Thursday November 27th 2014

Is random drug testing for chronic pain patients a good idea?

The Journal of Pain & Palliative Care Pharmacotherapy recently published an article arguing against legal statutes that require drug testing of chronic pain patients. The paper argues that there is not sufficient evidence that random drug testing can help reduce prescription drug misuse, addiction, and overdose and that laws themselves have not been proven to reduce the misuse of prescription medications. Further, the authors write that the efficacy of controlled substance agreements and random drug testing have not yet been proved to reduce opioid misuse. But the article is largely skewed and shows little understanding of the true nature of drug addiction. Here are some mistaken assumptions to address now:

Opioids are not the standard for chronic pain

Many doctors, including reputable pain management physicians, disagree with the very premise of the paper, stated in the first sentence of the second paragraph. Opioids are NOT NECESSARILY the gold standard of treatment for chronic, non-cancer pain.  Opioids can help some people, but can harm others.  In fact, we have much evidence that tells us some, though not all, patients on opioids for more than three months actually get worse, from hyperalgesia. This is a condition that develops in these patients where they actually become more sensitive to pain, due to the changes in the body with long-term opioids.

Doctors have the right to refuse patients

A patient has the constitutional right to refuse any medical testing. However, I also have the right to say I think a course of treatment is too risky if they don’t consent to testing. In other words, doctors have the right to refuse to treat a patient if they don’t follow our recommendations. That isn’t just with treatment of pain with opioids, but occurs with most other chronic diseases that require periodic lab tests for monitoring.

Is drug addiction a crime or a disease?

Objections to mandatory drug testing of chronic pain patients are based on the assumption that addiction is a crime, not a disease. To be clear, addiction is a disease, not a moral failing. The whole reason for drug testing is to detect addiction and refer to treatment as soon as possible, because addiction is easier to treat early in its course. Making a diagnosis of addiction can save a life. People die from this disease, and up to 20%, and even more in some studies, develop addiction as a complication of treatment for chronic pain.  This is serious, and missing a diagnosis can be deadly.

Consider the following situation: let’s say instead of opioids, we are talking about drug “X” which treats an uncomfortable and serious medical condition. Unfortunately, drug “X” causes kidney failure in about 20% of patients who take it. Now some lawyer says the following:

“No patient taking drug “X” should be forced to undergo testing to see if they have developed kidney failure. To mandate testing constitutes suspicionless testing and is unconstitutional, and violates their Fourth Amendment rights.”

Sounds screwy, no? Because the testing is done for the patient’s benefit, to check to see if kidney failure has occurred as a complication of treatment.

Does required drug testing violate fourth amendment rights?

The legal opinion that required testing violates fourth amendment rights can, in the end, harm patients instead of help. In a final exmaple, a woman’s OB may ask the patient for a drug test, but the reason should be to help the mom access treatment, not to call the authorities, because, once again, it’s a disease and not a crime. The authors of “The Fourth Amendment and Random Drug Testing of People With Chronic Pain” really must consider that state laws requiring drug testing can benefit patients health and lives, instead of restrict their personal rights.

Reference source: Journal of Pain and Palliative Care Pharmacotherapy Volume 25, No. 1

Photo credit: Sergei Golyshev

Leave a Reply

42 Responses to “Is random drug testing for chronic pain patients a good idea?
Joan Sura
4:10 am April 8th, 2011

Thousands of people must understand that this type of prescription drugs – hydrocodone, lortab or oxycontin – must be taken in a moderate way because side effects cause liver damage and that the overuse of pain medications can be dangerous. It’s suggested before making decisions with this type of medication to see a doctor and don’t buy pain meds without a prescription.

Bill Cohen
1:09 pm April 9th, 2011

…and the point of the above comment in relation to the arguments related to random drug testing were exactly what…?

Montgomery Jackson
4:05 am April 13th, 2011

Chronic pain should be treated quickly with drugs such as oxycontin, percocet and vicodin, which according to the doctors help control the pain, but which are dangerous for their side effects. It is suggested that you should buy prescription and they can look for information online about their contraindications.

Lisa J
5:18 am April 23rd, 2011

I was googling chronic pain and addiction because several years ago I developed severe pain and other symptoms that were finally diagnosed as end stage interstitial cystitis. I know I’ve read op-ed and other types of articles lately in the current public drug discussions that seem to insinuate that every chronic pain patient that is currently medicated is obviously an addict who would be much better off with some therapy and the occasional tylenol.

I don’t find anything wrong with random drug testing as part of my treatment. I am very careful with my medication and they would find nothing surprising at all. I am constantly saddened and dismayed in forums where patients talk about doubling and tripling up their doses because they absolutely can’t stand the pain. No matter how bad my flares get, I can’t fathom juggling doses, because I would be in writhing agony when I would ultimately be forced to skip because it wouldn’t be time for refills yet.

I have never been medicated to “high.” I haven’t even been medicated to “no pain.” Our goal is functionality – can I spend some time with my family and enjoy it? Can I help some with household tasks?

