Earlier in September, several B.C. physicians specializing in assessing addiction have been accused of “massive conflict of interest” by several organizations which have pointed out the addiction specialists’ potential financial interest in the drug testing industry.
The group of physicians in question are responsible for creating return-to-work plans for individuals treated for substance use disorders in safety-sensitive positions, with the requirements sometimes including alcohol and drug tests.
The tests are usually carried out by medical monitoring companies, while some of the companies are owned by the same physicians.
“Most of us have to pay crazy amounts of money to use the companies owned by the same group of doctors who dictate our return-to-work requirements,” said Rebecca Humberstone, a nurse in Victoria, B.C. who has been required to undergo drug testing for years after an evaluation by a doctor who owns a medical monitoring company.
In 2016, she was referred to Dr. Jennifer Melamed to undergo an independent medical examination (IME). The return-to-work plan assigned to Humberstone included mandatory medical monitoring.
Together, Dr. Melamed and Dr. Maire Durnin-Goodman are the directors of Precision Medical Monitoring based in Surrey, B.C.
While Humberstone used another drug testing company for her tests, the process has been very expensive for her. Her union paid for her first year of monitoring and her insurance covered another year, but she was required to cover the rest of the costs out of pocket.
Her employer, Island Health, covers employees’ drug-testing expenses only if they use the medical monitoring company the health authority has signed a contract with. In Humberstone’s case, this company is Precision Medical Monitoring, owned by Drs. Melamed and Durnin-Goodman.
Humberstone is the co-founder of Workers for Ethical Substance Use Policy, one of the organizations highlighting the potential financial interest of doctors who perform independent medical examinations (IMEs) for substance use disorders. According to her, even if a physician is not directly referring a patient to their own company, they’re still supporting a sector they profit from.
“It’s a relatively small group of doctors involved in the evaluations and reports stipulating treatment details, and they refer patients to each other’s companies to avoid being accused of a conflict of interest,” Humberstone said in her interview with CBC News.
Moreover, other organizations such as the Harm Reduction Nurses Association, as well as researchers from the B.C. Centre for Substance Use, B.C. Nurses’ Union, Douglas College, University of Victoria and RainCity Housing have expressed similar concerns in a recently released report.
According to Jonathan Chapnick, a workplace lawyer and consultant at Portage Legal Services and one of the authors of the report, it is essential to eliminate the financial ties between addictions specialists and the drug testing industry.
“That doctor will essentially spell out the next couple of years of the nurse’s life,” Chapnick said in the report. “We need to make sure that this exchange is free from conflict of interest, free from coercion.”
Currently, there is no legislation or regulations preventing a physician from profiting from the drug-testing industry; however, practice standards created by the College of Physicians and Surgeons of B.C. state that physicians must “avoid, minimize, or manage and always disclose conflicts of interest.”