Illicit Fentanyl Use and Urine Drug Screening Practices in a Domiciliary Residential Rehabilitation Treatment Program at the Bath VA Medical Center, New York

The VA Office of Inspector General (OIG) conducted a healthcare inspection to address concerns regarding illicit fentanyl use and urine drug screening (UDS) practices at the Domiciliary Residential Rehabilitation Treatment Program (DRRTP), Bath VA Medical Center, New York. The Veterans Health Administration does not require treatment programs to routinely test for illicit drugs, such as fentanyl, that are trending in the community. In response to incidents involving fentanyl abuse by DRRTP residents, facility leaders amended the UDS policy to include an extended panel UDS that tests for fentanyl. Residents were randomly selected each day for an extended panel UDS. However, the extended panel UDS was processed by a non-VA laboratory with a turnaround time that compromised the timeliness of clinical intervention and overdose prevention. Facility leaders took additional actions to increase the identification of fentanyl use, including the tracking of positive UDS results. The OIG determined that the facility’s fiscal year 2017 positive UDS tracking data was inaccurate. Staff stated there was confusion interpreting the thresholds and some UDS results were incorrectly recorded. To assist DRRTP staff in identifying residents with a history of opioid use and a high-risk for suicide patient record flag, facility leaders implemented a practice of placing color-coded stickers on resident doors. The practice was discussed in the facility’s Mental Health Council meeting; however, key staff reported being unaware of its use for residents at high risk for suicide. OIG staff also found that Domiciliary Assistants did not have sufficient personal protective equipment or training to safely conduct contraband searches of residents’ rooms and belongings. The OIG made eight recommendations related to drug screening guidelines, regional drug abuse identification, timely laboratory turnaround times and result notifications, positive UDS tracking and monitoring, UDS results interpretation training, color-coded sticker practices, and contraband search personal protective equipment and training.