It seems unfortunate that people who are especially careful because they recognize both the seriousness and the benefit of narcotic medicines in their life end up stigmatized by and possibly impacted by those who choose illegal behaviors.

5:22 pm April 25th, 2011

Hi Lisa. Thanks for you comment. I think it’s wonderful that pain meds are helping you. And I can see their use as applicable and helpful to many people.

We are all impacted by the behaviors of others -this is what it means to be in a society. So some may argue that drug testing is an inevitable precaution that benefits the whole. So although medications could or should be available only to people who use them correctly, this seems like a utopia (in other words impossible).

Addiction itself is a medical illness, and is also stigmatized. People who start out taking pain medications for non medical reasons may enjoy the initial euphoria, but if addiction occurs, pain pill misuse become a nightmare.

In other words, what is one person’s salvation can be another person’s poison.

ron
4:40 am May 12th, 2011

this is america not the country i was born in you would take someones med who smoke weed after kimo this is sick

CDF
12:16 pm August 4th, 2011

I agree that the drug testing would be good to check for liver failure but has anyone looked at the cost factor. I have and I have been billed for $500.00 for the doctor to administer the drug test and $684.00 for the drug test. Hummmmmm. Now I can not afford the pain medicine. Something is wrong with this picture.

LET
6:17 am August 13th, 2011

Do doctors have the right to drug test patients, and to refuse services if the test is positive for marijuana? Even though the patient has been taking a narcotic pain medicine (oxycodone 30mg and oxycontin 200mg daily) for so long that the same doctor has told the patient never to stop taking the medication, as it may cause death. The Doctor has also told the patient that because they have taken this medication (over 14 years) and his brain chemistry has been permanently altered and will never repair its self, therefore the medication has to be taken for the rest of the patient’s life. How then can a doctor that takes an oath to “do no harm” actually take away the treatment that he has said to never stop taking for fear of death is a reality for this patient. The marijuana was smoked to induce an appetite, as long-term use of the above stated drugs has caused the patient to have any appetite at all, as well as an aid to help the patient relax and get some sleep.

Anyone had this problem if so what did you do, and what should the patient do, stop using marijuana and not eat or sleep, or continue to use it and loose the treatment and medication he has been told to never stop taking?

Bob McCarley
2:59 pm August 30th, 2011

A positive marijuana test by a chronic pain patient currently results in not only the cessation of needed pain therapies but your supposedly “confidential” medical information is shared with other pain management practices. Now the federal government in the form of the DEA is getting into the game; medical records may as well be posted with court records in the local paper. There are many advantagous uses of marijuana with far less side effects than legal prescription meds.

artistic1
3:41 pm October 12th, 2011

There is a strong division among Chronic Pain Experts as to whether or not opoids are appropriate for long-term use. To say that is NOT is incorrect. There is also the subset that considers the physical dependency which may develop with long-term opoid use as a sign of “addiction”. This is also not correct. There is a big difference between drug tolerance after long-term use, physical dependency after long-term use and addiction–which is a cluster of behaviors characterized by the use of opoids for the euphoric affect, not to treat pain. It isWRONG to treat chronic pain patients like potential addicts simply because thier medication of choice carries a stigma. Would you demand drug testing of a diabetic that requires insulin? Just what does the drug test tell you? I recently moved to another state that considers drug testing the “norm” for chronic pain patients and I find it extremely insulting. If a patient has been using the same doses for years than just what does drug testing accomplish? If opoid use is effective in controlling a patient’s chronic pain then how is that a bad thing? I’ve been treated very effectively for years on stable doses of narcotics without side effects, yet now they want to experiment with other drugs–many of which I’ve already tried and which either didn’t work or which caused side-effects. How is that helping? Does this make me a drug addict or weak? Why should I be treated like a criminal–or a potential criminal?

Michaela
8:25 pm December 12th, 2011

I have a problem with it if the office forces the patient to stay there until a sample is given…even if they can’t “go” at the moment. I have a problem with it if the office says “because we have to” and that’s it. Explain why. Don’t be jerks about it and don’t pull this after the patients have been going to your center for YEARS before you FINALLY decide to do this. This isn’t random. Seriously, a friend of mine just went through this, this morning. Do they really think a 38 year old female, with bad veins, sinuses and lungs, is really going to start doing ILLEGAL drugs!? Her “testing” had NOTHING to do with prescription drugs. It had to do with ILLEGAL drugs, which she doesn’t do. If she did, she wouldn’t be in as much pain as she is in, in the first place!

Monique
12:57 am February 19th, 2012

Recently I went to the ER for kidney pain. I do have a history of kidney stones. The Dr. ask me when my last scan was and I replied 1 year ago. After she confirmed my story she then treated me. A week later I went to see my family physician because the pain wasn’t better. She then informed me that the hospital did a drug test on me.
I was not aware of this, my question is are they not suppose to ask me first?

