A new guideline on the use of drug testing by the American Society of Addiction Medicine (ASAM) warns against expensive and unnecessary tests that have led to “unethical and/or fraudulent activities.”
The ASAM is a professional society that represents over 4,300 physicians and specialists in addiction treatment. Its new guideline – the first attempt to set national standards for clinical drug testing – could also influence primary care providers and pain management specialists who are increasingly testing their patients for opioid misuse.
Here are two more articles about the great variety in individuals’ ability to metabolize opioids (and a list of 6 previous posts about this), which leads to great variety in the pain relief they achieve from opioids.
This is the scientific arguments against the CDC opioid guidelines and other such “standards” limiting opioid doses to some arbitrary standard.
Genetic Mutations in Cytrochrome P 450 2D6 – P1 – Practical Pain Management – March 2014
The majority of opioid medications are metabolized by one or more of the CYP450 isozymes. Continue reading
Just the thought of this makes my stomach lurch.
Politicians, bureaucrats, and financial interests are determined to control how much pain we must suffer by restricting access to the most effective relief.
Various industries which stand to gain from opioid restrictions (addiction-rehab, pharmaceutical, medical device, drug-testing) are colluding with political powers to pass legislation restricting opioid dosages to arbitrary limits.
Investigations of abuse or inappropriate prescribing would be shared with insurers enrolled in the giant Medicare/Medicaid system, even if the allegations are never proven. Continue reading
Public support for marijuana legalization is at a record high in the United States, but not everybody is embracing reform.
Certain industries have a financial interest in keeping weed illegal — private prisons, law enforcement, and Big Pharma, for example — but there’s another opponent to legalization that most people don’t think about: the drug-testing industry.
Against mounting evidence that drug testing is not cost effective, and that it unfairly targets marijuana users, the industry remains steadfast in its opposition to legalization.
The reason? The industry has a lot at stake. There are those who argue it has a conflict of interest in opposing legalization efforts and is ignoring the facts to justify its fat revenues. Continue reading
Milwaukee congresswoman Gwen Moore; “We’re not going to get rid of the federal deficit by cutting poor people off Snap. But if we are going to drug-test people to reduce the deficit, let’s start on the other end of the income spectrum.”
Moore plans to introduce a bill on Thursday that she thinks will even the playing field or, at least, “engage the wealthy in a conversation about what fair tax policy looks like”.
The bill, called the Top 1% Accountability Act, would force taxpayers with itemized deductions of more than $150,000 – which, according to 2011 tax data compiled by the IRS, would only be households with a yearly federal adjusted gross income of more than $1m – to submit to the IRS a clear drug test from a sample no more than three months old, or take the much lower standard deduction when filing their taxes. Continue reading
Why Drug Tests are a Massive Scam – September 3rd 2015 –
Drug testing may seem like an effective way to maintain a healthy and productive workforce and motivate people to abstain from illicit substances, but what drug tests really do is discriminate against users and waste money.
The American Civil Liberties Union put it bluntly:
“Blanket drug testing with no individualized reason for suspicion is unconstitutional.” Continue reading
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. Continue reading
Opioids, Pain and the CDC’s Guideline: Needs Improvement |
by Stefan Kertesz Physician, researcher
These arguments against the CDC’s guidelines are specific, logically argued, and carefully thought out, explaining some aspects that seemed muddled, but are clear to a practicing doctor.
The Centers for Disease Control report that 2014 saw a record of 18,893 deaths related to opioid overdose, including both medications and heroin. Given a rising tide of deaths, it is only sensible to look at how opioids come into distribution.
A major portion of the public health response has focused on doctors and their prescriptions (disclosure: I’m a primary care doctor trained in internal medicine and addictions). Many authorities and researchers believe the rising tide of overdoses has something to do with the opioid prescriptions we write.
Doctors frequently order patients to take urine drug tests to safeguard against prescription pain-pill abuse.
But federal investigators and Medicare say these routine tests — designed to ensure patients properly use opioid drugs — have led to questionable billing practices by some for-profit labs, doctors, and addiction-treatment centers.
Millennium Health, the nation’s largest lab and one that has conducted widespread testing in Arizona, agreed to pay $256 million to the federal government in October to settle claims that it conducted unnecessary testing. Continue reading
The CDC and Profit Driven Drug Testing | Pain News Network | January 05, 2016 | Mark Collen
There are a number of conflating factors which have led to the CDC‘s recommendation for urine drug testing (UDT) in pain management — none of which have to do with quality patient care.
- the federal government‘s complicity in the overprescribing of drugs,
- the unethical marketing of OxyContin by Purdue Pharma,
- the profit motive which drove drug testing patients in pain, and
- physicians‘ fears and inability to effectively treat pain.
The pharmaceutical industry‘s direct-to-consumer advertising (DTCA) has driven demand for drugs and has contributed to the escalating cost of prescription medications. Both Congress and the FDA are largely responsible for this overprescribing public health issue since they have allowed DTCA to exist and spread. Continue reading