Recently I read an article that had the following statement within the content, “A UDT policy and consistency is critically important because clinicians’ predictions of UDT results are frequently inaccurate.” In other words, providers who insist they “know” the patients who would not abuse controlled substances are many times just plain wrong. Ordering drug tests removes the subjectivity from the equation and if done as a clinic policy gets the provider “off the hook” so to speak. Recent studies have shown among patients under Chronic Opioid Therapy, the percentage with aberrant UDT results is between 9-50%. That same study showed that appropriate risk-based testing reduced the occurrence of aberrant behavior considerably.
When aberrant behaviors occur, or there are unexpected results on the UDT, it is usual, customary and expected that corrective action be taken. Regardless of what the corrective action is, there is not a one shoe fits all, a critical component is providing complete documentation of the plan in the patient’s chart. Additional documentation on subsequent visits should clearly define how the patient is progressing or not progressing and what changes will be made, including additional drug testing. Although all providers are schooled in the necessity of appropriate charting it is even made more critical with patients on controlled substances. Several states have mandated that providers cannot prescribe controlled substances if they know or should know that their patient is using drugs for a nontherapeutic purpose. There are simply too many peer reviewed studies determining patient self-reporting is not accurate, or that many physicians still work under the “truth bias”; that is, they have no reason to not believe their patients. Sadly these well meaning providers are many times easily manipulated by highly motivated individuals seeking their drug of choice. With the increase in morbidity and mortality related to the abuse of drugs, the proactive use of UDT is critical.
Did you know teenagers getting together and indiscriminately mixing drugs together in a communal bowl and then proceeding to grab and take handfuls, has been termed Pharming or Skittling. Many times the pills are washed down with alcohol. Most of the pills come from the family medicine cabinet. Another popular practice by teens wanting to escape from reality is called “Robo-tripping” which consists of drinking massive amounts of cough suppressants such as Robitussin, containing the drug dextromethorphan, which produces a high if the quantity is high enough. Since you now know the rest of the story it may be wise to inform your patients who have, or will have, teenagers. Perhaps an educational session or pamphlet discussing the importance of locking up their prescription medications is appropriate?
I hope you all have a tremendous Thanksgiving with family and friends. I know we at ILDP are thankful you have chosen us to be your lab. Thank you for your business.
Lance Benedict
President/CEO Industry Lab Diagnostic Partners
11/15/2019