3:54 pm February 21st, 2012

Hi Monique. Thanks for your question. I am not sure if it is legal to take a random drug test without a patient’s permission, or not. Sometimes drug tests are used for diagnosis reasons, and not to check for illicit drugs. To be sure why the screen was ordered, you may request more information from the hospital and the doctor who ordered the test. I would think that this is part of your right to information as a patient.

robin
2:14 am March 2nd, 2012

To CDF:
You are lucky that you were billed for only the amount your were. My first unannounced test (never informed) until the bill arrived was over $800.00 The second request for a urine test cost over $1300. This is all the patients responsibility. I’m sorry, I can no longer afford this. This to me seems ethically unsound that I take the test to protect my Dr. and then I pay for it as well. While I don’t plan to, this type of policy at the Doctor’s office/clinic level would only encourage an otherwise compliant good citizen to seek out the medicines in a way that they are trying to avoid in the first place. Who can afford pain medicine for a chronic condition and be at the mercy of a doctor who decides to test you “at random”? I’m really confused about this whole idea.

Lily
12:15 am May 18th, 2012

yeah, and half the time the test is off, or the doc can’t read it correctly. I was thrown out because my test showed hydromorphone, and I am on hydrocodone. Well the one metabolizes into the other! I learned that on the internet after I was stunned when they called me and told me I had hydromorphone in my urine. What a bunch of crap! now I have an 888.00 bill. I am not paying this. They can stick it.

Scott
9:37 pm June 11th, 2012

I have been receiving pain management from a Sarasota pain management clinic for almost seven years. My reason for going to a pain management practice in the first place (the records from my first visit to the clinic confirm this) was my fear of having to continue taking opiods for chronic pain for the forseeable furture. Fortunately, a non-narcotic medication- neurontin- worked for me by blocking the pain impulses without inducing any euphoria or creating an addiction. Within three weeks of going there, I was taking only neurontin for my chronic pain. Since then, I have never had anything prescribed by the pain management clinic except neurontin. Yet for the past two years, due to revisions taking place in monitoring pain management clinics , I have had to take “random” drug tests, which didn’t seem random at all. When I refused to test, I was told that the pain management Dr. would not continue writing pain medication. So, I am forced to take a drug test every time I go in to the pain management clinic to prove that I am not abusing neurontin, nor selling it on the streets- which, mind you, if I ever did try to sell neurontin as a drug to get high on, I would be shot the same night since neurontin does not get anyone high, period. So, why do I have to keep submitting a urine sample for drug testing, especially now that the lab is sending the urinalysis to a lab that is not in my provider network, resulting in hundreds of dollars in unnecessary debt? What does Florida statute say about this?

artistic1
12:42 am June 16th, 2012

As I mentioned earlier, I recently moved to a different state with a very suspicious mind-set towards people with chronic pain that use narcotics for pain control. The irony is that Oregon passed a law legalizing “medical marijuana” for a multitude of vague diagnoses including chronic pain–it seems to be relatively easy to get approved. Medical Marijuana is not covered under any insurance plan. There is no real regulation, in that you can grow your own or purchase from a licensed “dispensary”.

I have no objection to the smoking of marijuana for any reason although I don’t use it. I do find it hypocritical in the sense that any specific “joint” could have varioius levels of the active ingredient (THC) depending on variety of plant, growing conditions, etc. As far as I know, being approved for a medical card does not regulate how much marijuana you are allowed to buy or use, unlike the careful regulation of narcotics. You have no idea of how much of the active ingredient you are getting, and it is very expensive if you have to buy it (as opposed to growing it). While it’s true that many people benefit from Medical Marijuana, I for one do not want to inhale an irritating smoke (which is certainly not good for you), and digesting marijuana (eating it) significantly inhibits the effects. Most people using marijuana even for chronic pain get “high” unlike people using narcotics for chronic pain. So, chronic pain patients are being hassled and viewed with suspicion for using proven, effective, standardized medications which are carefully controlled and covered under insurance and yet allowed or even encouraged (if access to standard opiates is prohibited or inhibited) to utilize a plant that lacks consistent effects and little regulation over quantity and quality. Yes (and my information is limited) they regulate how many plants and how much marijuana one can “hold” at a time, but nothing stops the user from going back as many times as they want (again, as far as I know) as long as they can afford it. And if they can’t get it through a dispensary it is certainly easy enough to buy it on the street–with even less control over quality. How does that make medical sense?

I know many people believe that “natural remedies” are better than “artificial”, or lab-created remedies (most of which are based on “natural” origins–it is faster, more consistent and cheaper to create them in the lab), but the fact is that if I buy a drug from a regulated pharmacy I know what I am getting. Natural remedies can have as many side-effects and detriments as lab created–marijuana, especially chronic marijuana use has well-documented side-effects which I won’t go into here. There is an ongoing debate as to whether or not marijuana is “addicting”. I am happy for those people that find pot beneficial, more power to them, but does this not seem hypocritical? Keep in mind that Federal Law still declares marijuana illegal and last time I checked, Federal Law trumped State Law–making every medicinal marijuana user a criminal.

