Urine Drug Screening in Everyday Practice
As the practice of pain management continues to grow, the need for speedy, reliable drug screening also continues to grow. While everyone experiences physical pain from time to time, an inconsistent continuum of medications is used to treat pain in its many varieties. Numerous options exist for pain management (pharmaceutical and otherwise), but narcotics are often the heavy-hitters when other treatment modalities fail. With their effectiveness comes the obvious risk for the patient and the physician. Some patients legitimately need narcotics for management of moderate to severe pain while others seek narcotics for nefarious reasons.
With the increase of pharmaceutical pain management, addiction to prescription psychotherapeutics (including narcotics) continues to climb.1,2 Substance abuse places the physician at risk, the patient’s health at risk, and increases the overall burden on society, both in literal monetary value as well as societal costs (crime, decreased work productivity, emergency department visits). Certain areas of the country have larger problems with narcotic abuse than others but, with the proliferation of internet drugstores, no area of the country is immune. Although the internet has vastly increased the access to illegal prescription narcotics, the vast majority of illegal prescription pharmaceuticals ultimately come directly from a physician’s prescription pad.3
The reasons for the increased and sometimes uncontrolled accessibility are varied. Some of the problem is due to physician ignorance regarding proper prescription practices, some of it is due to an unwarranted sense of omniscience on the part of a prescriber, and some of it is due to some individuals operating outside the boundaries of the law. Regardless, prosecution of physicians happen as a result.4 Many physicians have little or no training in pain management other than the medical school pharmacology of narcotics and hand-me-down information from equally “opiate-na?ve” preceptors. This meager training leaves physicians no better able to handle the practice of pain management than studying cardiac physiology allows them to perform cardiac surgery. If physicians are not utilizing proper laboratory testing to detect illegal drug use within their own practices, it’s an accident waiting to happen.
Please refer to the April 2007 issue for the complete text. In the event you need to order a back issue, please click here.