why does my pain management doctor drug test me

The saliva samples need to be shipped to a Cordant laboratory for testing and the results generally wonБt be available for 48 to 72 hours. Currently the CORE test can be used to detect levels of oxycodone, hydrocodone, morphine, oxymorphone, hydromorphone, tramadol and fentanyl. Laboratory testing is far more accurate than POC tests, but some doctors donБt bother ordering confirmatory lab tests if something suspicious is found in a patientБs urine. We hear regularly from readers who say their doctor became suspicious or even БfiredБ them after a POC test turned up something unexpected. БLast week they had me come in to take a urine sample. A week later they called and said I failed because they found no drugs in my sample,Б said one man who has been taking hydrocodone for nearly 30 years. БThe doctor now tells me they can't approve any more refills. I thought they were joking. They also told me that no one in the area could either. It's crazy and I don't know what to do. I tried not taking pain meds and nearly went insane from the sleepless nights. Б
A woman who takes Percocet for her fibromyalgia pain wrote to us saying two urine tests failed to detect any opiates in her system. БMy physician of 14 years immediately interrogated me about compliance and asked if I was giving it away,Б she said. БBased on the negative findings, he said he could not prescribe me any further narcotic pain relief. БI have no idea how I will manage my pain now. This has turned into an insane circus. I feel betrayed by my physician, and the doctor-patient relationship has had its trust destroyed.


Б Stripp says he cautions doctors not to jump to conclusions after a failed test. БIf you donБt do the laboratory confirmation test, from a legal perspective you canБt say with reasonable certainty that the test actually contains or doesnБt contain the material it was tested for,Б he said. БYou never want to accuse a patient of aberrant behavior if you have an inconsistent result, because there are other reasons why you could have inconsistent results. It could be there are differences in metabolism or they could have a health issue that may be causing the problem. Or there may be a drug interaction. Б Another reader who is on probation was given a urine test that showed he was positive for fentanyl. "After a nightmare trying to keep myself out of jail, they allowed me to go to a hospital for another urine and blood tests. Both came back 100% negative! The second tests were taken an hour after the first," he wrote. "The judge accepted the hospitals tests and I am free, but this should not be happening. " The CDCБs opioid prescribing guidelines encourage doctors to conduct urine tests on patients before starting opioid therapy and at least once a year afterward. But they explicitly warn against dropping a patient after a failed test. "Clinicians should not dismiss patients from care based on a urine drug test result because this could constitute patient abandonment and could have adverse consequences for patient safety, potentially including the patient obtaining opioids from alternative sources," the guidelines state.


How common is patient abandonment? In a recent survey by Pain News Network, 20 percent of doctors and healthcare providers said they had discharged a patient who failed a drug test in the past year. And about 4 percent of the patients surveyed said they had been fired by a doctor over a failed test. What Is a Pain Treatment Agreement? Managing with is complicated and challenging. Doctors need to know if patients can follow the treatment plan, if they get desired responses from the meds, and if there are signs of developing. And, patients need to know the potential risks of opioids, as well as the expectations to minimize those risks. Physicians use "medication contracts" to make sure that the patient and provider are on the same page before starting opioid therapy. Such agreements are most commonly used when narcotic pain relievers are prescribed. The use of a agreement allows for the documentation of understanding between a doctor and patient. Such documentation, when used as a means of facilitating care, can improve communication between doctors and patients. If your doctor asks you to sign a agreement, discuss any concerns you may have with the doctor before signing the agreement. Questions you may want to ask include: What medications does the agreement include? What risks are involved with my taking these medications? How does the agreement affect emergency care? What if I fail to follow the agreement? A agreement may include statements such as those listed in the sample document below.


I understand that I have a right to comprehensive pain management. I wish to enter a treatment agreement to prevent possible chemical addiction. I understand that failure to follow any of these agreed statements might result in Dr. __________________________ not providing ongoing care for me. I, _________________________________________________, agree to undergo pain management by Dr. _____________________________. My diagnosis is __________________________________________________________________. I agree to the following statements: I will not accept any narcotic prescriptions from another doctor. I will be responsible for making sure that I do not run out of my medications on weekends and holidays, because abrupt discontinuation of these medications can cause severe withdrawal syndrome. I understand that I must keep my medications in a safe place. I understand that Dr. _______________________________ will not supply additional refills for the prescriptions of medications that I may lose. If my medications are stolen, Dr. _______________________________ will refill the prescription one time only if a copy of the police report of the theft is submitted to the physician's office. I will not give my prescriptions to anyone else. I will only use one pharmacy. I will keep my scheduled appointments with Dr. ________________________ unless I give notice of cancellation 24 hours in advance. I agree to refrain from all mind/mood altering/illicit/addicting drugs including alcohol unless authorized by Dr. ______________________.

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