So, if a patient is subject to random drug tests, what are they really looking for? What does this tell them? Drug levels? In which case they don’t need to be random at all. But that is not necessarily going to be helpful: levels will depend on when the patient took the medication and how they metabolize the meds; individual patients metabolize drugs at different rates and rendering levels pretty meaningless; and chronic pain patients can tolerate extremely high levels of narcotics without side effects. The only thing a drug level MIGHT tell them is if a patient is not metabolizing the drug very well, or the level is much too high for the doses given (which is not as straight forward as it might seem). If someone is not metabolizing the drug well it can lead to much higher or lower than normal levels (a particular problem in the elderly–making drug effects more difficult to anticipate). A patient could be taking a combination of meds that have a synchronistic effect–affecting the benefits and/or blood levels. For example, some drugs, even some vitamins can inhibit the absorption of certain other drugs. Liver or kidney damage? That doesn’t need to be random either, and is certainly a legitimate medical concern. The biggest problem with random drug tests is that they are not specific enough for any one type of drug. There are notorious for false positives and false negatives. And at least one poster here has pointed out: most narcotics metabolize into the same base ingredients. It won’t tell the doctor what specific drug they are using unless it is of a completely different family: a barbituate for example, instead of a narcotic–and how many chronic pain patients are on multiple kinds of drugs to begin with due to the effects of chronic pain? Sleeping pills? Check. Muscle relaxers? Check. Etc. Etc. So what exactly is a random drug test going to tell them? It certainly won’t tell them if the patient is an addict or a drug “abuser”. A random drug test won’t tell the doctor much of anything for most chronic pain patients. So what purpose does it really serve?

Avid
9:20 pm July 14th, 2012

I’m with artistic1. For most chronic pain patients a random drug test doesn’t tell them much of anything. It tells if you are at least taking the drugs prescribed, and if you are taking anything illegal.

Therefore, all I see is that chronic pain patients are being checked regularly for criminal behavior. Other people would find such a violation of their rights as american citizens shocking and appalling. What if your regular doctor randomly checked you for drugs? Can you imagine the implications on public health?

Furthermore from what I’ve read, the only illegal drug it’s really going to check for after that first “shocking” test is marijuana. All other drugs are out of your system within 7 days. You know when your appointment is, so why wouldn’t you just stop or alter your drugs for that last 7 days?

It just doesn’t make sense to me. It’s a test for marijuana, as far as I can tell.

artistic1
8:07 am July 30th, 2012

I should add that testing for kidney or liver damage does not involve drug testing at all! Any potential side effect is not going to show up in ANY drug test so that excuse is completely baseless. I dont’ think I can put it any clearer than that.

tony
7:36 pm August 30th, 2012

I’m a responsible parent going threw a lot . I am on pain med ,but I recently lost a close friend.So I smoke a joint .To get over it,that was it I had a doctor app. the next day then they gave me a drug screen.I failed for THC now he doesnt want to help me with my pain.I am not a addict. What do I DO

tony
2:49 am August 31st, 2012

hi this is tony again and i was upset earlier and misspelled some words…i need someones opinion please…i am a responsible mother and i have had my share of things in life to get me down…i have a cyst/tumor growing inside my ankle and i need to have surgery again and have the plate and screws removed to get to the cyst and then replace it with bigger screws and another plate…i also have panic attacks on top of all the pain i suffer through every single day…im not able to have surgery just yet because i will b down for a few months and i dont have anyone to raise my children for me…i also recently lost my best friend to suicide and she always helped me through things in life so therefore im dealin with that the best that i can and yes i was upset and out of my meds cuz my doc couldnt see me until several days after i ran out of my meds…i smoked a marijuana cigarette a couple of days bfore i went to the doctor…im not an addict i know that i can pass another drug screen if given the chance and yet my doctor will not c me and prescribe me my meds. anymore nor give me the chance to prove i can pass another test…what do u suggest….help please

11:24 am September 1st, 2012

Hi Tony. I’d suggest that you either request another drug screen, order one yourself or see a new doctor and seek the pain medications that you need.

artistic 1
5:50 am September 2nd, 2012

You failed for marijauna? How in heaven’s name would one test mark you as an addict or drug abuser? This is one drug that according to the majority of scientifically sound studies is NOT physically addicting (and honestly, can you overdose from smoking joints?). Unless you are an habitual user your doctor is over-reacting big time, and certainly discouraging his patients from being honest about their lifestyle choices. You need to be able to be honest with your doctor, and I think that argues most against this whole mind-set of random drug tests and forcing–or even asking doctors to literally “police” thier patients. Patients must be able to trust their doctors and be able to discuss ANYTHING with them without fear or the doctor-patient relationship is not going to work. That is why confidentiality is so fundamentally important legally and medically. This whole issue undermines that very important aspect of the doctor-patient relationship.

