While my little blog only touches a very small portion of the chronic pain community… lately I am seeing a disproportion of incidents that are very disturbing to me.
I have always had this “strange talent’ of picking up on social/bureaucratic developing patterns long before others see things coming together.
I am seeing a pattern of prescriber practices using URINE TESTING to summarily discharge pts from the practice…
These practices are treating urine tests like a guillotine.. once the lever is pulled.. there is no DO-OVERS…
No prescriber – worth their salt – would start treating a pt for a non-life threatening life condition based on a single lab test. Lab tests are a “snap shot in time”… if you want to see how bad a snap shot in time can be pull out your driver’s license and see if your picture on your license is a good representation of you ?
Pts who have never had a UA problem all of sudden has a negative test or some illegal substance in their UA.
One very suspicious incident… pt’s UA tested positive for the appropriate medication..but.. the prescriber sent it to a OUTSIDE LAB .. where it showed – NEGATIVE… the pt is told that the prescriber could no longer provide opiates – even though the pt was on a very low dose – but would be happy to keep the pt into the practice and provide ESI (Epidural Spinal Injections)… so instead of the prescriber getting paid $100 for a office visit to write a prescription… the prescriber would be generating THOUSANDS for giving ESI’s… the question is why would a prescriber test the pt’s urine TWICE after the first was POSITIVE and why keep the pt in the practice that – in theory – failed a UA ?
Second very suspicious incident… a long time pt was told UA was negative for prescribed medication… could not do another test… would not accept a outside lab test, hair test … nothing… ONE STRIKE AND YOU ARE OUT… It is common knowledge that these pee in the cup UA have a 20% +/- false positive/negative results. Even tests sent out to outside labs … could not have been stored/handled properly or some other issue that could cause a false reading. In this particular incident.. the clinic had CHANGED OWNERSHIP… first UA after ownership change – comes up NEGATIVE ??? Could it be that the pt’s insurance pays too slow or too low … could be that the pt’s daily opiate dose is higher than the clinic wishes to now prescribe ? THINNING OF THE HERD ???
Then you have prescribers who are seemingly unaware of what foods or OTC meds can cause false UA outcomes… one pt showed COCAINE in UA… pt asked me.. a simple web search and the Amoxicillin/Augmentin that the pt had been taking could cause a FALSE POSITIVE for COCAINE… pt won the argument on this one 🙂
A second similar case… pt had a opiate show up in UA… again the prescriber is ready to discharge the pt.. come to find out the pt was recovering from a cold and had been taking Robitussin DM..and DM (dextromethorphan) and DM… can cause a UA to throw a false positive for a opiate …
The really DOWN SIDE to all of this.. is once a pt is discharged from a practice for negative UA and/or because of illegal/non-prescribed meds in their UA… you might as well draw a BIG RED “A” on their forehead. No other presciber/pain clinic will treat them.
Here is a link to the common or OTC medications that can cause UA’s to come up with false outcomes:
http://www.keystosaferschools.com/drug-testing/drug-testing-false-positives-for-urine-testing
Filed under: General Problems
Sorry, one more thing – suppose a patient does, in fact, test positive for a dangerous drug such as PCP or meth. Patient admits they have a drug problem. Aren’t doctors supposed to care for humans, regardless of disease or condition? Does “first, do no harm” even apply to doctors any longer??? If a patient already has a problem abusing drugs, wouldn’t cutting them off cold-turkey force them to the streets and cause harm to them even more? I mean, seriously, the medical care in this country has become a joke.
Do patients with drug abuse or addiction problems suddenly pieces of trash in the prescribing doctor’s eyes? Since when did kicking patients to the curb help ANYONE??? Those within the medical community are supposed TO CARE for all humans, regardless of condition or disease. Doesn’t cutting patients off medication cold-turkey and dismissing them as a patient harm them even more? If they’re abusing meth while also being prescribed an opioid, wouldn’t it push them to seek out dangerous street heroin once they were cut cold-turkey from the prescription opioid? Our system is merely creating more harm towards humans.
