This is part of the “Ask ECRI” series of articles provided to Copic to share with our insureds; it focuses on questions ECRI receives from members regarding healthcare issues and concerns. ECRI is an independent, nonprofit organization improving the safety, quality, and cost-effectiveness of care across all healthcare settings.
A member recently asked for guidance on developing a policy regarding patients that appear to be under the influence of drugs and other substances (e.g., cannabis, opioids, benzodiazepines, hallucinogens, stimulants) upon arrival for their appointments. In our response, we noted that the primary goal of any patient substance use policy is to ensure the patient’s safety and well-being as well as of staff and other patients and visitors.
In our response, we noted that the primary goal of any patient substance use policy is to ensure the patient’s safety and well-being as well as of staff and other patients and visitors. The policy should define “under the influence” and other related terms (e.g., “impaired,” “intoxicated,” “drunk,” “high”) and these definitions should be consistent with the definitions used in an employee policy on drug and alcohol use. Sample language may say: “A patient is considered under the influence if they exhibit signs of impairment, such as slurred speech, impaired coordination, disorientation, or other observable behaviors indicating substance impairment.”
The Department of Veterans Affairs provides a flowchart entitled Determining what to do when participant is using a substance or under the influence during an assessment or therapy session.1 The flowchart describes steps to take if the person passes or fails the assessment (e.g., ask follow-up questions to determine how the participant will get home, monitor the patient/check vitals, complete an incident report, notify authorities, provide support materials or referrals). Keep in mind that this flowchart was intended to be used by nonurgent or emergent care providers. Additional actions may be necessary if the patient requires emergency treatment or stabilization, either because of their condition or due to the nature of treatment they were originally seeking. For cases where treatment is to be withheld, you will need to follow any legal, ethical, and standard of care requirements; therefore, be sure to consult with legal counsel.
- Clinical Practice Guidelines for Assessment and Management of Patients with Substance Intoxication Presenting to the Emergency Department: https://pmc.ncbi.nlm.nih.gov/articles/PMC10096213/
- In-hospital Substance Use Policies: An Opportunity to Advance Equity, Reduce Stigma, and Offer Evidence-based Addiction Care: https://pubmed.ncbi.nlm.nih.gov/35914181/
- Sample Substance Use and Possession Policy (hospital): https://cdn-links.lww.com/permalink/jam/a/jam_00_00_2022_06_23_martin_jam-d-21-00371_sdc1.pdf
The recommendations contained in Ask ECRI do not constitute legal advice. Facilities should consult legal counsel for specific guidance and develop clinical guidance in consultation with their clinical staff.
ECRI Published Date: January 26, 2026
The information provided herein does not, and is not intended to constitute legal, medical, or other professional advice; instead, this information is for general informational purposes only. The specifics of each state’s laws and the specifics of each circumstance may impact its accuracy and applicability, therefore, the information should not be relied upon for medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation.
Article originally published in Copic’s Copiscope 2Q26 newsletter.
