Doctor Defends Use of Urine Drug Tests

Doctor Defends Use of Urine Drug Tests — Pain News Network

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.

For example,

  • 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:

These tests are a burden for all pain patients, especially those who have been maintained on a stable opioid dose for years, sometimes decades”




3 thoughts on “Doctor Defends Use of Urine Drug Tests

  1. Doc Anonymous

    It is too bad he does not promote “Medication Screening” for the steroids that he promotes so successfully. Dr. Manchikanti heads the organization that has promoted or at least cultivated the rapid growth of the injection (interventional) pain industry. Some of his members tout themselves as the “only” alternative to opioids for chronic pain, even there is no proof of that. Nonetheless, steroid injections have grown massively with high financial rewards and no sanctions for those doing only injections.

    History has shown that the uncontrolled growth of pain intervention has led to a plethora of companies putting contaminated medications on the market and the steroids used for pain interventions are among the most commonly contaminated.

    It would be very possible to screen batches of meds for contamination using modern techniques such as PCR testing. This test has already shown the presence of multiple species of fungus in the blood and/or tissues of people infected by steroids supplied by NECC and the owner has been charged with murder. The FBI says 86 people were killed, although the CDC only lists 64.

    Yet Dr. Manchikanti and his group have been absolutely silent about the contaminated medication. Remember that the interventionalists in general step in when a patient is sent in an attempt to get away from opioids. Dr Manchikanti promoting urine tests seems to be truly a case of having the fox guarding the henhouse!

    Liked by 1 person

    1. painkills2

      I had three different sets of steroid (and botox) injections, which had to be done in the hospital, as I had to be put under for each procedure due to the pain involved. I remember immediately following each procedure, it seemed like I felt some relief. After one of them, I remember having increased range of motion, at least in my neck. I didn’t realize it until much later, but that immediate relief was due to the IV drugs given for each procedure, because it didn’t take very long for those benefits to wear off. If I remember correctly, for maybe a day or two, I had a little bit of relief.

      I think a lot of patients mistake that initial relief (not due to the steroids) as a sign that the procedures help, and so keep having them. There’s also patients who keep having them just so they have access to opioid therapy. After three failed procedures, my pain “specialist” told me there wasn’t any reason to do more of them. (Then gave me that line I’ve heard so often: “There’s nothing else I can do for you.”) And yet, I think many doctors keep doing them and doing them, regardless of any benefits achieved.

      Pain patients should know that just like with any other drug, too many steroid injections are not a good thing. They weaken your immune system and… a bunch of other stuff I can’t remember right now. For instance, I have a suspicion that it was these kinds of treatments that opened up my system to eczema, a condition that usually doesn’t have adult onset.


      1. Payne Hertz

        I have seen a lot of this sort of thing. Often you have to agree to getting repeat injections regardless of whether they help or not as a quid pro quo for getting pain meds. Studies that don’t take into account the pressure people are under to report success with unhelpful therapies are worthless, in my opinion.

        My friend is dealing with this right now. She has to get the shots and pretend they work, has to go to all kinds of therapists both physical and mental and has to take every other drug they prescribe for her even when the side effects are terrible. Then there are the urinalysis tests, of course.

        Since they have us by the short rabbits, they can force us to do anything and a lot of the “science” being trotted out by the industry nowadays seems designed to create new and lucrative treatments to fleece us with.

        Liked by 1 person


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