protocol for urine testing by gp

[oneofthegoodones]

if you never signed a pain contract, (NY) and your
GP is writing your scripts for pain, must you submit to a urine test?  i do not use illegal drugs,  i know the drs are always under the microscope from DEA. but i wonder what the "rules" are. thank you all for any input i am in horrible pain this evening and typing hurts :(  but was really surprised that i was tested today.

[Weathergirl21]

We are going to have to agree to disagree. I do not know of any PM that uses a blood test to monitor their patients for opiates. They either use the urine dip stick test or send it out to a lab. You can read on these boards that many of the patients' Dr. sends out the sample to a lab.

And the levels of opiates are absolutely a concern of the PM Dr. as they are not just checking for illegal substances.....but they are making sure that the patient is not taking more than prescribed or selling their medications. This is the reason why so many PM's also require pill counts.

This is becoming more standard in each state and as I mentioned earlier, every state has different laws/regulations about PM contracts or prescription opiates.

And I'm not sure I get the comment of "get over yourself"? What is this referring to? I have been friends with my PM, his wife and family for 6 years. We have dinners, have family get togethers, etc. Just like any friend I have. So I don't understand your choice of words.

As far as law enforcement goes, a blood test is done if needed to check for substances as that is the only one that will stand up in court. They do not rely on a urine test for any case.

Not sure what 911 has to do with anything?

Oh well...I'll end with this back/forth as we have differing opinions...No biggie..

[shinty]

Actually I don't think i said what I said very clear. Given the choice to use urine or blood to detect levels of opiates, blood is the clear choice. Urine is affected by many more factors than blood in this instance. The gas chromatography mass spectrometry (gc/ms) is indeed the "Cadillac" of methods to determine the make-up of just about anything under the sun! Most Pm doctors don't test for "levels" they test for the PRESENCE of certain substances. The substance being present can be a good thing or a bad thing. It's strange that your doctor friend (get over yourself) goes to the extent of using gc/ms, and then use urine for the sample instead of blood. Makes no sense at all. I don't know of any PM Dr. that does a gc/ms test on their patients for pain management. Evey major city's forensic lab has gc/ms capabilities. Thank 911 and The Dept. of Homeland Security for that. If they can only solve the backlog upon backlog of backlogged cases!      

[Weathergirl21]

Actually....as I wrote, the labs that use gas chromatography mass spectrometry can tell exactly what levels of opiates and drugs a person is using. I am friends with my PM outside of my appts. and we discussed this when our state started requiring a yearly urine test two years ago.

He refuses to do the urine dip stick tests as they are not as accurate and only show a positive or a negative for all the substances.

So, if it is sent out to a lab, there are many labs use the GC/MS. My PM uses Millenium Laboratories out in CA. The samples get overnighted there and they turn the results around within 24 hours online for my PM to read and then we, the patient, get mailed the results. It is an expensive test because it is extremely detailed and as I mentioned, 99.9% accurate. It can absolutely tell the difference of someone taking one or even one half of an extra pill.

Usually only police or hospitals use actual blood tests for substances and yes, that is also very accurate on the levels. But I don't know of any PM Dr. that does a blood test on their patients for pain management.

Oneofthegoodones....Thank you for sharing more about your story on your other thread...I'm sure that was very disconcerting to have them misplace your sample. That would make me upset and nervous as well on their protocol.

I'm hoping that things are straightened out now and you are doing well!

[oneofthegoodones]

thats good i really dont have any concerns i have since learned that the dea is really riding drs writing pain scripts, so i do not take it all personally any longer.

[oneofthegoodones]

thank you all for you answers i have been away caring for my chronically ill son, so wasnt able to respond thank you for input!

[shinty]

the tech. also said the test to determine the levels of a drug in your body are not used very often, as they are simply a "snapshot" of the level at the moment of testing. you might have taken a pill four hous ago, or 10 minutes ago. The blood will show vastly different results. i guess if the level isn't over the prescibed dosage, everything is "hunky dory".

[shinty]

The laboratory testing for drugs needs blood to get the levels of a drug in the human body. Levels can't be done with urine. Urine tests only show whether drug is or isn't present in your system. This info. is from an actual lab technician.

[Weathergirl21]

Yes....any Dr. who is prescribing narcotics has the right to do a urine test whether it is mandated by the state or not. They can choose solely at their own discretion.

They are looking for both illegal drugs and whether you are taking the medicine you are prescribed.

Was this a dip stick in house test? Or are they sending it out to a lab. Hopefully it was the latter as the first one has a higher percentage of false readings.

The lab, especially ones that do gas chromatography mass spectrometry are 99.9% correct and are expensive...but completely worth it because of the chance of a mistake is extremely low.

And the lab testing can tell exactly how much medication you are taking so if someone takes an extra pill of their prescription, it can tell the levels.

They are just covering their bases which if you are doing everything the correct way and taking your meds exactly as prescribed, this is actually good for you because it will reinforce their faith in you as a patient. And if you ever had to change Drs. down the line...having this type of proof that you are a compliant patient is helpful.

In my state (VA), they just started requiring a yearly random drug screen and it gets sent to the type of lab I mentioned. My PM will test someone more often for those he is more concerned about.

I have been a patient there for 6 years so I am only tested once a year and they even ask me, "Do you want to go ahead and test today?"..LOL But he knows me and knows I do everything to a T. And he also knows I don't have insurance right now and the test is close to $600 so the last two years he has told me to ignore the bill and it will bounce back to his office and he will cover the cost/write it off for me so I don't pay a dime!!!!

So, you can check if NY has passed a new law (contract or no contract) about yearly testing or whether it was just the choice for your Dr. to randomly do this now with patients just to help weed out those that are doing the wrong thing.

I have no problem with the testing as the more we can get rid of those who are abusing...the more time the Drs. have to spend on us his real patients. But again...I think people should ask for the more sophisticated test if they are doing it once a year...

I feel for those who's Drs. are doing it every single month as that is their choice as I don't know of any law in any state that requires it monthly at this time.

[shinty]

My doctor tests EVERY visit! I think it's overkill personally, but it's up to the doctors writing the scripts, and the fears they have of "big brother". It's not that you use illegal drugs necessarily also, testing insures that you are at least taking some of your medication instead of selling it, or giving it away to others. It is the actions of a few that screw it up for many. Or is it the other way around---few REAL pain patients, and may, many, malingerers. Whatever.