Pot is certainly not good for your lungs true, but as it is also used medicinally in several states then I find your doctor’s response extremist, unfair and biased. Would he have reacted like that if you told him you’d gotten blitzed instead–imbibing illegal (and dangerous) levels of alcohol? I doubt it. Find a new doctor if you can, tell the new doctor what happened if you are at all concerned that the old one would pass on the test results. Better to hear it from you first. You want a doctor you can be open with, who isn’t going to over-react and who will treat you appropriately. Denying you medical care, let alone appropriate pain relief for one failed THC test is unreasonable–especially when you volunteered to repeat the test. There are far too many false positives. You can literally eat too many poppy seeds on your morning bagel and fail a drug test.

Bryan
12:25 am September 22nd, 2012

I see many others find the testing for drugs about as painful as it gets. I am certainly fed up with it and no one seems to mind that if you are a chronic pain patient the doctors literally hold in their hand whether or not you can even keep your job and therefore your house and kids fed. No pain medicine then many cannot even work and no one can live on Disability as the only income ssource, if you even can get with the government debt.

It is so frightening to think about the bills coming due and losing a job because you cannot work and what is coming up? A pee test that you have to pay to prove you are not a drug lord and a false postive comes back or you drank a sip of wine. Doctors need to consider the implications of being subjected nonsense and do all they can to see this absolutely wrong practice is stopped.

Talk about lives being lost or destroyed people needing medications who have lost everything and cannot even keep their job or they can’t get medicine because they cannot afford to go to the Dr.. I am sure many stories abound of those who have lost jobs, homes, wrecked lives over this totally needless and expensive testing to appease those who are out to save us from ourselves.

Bradley
1:32 am October 31st, 2012

It’s funny that a type II diabetic, for instance, who probably has diabetes because they are overweight, wouldn’t be denied their diabetes medication if they couldn’t prove they were exercising and eating right. Where does it stop?

Samantha Byler
12:20 am November 20th, 2012

It’s all about Ameritox’s profits. If Ameritox reps scare doctors
enough, the doctors force a drug test at the patient’s expense. Doctors don’t want to get sued and are told the tests may lessen their insurance. It probably won’t. These tests can run from 200 to 1,500.00. They test for everything including bath salts. They do this every 3 months and the doctor gets a kickback. Ameritox was busted in 2010 and paid a fine of 16 million for medicare fraud. Now they have been targeting private insurance but private ins doesn’t pay for it. It’s all about profits. Hurry and get your stocks in Ameritox. It will pay off.

Rick Carufel
4:11 pm December 17th, 2012

I had a positive drug test 8 years ago and The local HMO still refuses to give me pain medication for my chronic pain. I have degenerative joint and disc disease and the pain is getting worse and worse. How long is a reasonable amount of time to deny meds for s positive test?

12:34 pm January 2nd, 2013

Hi Rick. That is a great question. I’d suggest that you call the National Drug Abuse hotline at 1-800-662-HELP (24 hour) and ask them where you can go for more information. SAMHSA is another good place to start. There may be a federal or national association that can help advocate for you.

Rick Carufel
3:17 pm January 2nd, 2013

I have contacted every agency I can think of and they all have the same answer, they don’t know how long is a reasonable time to deny pain meds. There has to be somewhere in the statute that decrees mandatory testing of patients on narcotic medication on how long a person should be disqualified from receiving their medication for a positive test. The National Drug Hot Line referred me to a local clinic who referred me to the local lab that does tests how referred me to a receptionist none of who knew anything and couldn’t even identify the legislation that mandated drug testing in the first place. Is there any legislation or is this just a policy HMOs have adopted with not written limits or guidelines?

ladybug2535
6:59 pm January 3rd, 2013

Fundamentally, random drug tests don’t screen chronic pain patients for addiction. A better and cheaper method to check for over-use or selling is to have the pt bring in their med bottles. Concerns over liver or kidney effects aren’t answered by drug tests. As far as this article goes, the justification for random testing is lacking.

4:56 pm January 4th, 2013

Hi again, Rick. Maybe it’s time to contact your county or state legislative representative. I think that it will take some digging to learn more, and if I know your county/state I can help you look into it.

Rick Carufel
5:13 pm January 4th, 2013

ladybug2535: The drug test did not test positive for overuse of the prescribed drugs. It tested positive for cocaine, which I had not taken. I believe it was a false positive caused by the Lidocaine patches I was using on my lower back. But of course no-one would consider that possibility when I challenged the results. The test manufacturer refused to even divulge what could cause false positives, the lab refused to consider it may be a false positive and neither would my doctor. But my pharmacist told me that the Lidocaine may very well have cause the false positive.
Addiction Blog: The county is Winona and the state is Minnesota.

5:43 pm January 4th, 2013

I just sent you an email with the necessary details. Good luck!!!

