Year one

There’s going to be some sort of tracking going on, most days. In our program’s case, we have an app that we check in on every morning, and after we check in, it tells us whether we’re doing a drug test that day or not. Whatever the method is in yours, the day starts with it.

The urine tests are usually fairly frequent in the beginning, and as you move through the program they often get less and less frequent. They’re somewhat random. It doesn’t always seem that way, but they certainly can come at any time.

A lot of people are also required to use a breath alcohol device, where you blow into it at random times of the day, and sometimes at scheduled ones, to verify that your breath alcohol is negative.

Usually anywhere from a $20 to $25 fee at the facility that’s doing the test, and then a separate fee that varies depending on what tests are being run, anywhere from $30 to $80, paid to the company that’s actually processing the test. It’s usually a credit card on file somewhere, billed automatically.

Where you go for those screens matters more than it sounds like it should. The collection sites guide covers why some sites handle monitoring smoothly and why picking the closest one is often the wrong move.

Depending on your contract, there are reports going in about you all year. A workplace monitor turning in monthly or quarterly reports. Ongoing therapy turning in, usually, a monthly report.

These reports are our responsibility. They aren’t the responsibility of the person writing them. If six months go by and none of your therapy reports have gone in, that’s going to be put on you as a participant. There are too many people in the monitoring programs, and too few staff at the health programs, for them to stay on top of all of it.

The monitoring contract page shows how to build a checklist from your own contract; the reports belong on it. And the reports guide covers whose job they are, and why that answer surprises people.

Typically, the first time you hear about a positive screen is a phone call from a medical review officer. That’s usually a physician, and they’re the first line for gathering information to explain a positive screen. From the beginning, they’re looking for medical reasons the screen may be positive. Is there a medication that interacts? Is there a medical condition that could cause it?

They usually don’t tell you exactly what it is at the beginning. They take a history first, and gather information, before they tell you which part of the screen was positive. Knowing that in advance changes how that call feels.

Ordinary cold medicine can produce a real positive, and the cold medicine guide exists for exactly that reason. There’s also a full guide on the positive screen call.

Yes. A 2008 study followed 904 physicians across 16 state physician health programs for five years. About 79% of them (631 of 802) were licensed and either practicing or working in a related field without restriction by the end of that stretch. Only 11% had their license revoked. 81% had no identified substance misuse during the entire monitoring period.

That’s not a small or informal sample, and it’s why year one, as tedious as it gets, is worth going through.

How often you test, and when the taper starts. Whether a breath device is in your contract. Which reports yours requires, and from whom. What the year costs you.

Those genuinely vary by contract, which is why the monitoring contract page says to read yours slowly. Most contracts also require professional group meetings — the Caduceus and professional groups guide covers what those rooms are actually like. The morning check-in, and the rhythm the year settles into, don’t vary much at all.