In chronic pain management, what is the Single Most Important Item in a urine toxicology screen, for patients receiving opioids?
In the forthcoming “Pain Management Pearls” I will address my own answer to the question. But first I want you to weigh in, and then I will compile the survey responses. Submit your answer to the single question below, and get the results as well!
What is the single most important item in your urine screening test for patients receiving opioids for chronic pain management?
If this were a trick question, I might say the most important is “any”, because these tests are often underutilized, and the reports so hugely beneficial to helping patients to get proper care. (That is not to say they are not also over-utilized, but medical necessity is on your side in the example above for a patient who has never had a urine toxicology screen and report). If your clinic is not accustomed to generating urine toxicology screening reports, you can expect that in the first 100 patients who receive opioids for chronic pain, undisclosed medication behaviors will be exposed in greater than 20% of the samples tested. This is an important opportunity to learn more about your patient, and support healthier outcomes than you otherwise could in the absence of the report. Take the one question survey above, and see how your answer compares with others!
Providing pain management in a manner that is patient centric includes elements of being vigilant on behalf of your patients (i.e. ordering the tests), suspending unnecessary bias related to age, socio-economic status, race, or other factors that can impact whether or not you order a urine drug screen in the first place. A patient who is apprehensive about what may be on their urine drug screen result, is the same patient who may attempt to talk a provider out of ordering it. Providers sometimes feel they are doing the patient a favor who “can’t afford it”, but they may be introducing a bias (economic) that results in higher risk care (failure to identify co-morbid risk factors). Chronic pain management with opioids is a high risk endeavor. It requires appropriate oversight with face-to-face periodic review, urine toxicology screening, visits to the pharmacy, and management of what may (or may not) seem like unrelated risk components like obstructive sleep apnea (OSA), mental health disorders, alcohol and substance abuse, hormone disruption/bone depletion/fall risk, and other circumstances that require money to mitigate. If the patient is unprepared to pay for monitoring, and only medications, that patient is probably not a suitable candidate for chronic opioid therapy.
Register here for a Webinar Replay, A 3-Step Solution: Eliminating Problems Due to Prescribed Narcotics.
Across the United States, clinicians and patients are dancing a dance together that leads to frustration and risk.
This mini introductory course outlines a solution for primary care practices for reducing frustration and developing reasonable care when it is driven by unreasonable elements. <more>
(Answer: “Reverse Engineered” Physician/Patient Centric Support) <…more>
I got so many good questions about urine testing during the recent CME Webinar “Transitioning Care in the Face of Painkiller Addiction and Abuse” I decided to devote a post with more than one true story about urine drug screen results with patients. <…more>