Bob
11:27 pm February 26th, 2013

Physical dependence is not addiction. That’s something most GP’s don’t get.
Chronic pain patients are treated as if they are “acute” patients on steroids…….its wrong.

The methods used to implement these programs are abusive. My last Dr. required me to go to his office within 24hrs of call. I’m disabled, don’t drive and require PCA help to dress. It costs me time, money and pain only to protect the DR in fact. Dr.’s malpractice insurance should pay for the urine tests. All experts agree its main point is to protect Dr’s license.

Artistic1
7:01 am May 25th, 2013

Here’s a new twist on Oregon’s Medical Marijuana plan: I was just informed by my GP that he could/would no longer prescribe my long-standing pain meds if I EVER tested positive for Marijuana. I would have to choose Medical Marijuana over prescription drugs. Now, as I have said in prior posts, I don’t smoke Pot, and I’m not interested in using it. My point here, is that patients are being forced to choose one over the other! I asked why and the doctor didn’t provide an answer. The only real justification I can fathom is that using both could potentially cause a synchronistic effect–exaggerate the effects, or possibly cause increased sedation if used together. Why not tell their patients the potential problems instead? Since medical marijuana is legal in Oregon, it should be discussed just as alcohol would be discussed. In other words, my doctor freely lets me know that drinking alcohol with some of my meds would be a terribly bad idea. Shouldn’t marijuana be discussed in the same manner? Why is it that using legal medical marijuana is still being treated as an illicit act by some doctors? Why not do more research into the potential medical benefits while a volunteer population is available? And by that I mean investigating any potential benefits gained by voluntarily testing marijuana use in conjunction with other medications–just as patients have done illegally for decades with chemotherapy. This is one of the major problems I see in forcing doctors to act as law enforcers. Patients should be able to discuss any potential complications with mixing drugs–legal or illegal. They NEED to be able to be honest and open with their doctors. They need to be able to ask any questions without condemnation.

Rob
2:51 am December 31st, 2013

If you think that drug testing does not give the patient or the doctor helpful information you are a fool. Qualitative and Quanitative drug testing can not only protect a physician from losing his or her license but it allows the physician to have an honest conversation with his patients . Its gives them a tool to council. And in some cases YES patients may choose to not abuse illicit substances if they know they are getting tested. And when you get an expensive drug test it tells the Dr. if your Taking your meds correctly, your not doing anything to kill yourself and your not hoarding or selling your medication. The reality is there are more people dying from complications with medication ( Opioids especially ) then car accidents, Heart Attacks , and cancer in A DAY. Close to 100 people a day . SO Plain and simply physicians who don’t do this random testing and those who don’t support it are APART OF THE PROBLEM AND NOT THE SOLUTION!

Artistic1
2:58 pm December 31st, 2013

You’ve missed virtually every point raised here: The drug test do NOT tell the doctor if the patient is taking the drug correctly. It MAY tell the doctor if a patient is also taking other drugs–which may or may not be illegal. Illicit drugs–as opposed to strictly illegal drugs, are medications that have not been prescribed to the specific patient who is using them. Illicit drug use also includes altering their doses, which may include purchasing that drug (which may be the same pain med legally prescribed) but it is being used in a manner inconsistent with the way it was prescribed. Sometimes this is an indication of addcition, but it can ALSO be a sign of under-treatment or ineffective treatment as opposed to an addictive behavior.

Drug testing does not (concretely or definitely) confirm if the patient is taking the appropriate dose (see the previous post about individual metabolism and other factors that can affect absorption). Drug testing cannot tell the doctor if a dose is too high or too low (long-term narcotic chronic pain patients can safely tolerate extremely high doses of drugs as posted earlier). Drug testing does not tell the doctor if the dosage prescribed is effective for the condition being treated. Drug testing does NOT prevent complications from taking drugs. As already posted, it will NOT tell a doctor is a patient is experiencing kidney or liver problems (for example). Those tests are NOT drug tests. If a patient is taking a pain med PRN (as needed) it does NOT tell the doctor if the patient is hoarding or selling their meds (also as previously posted).

Drug testing does NOT open communications between doctor and patient, instead it puts the doctor in the abhorent position of law enforcement, as they are REQUIRED to report any “positive” drug test (which may be wrong) to law enforcement–a consequence that can directly negatively affect their medical treatment. That is NOT conducive to open communication and is far more likely to shut it down as well as adversely affect the doctor/patient relationship altogether. How can any patient safely or openly communicate with their doctor if the patient is afraid the doctor will report them to the legal authorities and state-wide medical authorities (in this case, even if the drug is legal); or will in fact refuse to treat you any further (as also previously posted); and in fact may prevent anyone else from treating them–even if the test was WRONG. With electronic files something like this–even an error like this can haunt the patient for the rest of their lives. In fact fear of reporting, punishment or stigma is going to interfere with any open communication between doctor and patient (even without a drug test) as I pointed out above which prevents a patient from openly asking questions about the potential problems of these drugs, of mixing these drugs or of notifying the doctor about what works and what doesn’t work so the doctor could use this information in planning the patient’s care. The lack of communication can directly affect a patient’s care resulting in over-treatment or under-treatment (remember we are also talking about communicating about LEGAL medications, not just legal meds). Patients can ask about alcohol, which is often quite dangerous to mix but they don’t dare ask about pain meds, unprescribed medications, altering their doses (as others have mentioned) due to inadequate control, or their use of illicit or illegal drugs.. Sometimes they lie anyway, but at least they can tell the truth without being afraid of getting thrown in jail or having their meds cut off. This bad and expensive policy serves no useful purpose and is a violation of patient privacy, of doctor/patient confidentiality and of our civil rights (against unwarranted search and siezure). If we are doing this for the patient’s benefit, then it absolutely can NOT be reported or used to “punish” the patient in any way.

