Urine drug testing has become standard protocol for many patients who are prescribed opioid pain medication.
But a new study suggests the practice may be counterproductive, because it increases the odds a patient won’t come back for further treatment.
I’m not sure I see this as a huge problem. If pain is severe enough, a patient will jump through endless hoops to get any treatment that works. If the drug test is a problem, I believe patients can prove they are not addicts by stopping that illicit substance long enough to have a clean drug test.
However, urine drug tests are notoriously unreliable and repeated testing increases the odds of a false positive.
- This is the first flaw:
Urine Drug Test Often Gives False Results
The danger is that this erroneous result could be posted in a patient’s medical records.
Any medical notation even hinting that a patient might have “addiction issues” would thereafter raise red flags it could prevent a patient from ever getting opioids again.
- The second flaw is that a false positive can cause a pain patient to lose any hope of treatment:
Patients “Fired” for Misinterpreted Urine Drug Tests
Genetic flaw affects opioid metabolism and drug tests
- The third flaw is that with such a huge mandated captive audience, the potential profits attract fraud
Lucrative drug tests for pain-pill abuse
Drug Testing for Painkillers Motivated by Profit
Before mandating drug testing and generating an incredibly lucrative business opportunity with a captive market, these tests must be improved to be more accurate and less likely to damage patients reputations.
If the drug test is a problem, the patient may have been using other drugs to fight the pain. However, patients can just prove they are not addicts by stopping illicit substances long enough to produce a clean drug test.
If a pain patient is unable to stop taking an illicit drug long enough to pass a drug test, even if it leads to being denied opioids for pain, then they are probably dependent or addicted. In this case, addiction treatment would seem the treatment of choice (along with opioids for the pain), but effective addiction treatment does not exist in this country.
AA only has a 5%-10% rate of success – ineffective by any standards.
If there were effective treatments available for addiction, we wouldn’t be having an “opioid crisis” or a “heroin crisis”, and pain patients wouldn’t be denied opioids.
No, it’s not fair, and probably not even moral, but in the current environment, we have to be willing to compromise. Agreeing not to be dependent on or addicted to illicit drugs while on opioid therapy seems a reasonable request to me.
I completely agree that these tests can destroy the doctor-patient relationship, turning what should be a therapeutic meeting into a suspicion-laden and threatening adversarial relationship.
Instead, pain patients feel that their doctor visits are more about anti-addiction and law enforcement than healing.
In a study involving 723 chronic pain patients being treated at a pain clinic, researchers at the University of Houston and the University of Texas Medical Branch at Galveston found that nearly a quarter (23.75%) who were given a urine drug screen on their first visit failed to show up for the next appointment.
the “no show” trend also applied to patients whose drug tests were negative.
“On one hand, concerns about patient safety and public health necessitate the monitoring of patients on opioid medications. On the other hand, aggressive monitoring may interfere with the therapeutic alliance.”
Routine use of urine drug tests is one of the main recommendations in the CDC’s draft guidance for opioid prescribing, which calls for primary care physicians to “use urine drug testing before starting opioid therapy and consider urine drug testing at least annually.”
Researchers say one possible solution to the high-rate of patient “no shows” is for doctors to delay drug screening of new patients until they’ve had a chance to develop rapport and trust with them.
“If the patients are disengaging from the clinic, where are they going? Is the illicit market place their next stop?
It’s almost unheard of for a legitimate pain patient to resort to street drugs. Most pain patients haven’t the slightest idea of how to connect with this illicit market.
Thus, while UDS may induce the problematic patients to go away from the clinic, the problem of opioid misuse may continue to persist.”
The opioid problem isn’t caused by pain patients, but by people with an addiction that choose opioids to feed it.