If you have not noticed, the US is experiencing a verifiable epidemic when it comes to drug abuse. A CDC report last year showed that pain reliever abuse has increased 111% in the last 5 years.
In addition, a new Institute of Medicine report showed that over 100 million Americans are dealing with chronic pain, at a cost to the country of over $540 billion dollars a year. Yes, that is not a typo! Twenty percent of doctor office visits involve a narcotic prescription.
Most physicians, when asked if they drug test their patients, say "I know my patients, they are not selling it or diverting it." This is a fallacy, as studies have shown that 30% of patients divert their medications. This means they are either selling it, giving it to someone, or trading it for illicit substances. The culprits include young patients who one would suspect all the way up to retired individuals looking to supplement their social security.
Here are 5 reasons why doctors should drug test their patients who they are prescribing narcotics.
1. Drug testing provides the clinician with an objective test documenting prescription adherence. With the numbers of patients diverting their medications in all age groups, testing will help make sure that patients are taking their medications and also not abusing illicit drugs. How betrayed will a pain doctor feel if his patient is negative for the medications prescribed and positive for heroin and cocaine? It happens more than you would think!
2. As states become more regulated with narcotic prescriptions (e.g. Washington state), drug testing your patients will become the standard of care. Multiple medical boards now recommend it for chronic narcotic patients. With its low cost of doing the testing, instituting it now is an excellent pre-emptive maneuver for compliance.
3. Protects your practice from legal issues. If a patient sells the medication they are being prescribed to a person who becomes impaired while driving and hurts someone, the trail of narcotic may lead back to the prescribing doctor. If a screening mechanism has been in place to detect prescription compliance, it will serve as a legal deterrent to anyone who tries to say that the prescribing doctor was not properly monitoring the patient.
4. Places the practice on a level playing field. Testing on a random basis is a very common pain management screening method with urine cups. However, it is not random if only the 18-15 year old crowd is selected. A "level playing field" for testing would include random testing for all age groups receiving chronic pain medications.
5. Patients who call in early for refills or are first time patients. Establishing a baseline for patients' narcotic usage or illicit substance intake should be standard practice for first time patients at the office. This will ensure that patients' results correlate with what they write on their history and the medical records detail. Also if a patient is calling in early for refills a smart approach would be to make the patient show up in person for a refill and find out what's going on and perform a urine screening to ensure legitimacy with the request.
Prescribing narcotics is risky business these days, but with proper precautions can be effectively monitored for diversion. One of the best methods currently is urine drug testing.
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