Drug testing does not protect the doctor either–by placing them in the middle it changes the relationship between doctor and patient and disrupts open and honest communication. By requiring them to report illegal drug use it effectively bars the patient from being able to discuss this drug use (and the potential consequences of such use) placing the doctor in GREATER liability and at greater risk (not all illegal drug users show outward signs–especially if they are also using pain meds). If the patient can openly discuss their illicit (not necessarily illegal) drug use then the doctor is in the position to offer addiction treatment (if that is the issue) or to solve the problems that are pushing the patient to illicit drug use (which may mean inadequate pain control under the prescribed dosage, so they are using more than prescribed, or not as prescribed) or to find other medications that can perform the function the illicit drug is providing. For example, inadequate pain control (as mentioned), nausea and vomitting (pot use helps–as an example), depression (may require a change in anti-depressants or other treatment), etc.

It IS true that doctors can lose their licenses if their patients are abusing their medications, and it is true that drug testing can provide a slender measure of protection. However, I’ve never heard of a case of any doctor losing their license because they refused or did not administer these drug tests when they were voluntary. The only time drug tests have cost a doctor their license is when they were MANDATORY and the doctors didn’t comply–usually for the reasons listed above.

Addiction IS a serious problem. I’m not asking anyone to pretend that it doesn’t exist or that narcotic abuse doesn’t occur. And the consequences of drug abuse are serious. But mandatory and random drug tests do NOT help narcotic-using chronic pain patients–certainly not in any of the ways it is supposedly “aiding” the patients. Instead mandatory random drug testing stigmatizes the patient–no matter how unintentional, by treating that patient as a criminal, or a POTENTIAL criminal and as someone to be viewed with suspicion, as someone who cannot be trusted. This effectively undermines the doctor-patient relationship which has a definite and detrimental impact which works against the patient and does not protect the doctor. If the doctor suspects abuse, there is nothing to stop him from requesting the test himself. THAT is an appropriate use for the drug test, if the doctor suspects the patient is not being honest. Mandatory random drug testing also undermines doctor-patient confidentiality, and breaks the sacred trust that is required for effective care. It is bad policy all around.

Artistic1
3:17 pm December 31st, 2013

CORRECTION (I was unable to edit my submission). This sentence near the bottom of the third (3rd) paragraph: ” Sometimes they lie anyway, but at least they can tell the truth without being afraid of getting thrown in jail or having their meds cut off.” SHOULD read: ” Sometimes they lie anyway, but at least they SHOULD BE ABLE TO tell the truth without being afraid of getting thrown in jail or having their meds summarily cut off, effectively leaving them without treatment for their physical pain; possibly without treatment for ANY of their medical conditions (If the doctor drops them altogether out of fear of legal ramifications); or their addiction (if that’s the issue–it is important to note that many addicts are self-medicating, attempting to “treat” or manage some type of psychological disorder). This level of open communication is very important–for their safety; for receiving appropriate and adequate care; and for the protection of the doctor.”
(END)
If it’s possible to re-edit before posting I would appreciate the opportunity. (I would also shorten my response). Thank you

Barry
2:41 am January 2nd, 2014

ROB, who are you calling a fool? I look at you and think the same about you I guess. I am an honest person that suffers from terrible chronic pain from a accident 10 years ago. Like you, I always said I welcome a drug test since I am an honest person.

Well that was before I got 2 false positives on 2 different tests. Your integrity is in the hands of God knows who. Illegal immigrants maybe? He sends his tests from Michigan to Florida(probably because the Cubans in Florida work cheap). His pee girl hands you the cup and does a preliminary test.

Last time I was there I did the usual test and the girl was in a hurry (after I waited 2 hours to see the Doctor). All she did was write my initials on the lid and put it in a box with no less than 100 other urine samples in it. I said hold it, you can’t just write my initials on the lid!! She handed me back my sample and said “here, write whatever you want on it and put it in this box with all the other ones.” There I was holding my sample,, all alone with 100 other samples. I could have done anything. In hindsight, I should have put it in my pocket and left.

If they are going to use drug testing, there shouldn’t be mistakes. His girls told me they get false positives all the time.