Let me put it this way – I would rather see a patient abusing prescription medication (which contains a known amount of specific chemicals) than taking seeking their high from street drugs with God only knows what chemicals within them. Again, our system is just pushing both addicts and legitimate patients with painful diseases or injuries (or both) who are desperate for some relief from debilitating pain onto seeking their high or pain relief in the form of dangerous substances from the streets.
They can help fix this problem by exempting doctors and pharmacists from laws intended for drug dealers. If a doctor screws up (on purpose), let the state medical deal with that doctor instead of the law. We don’t hold alcohol manufacturers and liquor stores responsible when a drunk driver kills an innocent person, so why in the hell are we holding doctors and pharmacists responsible for when their patients overdose???
Totally agree with you everything you said is what’s happening to me.
100% agree, Steve. Many, many years ago, I tested positive for PCP. I have never in my life even seen what PCP looks like, let alone even know how to ingest it. I have never been around anyone who would even think of trying PCP. Fortunately, this wasn’t for a job or pain management. IIRC I was having a procedure done at the hospital and was tested prior to the procedure. I have never been so embarrassed and doubt they believed me. Looking back, I realize most likely it was the antidepressant (Effexor XR) I was taking that caused a false positive. I wasn’t smoking pot either, so there was not even that very slight chance of pot being laced with it. To this day, it irritates me that I didn’t demand them to retest it, but I had no clue back then about the percentage (10% to 15% or more) of false positives and false negatives.
This is exactly why we MUST fight this BS! I know a lady who was discharged because she could not go do a pill count as she had started a colonoscopy prep, her GI even sent a fax stating the she could not drive the hour to the PM’s office, she was discharged! Yet they are told not to discharge addicts but to get them treatment and we are left to suffer with nothing. It is no wonder so many CPP’s are taking their lives and we have no idea how many have turned to street drugs. This is wrong on so many levels. Keep up the great posts Steve, I KNOW you are helping many!
I worry about this every month, poppy seeds in bread will get you too. Don’t know about the cold medication I have been on. I try to write down every little thing on the paperwork just in case but I know they will drop you, no questions asked.
Dorlee, I was shocked to see the list of everything that can cause false positives. Something as simple as naproxen and ibuprofen can cause a false positive for THC, barbiturates and PCP. Dextromethorphan (OTC cough syrup) can cause a false positive for opiates and PCP. Diphenhydramine (OTC antihistamine) can cause false positives for methadone and PCP. Metformin (a common diabetes med) can cause a false positive for amphetamine or methamphetamine. The list goes on and on.
What gets me is many doctors won’t even consider the idea that the tests are NOT even accurate at least 90% of the time. (I think these doctors know these tests can be very inaccurate. They’re just looking for any and all excuses to dump their patients – most likely, patients who require higher doses of pain medication, patients who are younger, patients with insurance (or government-provided insurance) with crappy reimbursement rates, and patients who will no longer get those pricey (and somewhat dangerous) injections.
Yep i was black listed twice. The first time the provider put a permanent note in my medical record saying i failed my drug test and i was a behavior problem. I never had a failed test she knew it too. Then a year goes by and another pain provider sets up shop i get in and I’m asked to explain what happened with the last provider i told her. She said she was willing to give me a second chance. I saw her 5 times then the last time i saw this one she came in and said i failed the drug test said it was positive for meth and offered me drug treatment. I was really dumbfounded when she said that. I didn’t see the urinalysis results till months later. It wasn’t meth i tested positive it was an adhd medication i had started ten days before the ua and wasn’t asked about if i had started a new medication and i had completely forgotten i had started it. No one will treat me now where i live. Even the provider i see for mental health abandoned me today. I give up.
Wow! That’s such a low and dirty trick to play on patients…also the practice of having to sign agreements to have procedures done at the discretion of the doctor. Procedures mentioned in a pain contract as part of the contract at the physicians discretion seems dubious…we really do need a national bill of rights of patients to choose to deny these risky procedures…What is happening in my state is PCP’s are refusing to write for benzos or pain medications and sending patients to “pain specialists.” All of these “specialist’s ” do pain medication management AND procedures..None left that only do pain medication management. Travesty. It’s akin to being held hostage to have your pain relieved..scary and wrong, but no other options for people in most states anymore..!
So much for CDC Guidelines for Primary Care Doctors.