer-ordered drug screenings. Most problems arise when the professional has applied to a hospital or a placement agency for work in a hospital and they must submit to a pre-employment drug test.

The client often contends that the result is a false positive and that some other substance must be responsible for it.

A positive result for any drug for which you do not have a valid prescription from a physician, including marijuana, will cause you to be eliminated from consideration for a new job or terminated from a current position and a complaint against your professional license, which could cause you to lose it. We are routinely called on to defend such situations.

Series of Blogs to Discuss Substances that Can Mimic Prohibited Drugs on Drug Tests.

In the years I have been doing this, I have encountered many cases in which other substances have caused a positive result for a prohibited substance on a drug screening test.

In this series of blogs, I intend to discuss some of the substances scientifically shown to cause false positives on employer-ordered drug screening tests. This is the second in the series. Remember to read Part 2 and Part 3 of this blog series! Part 2 deals with substances that may cause a false positive for cocaine. Part 3 deals with Marijuana and THC Imposter Substances.

Over-the-Counter Medications Mimicking Amphetamines on Drug Tests.

Following is a discussion of substances that can cause a false positive for amphetamines on a urinalysis drug test. This material comes from an article in Case Reports in Psychiatry published in 2013. (Ref. 1)

Many prescription pharmaceuticals and over-the-counter (OTC) medications have been previously reported in the literature to cause a false-positive result for amphetamines on urine drug screens. Many OTC medications have been reported in scientific literature to produce false positives for amphetamines on urine drug screenings, chiefly antihistamines.

The OTC medications that have been documented to and are well known as causing false positives for amphetamines on drug tests include nasal decongestants, Vicks inhaler, MDMA (3,4-Methylenedioxy methamphetamine; commonly known as ecstasy, molly, mandy or X), and pseudoephedrine. (Refs. 1-5) Some of these are prohibited medications that cannot be prescribed and are only available as “street drugs” such as MDMA.

Prescription Medications Documented as Mimicking Amphetamines.

Prescription medications known to have mimicked amphetamines on testing include antipsychotics and antidepressants. (Refs. 1 & 2)

The prescription medications known to cause false-positive amphetamine urine drug screen include fluoxetine, selegiline, ranitidine, trazodone, nefazodone, brompheniramine, phenylpropanolamine, chlorpromazine, promethazine, ephedrine, methamphetamine, and labetalol. (Refs. 2-5) However, the fact that the individual taking the drug test might have a prescription for one of these might cause the employer to disqualify the employee or potential employee from consideration for the job.

Bupropion (an atypical antidepressant that inhibits norepinephrine and dopamine re-uptake), is a drug used to treat depression and smoking cessation, but may also be used off-label to treat ADHD. It has also been documented as causing false positive results for amphetamines on drug screenings. (Ref. 6)

The drug atomoxetine has metabolites that are similar to those of amphetamines (phenylpropan-1-amine verses phenyl-propan-2-amine). This could also result in a false positive on a urine drug screen. (Ref. 1)

Other Discussions in Future Blogs.

In this series of blogs, I intend to discuss some of the substances scientifically shown to cause false positives on employer-ordered drug screening tests. Remember to read Part 2 and Part 3 of this blog series! Part 2 deals with substances that may cause a false positive for cocaine. Part 3 deals with Marijuana and THC Imposter Substances.