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Policy:


In its role as a comprehensive academic health sciences training center, the University of Nebraska Medical Center (UNMC) considers substance use disorders as diseases that can endanger the wellbeing of students and patients.

When identified as experiencing possible signs and/or symptoms of a substance use disorder, UNMC students are given the opportunity to seek appropriate assessment, treatment, and aftercare services in a manner consistent with legal requirements and protection of the public.

Drug diversion will trigger the referral process described below. Refusal to participate in the referral process may lead to disciplinary action up to and including dismissal. Diversion for the use by or sale to others will lead to immediate disciplinary action up to and including dismissal from the academic program.

UNMC does not discriminate against students who are recovering from a substance use disorder, are no longer engaging in the illegal use of drugs, and are otherwise legally able to begin or continue their education in a UNMC academic program.


Definitions:


Drug diversion: theft or other illegal methods of acquisition of a controlled substance by a student for personal use or sale.

Substance use disorder: one of several diseases as defined in the Fifth Edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) that can endanger the wellbeing of students and patients. 


Procedures: General


  1. Each college dean will designate one or more academic program administrators (referred to below as designated administrator) to coordinate the response to students with a suspected substance use disorder or reported drug diversion.
  2. Students who have questions about potential problems (involving themselves, family, friends, etc.) related to substance use are encouraged to voluntarily seek confidential assistance at the UNMC Counseling & Student Development Center in Omaha or the designated student counseling services for other UNMC campuses. 


Procedures: Behaviors Indicative of Substance Use Disorder:


  1. When students exhibit one or more of the following behaviors that may be impairing their academic or clinical performance or are otherwise jeopardizing their personal or professional well-being and are interpreted as possibly indicative of a substance use disorder, faculty shall contact a designated administrator immediately and shall remove the student from patient areas or the classroom unless in the judgment of the faculty member the student’s behavior is not an immediate danger to patient or peer safety.
    1. First-hand evidence (i.e. direct sensory awareness by the reporting person) of impairment from a substance causing a substance use disorder as defined in the DSM-5 (e.g., the smell of alcohol on a student’s breath in a patient care setting such as a clinic, hospital, or pharmacy)
    2. Excessive tardiness or absenteeism
    3. Violations of the law
    4. Unprofessional conduct
    5. Diversion of controlled substances
    6. Marked changes in appearance, speech, or mood
  2. The designated administrator will coordinate a timely referral to Counseling & Student Development in Omaha or the counseling services available on other UNMC campuses for a substance use disorder screening assessment.
  3. When removing a student, the faculty should consider the following:
    1. Remove the student as discretely as possible (with assistance of campus or other jurisdictional security if needed).
    2. Inform the student of the concerning behaviors observed and that he or she will not be allowed to remain in the classroom or clinical setting.
    3. Escort the student to student health, a health clinic, or other designated site for appropriate medical evaluation and lab work, informing the staff on duty of the specific concerns. The faculty member may consult with security or other UNMC officials regarding transportation if necessary.
    4. If the student refuses to comply with the requests, the student will be offered the opportunity to call a cab (at the student’s expense) or a family member or friend for a safe ride home.
    5. If the student is disruptive, belligerent, or threatening harm to self/others, that campus’s or clinical setting’s security service, or, if necessary, the appropriate police agency, will be called immediately.
    6. Faculty members should not attempt to physically restrain the student from leaving the premises.
  4. Students who are removed from a classroom or clinical setting should note that refusal to comply promptly with the requests of the faculty or designated administrator will be noted in a written incident report to the dean that could lead to disciplinary action up to and including dismissal from the program.
  5. A drug screen may be requested as part of the screening assessment at the discretion of the medical staff and at the expense of the student. If the student consents, the drug screen should be obtained in conformity with chain of custody requirements used for employee drug screening. Failure to comply with this medical staff request may lead to disciplinary action up to and including dismissal from the academic program.
  6. Following the medical evaluation by student health or other provider the student will be referred to the appropriate student counseling center for follow up.
  7. Following the referral to the designated administrator the reporting faculty member will:
    1. Document the behaviors or performance problems in writing
    2. Provide this written report describing these observations to the designated administrator
  8. When students observe behaviors described above under paragraph 1 of this section in another student, they should report such observations to a faculty member or a designated administrator. Questions about the appropriate course of action may also be directed to the Counseling & Student Development staff in Omaha or the designated student counseling services for other UNMC campuses.
  9. Students who are diagnosed with a substance use disorder will be requested to sign a formal written agreement describing their participation in further evaluation, treatment, and aftercare programs as recommended by their assessment results and the student counseling staff. The agreement authorizes counseling staff to update the designated administrator on the student’s progress. Failure to sign the written agreement or follow the terms outlined in this agreement may lead to disciplinary action up to and including dismissal from the academic program.
  10. The academic program administrator will monitor the student's progress with respect to fitness to continue in the academic program or the need for a leave of absence.
  11. Existing UNMC policies governing medical leaves of absence will apply to students needing time off for substance use disorder evaluation and treatment. 
  12. Responsibility for any cost associated with evaluation, treatment, or aftercare will be borne by the student.
  13. The designated administrator, after consultation with the appropriate medical, student counseling, and/or student disability staff, will determine a student's readiness for reentry into the classroom or clinical setting after a medical leave of absence.
  14. Students or residents with identified substance use disorders may be subject to possible state licensing discipline and legal action including criminal prosecution.
  15. Relapse episodes will be addressed in a similar manner to the initial diagnosis. Students who have relapsed will be subject to further evaluation, treatment, and aftercare requirements. Depending on the circumstances, relapse may be cause for disciplinary action up to and including dismissal
  16. Following evaluation, treatment, and aftercare, the designated administrator may require random drug screening to be performed at the expense of the student. The designated administrator will make the arrangements for any required drug screen protocols. Failure to comply with the request for random drug screening may lead to disciplinary action up to and including dismissal from the academic program.
  17. Evaluation and treatment records maintained by student counseling, student health, or other treating professionals are confidential and will be released only with the student's written permission or as required by law. 


Procedures: Behaviors Indicative of Diversion or Illegal Use:


When a student in a clinical setting is suspected of diversion of prescription medication or illegal use of substances known to cause substance use disorders, the faculty member should notify the appropriate clinical administrative staff. 


 Faculty Documentation of Incidents:


When a UNMC faculty member or administrator other than the designated administrator is involved in managing any incident under this policy, he or she should document the incident and actions taken in writing and forward this information to the designated administrator as soon as possible.


Americans with Disabilities Act:


UNMC recognizes that there may be instances involving the use of alcohol or other substances where a student with a previously or newly diagnosed substance use disorder falls under the protection of the Americans with Disabilities Act. UNMC will take appropriate measures to comply with the Act while also ensuring student and patient safety. 


 
Date Policy Adopted: March 2016
Date Policy Revised:
Date Reviewed by:
University General Counsel
January 19, 2016
Reviewer by: Education Council/Vice Chancellor Academic Affairs
Approved by: UNMC Chancellor
Reviewed: Every three years