A prominent pain doctor is disputing reports that a widely used urine drug test often gives faulty results.
“They are reasonably reliable and highly cost effective for use in a pain management practice. I would strongly recommend the practitioners use this,” said Laxmaiah Manchikanti, MD, chairman and CEO of the American Society of Interventional Pain Physicians.
Interventional Pain Physicians are the ones who perform dangerous and expensive epidurals, surgery, and other invasive procedures. This is the organization behind Physicians for Responsible Opioid Prescribing (PROP), which does not believe in using opioids for chronic pain.
So now we have to choose which to believe:
- the lucrative business that does drug testing?
- the lucrative business that does interventional procedures?
The urine tests are inexpensive and give immediate results, and doctors often use them to monitor their patients for opioid or illicit drug use
“The UDT (urine drug test) with immunoassay in an office setting is appropriate, convenient and cost effective. Compared with laboratory testing for opioids and illicit drugs, immunoassay office testing had high specificity and agreement,” Manchikanti’s study found.
Pain News Network recently reported on the results of a second study conducted by Millennium Health (see Urine Drug Test Often Gives False Results)
which found that POC tests were wrong about half the time – frequently giving false positive and false negatives results for drugs like marijuana and oxycodone.
Urine drug tests are notoriously difficult to interpret (see App for better Interpretation of Urine Drug Testing), so the problem may not be with the test as much as with the interpretation:
The Millennium study advocates the use of chromatography-mass-spectrometry – a more complex laboratory test that costs thousands of dollars – to confirm POC test results.
Following the advice from companies in reference to numerous expensive tests and also income generating avenues will only lead to time in the slammer and will not improve patient care at all,” said Manchikanti.
“(The) Millennium study is performed by the company which makes a living by testing. The more samples that are sent to them, the better off they are. Further, they are not even a practical setting. From our practice we send approximately only 2% of the samples for confirmation testing. Even then, the patients can’t pay their bills.”
Manchikanti’s study found false negative and false positive rates for POC tests that were far below the rates reported by Millennium.
- Millennium’s false positive rate for oxycodone was 41.3 percent. For Manchikanti, it was only 7.7 percent.
- Millennium’s false positive rate for marijuana was 21.3 percent. For Manchikanti, it was just 2 percent.
There were discrepancies between the two studies for several other drugs, including methadone, cocaine and methamphetamine.
Millennium Sponsored Both Studies
There were some differences in their design.
- Urine samples in the Millennium study came from nearly 4,300 patients in addiction treatment clinics, while the
- urine samples in Manchikanti’s study came from 1,000 patients in pain management programs.
Millennium maintains the patients in its study were younger and more likely to be drug users.
Ironically, the laboratory tests for both studies were conducted by Millennium
A source with broad experience in the drug testing industry told Pain News Network the data in Millennium’s study was “skewed toward exaggeration.”
“It does not surprise me that Millennium would show a high rate of inconsistencies with the POC test. Remember, their business is to sell confirmation testing
Millennium bristles at the notion that its study was biased.
In recent years a growing number of doctors who treat addicts and pain patients have required them to submit to drug tests. The competition between Millennium and other laboratories for this business is intense. According to one estimate, drug testing has grown into a lucrative $4 billion dollar a year industry.
But Manchikanti maintains that a single inexpensive urine test that costs about $20 is often the only one that’s needed.
Health care is no longer a human service, but rather a business with tremendous profit potential. Financial interests, which are motivated solely by profit, are distorting the entire landscape, and actual patient health seems the least of their concerns.
Drug testing has become the Golden Goose of pain treatment:
- Drug Testing for Painkillers Motivated by Profit
- Drug Testing Can Make Doctors Rich
- Medicare on drugs: 24,000 tests for 145 patients
These tests are a burden for all pain patients, especially those who have been maintained on a stable opioid dose for years, sometimes decades”
- Increase in Urine Testing Raises Ethical Questions
- Drug Testing: Balancing Need to Test With Need to Treat