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

Some U.S. states may start to require that patients being treated for chronic pain be randomly tested for the presence of opioids. But will this practice reduce prescription drug misuse, addiction, and overdose? Or will required testing for opioids benefits patients? Dr. Burson comments here on random drug testing for opioids here.

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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
About the author
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.
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