I would bet a years pay that there is someone in Jail that was on probation and got a false positive. I’d bet another years pay that some poor woman has had her child/children taken away by the State over a false positive.

If you want to put your faith and trust in a corrupt, inept system and think it’s good,, who is the fool?

Artistic1
4:33 pm January 3rd, 2014

Dr. Jana Burson, MD, I hope these posts are informative–particularly from the people who are being penalized over these tests in any form. I am not saying there is never any justification for a surprise drug test, but there are far too many problems with the tests and there is no reasonable recourse for someone who fails a test–false positive or not. You would never cut off a diabetic’s insulin if they were non-compliant (even if they were constantly lying about it), nor would you blame someone–let alone refuse to treat someone with OCD for repeatedly getting infections in their hands due to cracked skin from constant hand washing. The difference in results for a failed drug test indicates that there is still massive misunderstanding regarding chronic pain AND drug addiction. Worse, it clearly demonstrates that BOTH are being viewed as moral failures rather than as medical conditions.

This HAS to change and random drug tests have to be discontinued unless there is CAUSE to be suspicious of illiict drug use, and then ONLY out of concern for the patient’s safety. It is not fair (and frankly I considered a gross violation of our civil liberties and against Constitutional Law) to the patient OR the doctor when there is no appeal system and when the results of a failed test essentially costs the patient medical treatment. Results which can follow them for the rest of their lives. It’s not just the lack of pain treatment either, many doctors won’t continue to treat–or accept any patients who are pain patients, let alone who has failed a drug test. The patient may not be able to receive ANY MEDICAL CARE AT ALL. This is not reasonable, and it hardly seems to meet the standards of being “for the patient’s own good”.

I say again: Chronic pain and even reasonable narcotic use (this goes beyond drug addiction) are BOTH are being viewed as moral failures rather than as medical conditions. I’d be very interested to hear your response to my assertions Dr. Jana Burson, MD.

J. Smith
8:00 am January 17th, 2014

I was just at my pain management doctor and they asked for a urine sample. I questioned this since he had been doing them about every six months and it had only been four since the last test. The doctor and the nurse both told me that the DEA changed the rules and now required the testing every four months. Initially I was willing to accept what the doctor told me when he started this about two years ago and it was every six months, but this latest change made me suspicious because of the increased frequency. The problem I have is that I can not find anywhere on the DEA web site or in the Code of Federal Regulations where it says anything about mandatory drug testing of pain management patients. I am getting the feeling that I am being lied to. I have also recently discovered that the doctor has a financial interest in the lab that he is using to do the tesing, which only makes me that much more suspicious. Does anyone know if there actually is any DEA requirement for drug testing of pain management patients and, if so, what the applicable code number in the CFR I can find it under. Also, is it possible that this is a CA state requirement and not federal and the doctor is just mistating where the requirement comes from.

I would appreciate any help that anyone can provide on this issue.

Thomas
8:31 pm June 29th, 2014

Have those who publish ever experienced chronic pain themselves to reach conclusions? Do they truly realize how pain meds really provide bullet purpose to those with documented need, yet no right to argue that point. I’ve experienced no side effects. The exception is having increased mobility, not pain freedom, that as a dose wears off causes a temporary heightened pain level, doctors call breakthrough pain that might not happen with proper medical treatment. Low doses with constant daily need to remember over lapping doses rather than when pain returns with impunity can be difficult. And some pain is more demanding when considering spinal issues, kidney disease clots or stones, gout etc.
After 20 years of climbing the pain ladder and the hoops, now on top, I chose to quit pain med under-treatment, for six months now. The pain is more wide spread and those areas were under control, yet my testing the assumptions of addiction or abuse could not be self tested any other way. I experienced no withdraw. It seems I fall into category where logical opioid use helps. My self question: is it my Great-great-great-great Grandfather S. Guthrie’s making of ‘Sweet Whiskey’ better known as Chloroform a cause of genetic abnormalities and/or a handing down of tolerance?
The biggest problem of intolerance, I find repulsive, is book learning verses knowledge from real experience, under-treatment as normal, the small pool of doctors where most are better suited for operating rooms, the promotion of doctor abuse because of admissions of DEA fear over proper treatment of patients and refusals to treat, despite referral, due to screeners. In my case monthly visits are an unfair joke, yet I have no problem with testing and more fair contracts. I have the right to dismiss incompetent physicians to search for a knowledgeable doctor, but Internal Medicine does not apply. Feel free to use my thoughts.
Thomas, US VETERAN

Leave a Reply

About Dr. Jana Burson, MD

Jana Burson M.D. is board-certified in Internal medicine, and certified by the American Board of Addiction Medicine. After practicing primary care for many years, she became interested in the treatment of addiction. For the last six years, her practice has focused exclusively on Addiction Medicine. She has written a book about prescription pain pill addiction: "Pain Pill Addiction: Prescription for Hope." Also see Dr. Burson's blog here.