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Drug screen?

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Chitoshi

MyPTSD Pro
Hi everyone,

I'm not sure of procedures, but I just got a letter from my doctor's office that I need a few blood tests, one to test liver function, and one called a "comprehensive metabolic panel." The third test says "Drug Urine Screen." The reason for these is "Chronic Pain Syndrome."

So I understand that a drug test is to obviously test for drugs in your system. Anyone who's been following will know that I have neck and shoulder pain and have been struggling for about three years-ish now. Anyone who hasn't been following me, well, you just found out I've been struggling with near-constant pain! Haha.

Anyways. I was never given any drugs for this condition, and I was given 15 muscle relaxers that were 10 mg from my primary care physician to get me to my "pain management specialist" appointment. (I have an HMO if that's relevant).

So my question: I thought drug tests were for those who had already been prescribed opiods or something? I can't help but feel highly suspicious that they'd bill my insurance for a drug panel if it isn't needed. I don't have anything to "hide" because I'm not doing drugs.

The reason I am suspicious about it is because the lab technician I talked to said it was strange they were looking at a liver function panel as well as a comprehensive metabolic panel, because the comprehensive metabolic panel already gives you the numbers you need for the liver function panel so it's redundant.

So if the liver function panel is redundant (and presumably unnecessary), why the drug test?

Could anyone give me insight into this?

They requested these labs from me in September and did not inform me that they had requested them from the insurance company, and they just sent a reminder January 4th in the mail which is why I got it today.

I guess I'm just confused why the drug screen is necessary because I'm already using my insurance a lot so I don't want them billed unless I need it because my health is already precarious.
 
It’s probably related to liability in the midst of an opioid crisis. HMO’s are especially systematic and sometimes redundant with some of this stuff.

If it’s a pain med clinic or a clinic working with one, it could be standard across the board thing they require of all patients even if they are not getting any meds. (A friend of mine with fibromyalgia had to deal with that at her pain med clinic despite not being on any pain meds.)

Muscle relaxants could have lead to this coming up. While not an opioid, they can still be abused recreationally.

I’ve been asked to do drug testing for a condition that I have despite not being on pain meds of any kind. The condition does cause pain and that was enough for a nurse to check off that I needed to do a urine drug test.

When I went in, I explained I wasn’t looking for pain meds, only regular yearly physical and a script for physical therapy. They explained it was office policy. I told them I didn’t want to pay for it. They said I could do it or not. It was just a doc covering their ass. My doc said it was more than fine that I skipped it. Didn’t actually care.

In the end, I hope that you can ask the doc who signed off on ordering these tests and see why they have asked for them to be done. They should be willing to honestly explain it.
 
Because you're going to a pain management specialist. And there's an opiate epidemic. (where we're losing service members daily, different thread entirely!) They are going to want to know exactly what is in your system. That's what I would want my doctor to do. People lie. Especially drug seekers. No, I'm not saying you are. But I worked in the field a long time and it really is a huge problem.

As for the liver function tests. They most likely will be prescribing meds which will effect the liver and they'll want an accurate baseline. Be prepared to have blood work done at all of your visits to monitor the liver and level of medicine in your system. Be accurate when doing your paperwork. List all your medicines. Including vitamins, aspirin, allergy meds, cold meds, birth control (not sure of your age) ;)

I think I answered your questions. If you have any more, let me know. Good luck and I hope you feel better soon!
 
They should be willing to honestly explain it.
This.

I seem to be getting asked to provide urine samples every time I come within sneezing distance of a medical office these days. Anyone assuming any kind of responsibility for any of your medical treatment may need to tick off (for the purposes of their own professional liability) that they’ve done a drug screen and they’re satisfied they know exactly what’s in your system.

A couple of weeks ago, I had a ED doctor tell me that 1 in 10 women who know they’re pregnant? Lied to her and said they weren’t when she asked, never mind people being honest about what they take in terms of prescription and non-prescriptions meds!

There’s also the issue with any kind of potentially addictive medication that the person taking the meds actually isn’t honest even with themselves about how much they take. Add to all that, we have a similar opioid medication abuse issue unfolding here in Aus that is occurring elsewhere in the world. And just to make the waters really murky, in some treatment facilities, they have to ask everyone for the same drug screens up front so that they don’t get accused of bigotry and discrimination.

So, there’s lots of reasons why doctors ask for drug screens that have much more to do with ticking boxes than “Is this person a great big liar and drug abuser?”

But, always (always) you’re entitled to ask why a test is being done, and you’re entitled to an adequate, honest and frank response.
 
A comprehensive metabolic panel is essentially a "fasting blood levels test". They usually draw a sample first thing in the morning, after not eating or drinking for about 8 hours. This is to see where your baseline metabolic readings are, without any influence or interference.

The liver function panel isn't as frequently needed, since most drugs prescribed within the last 25-30 years have become designed to be less damaging to the organ. However, some categories (including opiods, statins, cholesterol reducers, EDs, steroids, anti-rejection, fibro, CF, etc.) can still do damage to a compromised person's system.

It largely depends on past and present illness, dietary and lifestyle habits, age and gender to some degree. Collectively, these can present a good at-risk indicator for treatment options.

Typically, the liver function panel would be given at the same time as the comprehensive metabolic panel, as both require blood samples. The urine test is part liability CYA, but also it's pretty impressive at what shows up from that stuff compared to the other two.

The opioid crisis has gotten to the point that county morgues are overflowing with victims. A lot of doctors and insurance companies are catching hell from Social Security, the DEA, and DHS, for not being diligent enough to prevent it. Unfortunately, it's no different than street dealing, the money's good (copays, premiums, kickbacks, media sponsorships) and it's just "people nobody will miss". :oops::oops::oops:

In other words, it ain't you. They're trying to stop the problems by going down the checklist, and they want to make sure you're not in danger. It sucks, but this is the best chance we have to keep our elderly, disabled, and injured, healthy.
 
Thanks guys. It was my primary care physician, and the specialist didn't order this one. I did a drug test with the specialist already. :) The specialist is actually part of a different hospital group than my PCP, but he's one my insurance will cover.

I'm not sure all of the details, but the take-away message is that the specialist and the PCP don't share information, which is a pain in the butt because I had to ask for all paper copies from my PCP to give to the specialist!! So maybe that's another reason my PCP wants a drug test....

I have an IUD and I still end up with random pregnancy tests that end up on my bill every time I get any blood drawn for any reason, so I get that they have to make sure because IUD + pregnancy = no good, even if the chances are slim.

Thank you all for assuaging my fears. I really do appreciate it.

I'm just one of those people that even if the police came to my door and wanted to search my house or my car, I'd want to know if they had probable cause, what for, and I would like to say that I would ask them to get a warrant.... Might sound mighty paranoid, but I like my privacy, so the extra drug screen without what I felt was "probable cause" felt like an invasion of my privacy.

What bothered me was that they didn't tell me they wanted to do this when they scheduled it in September, I just found out about it now, and they sent my order to a hospital that is like way far away from me, lol. Ticked all of my "suspicion" boxes.

I am going to call the doctor tomorrow and see if I can't have them walk me through it, but I just couldn't shake feeling extremely uneasy about it. This helped a lot. :)

I'll let you guys know what happens.
 
Are you on pain contract? I would be deeply surprised if you could even schedule an appointment with a pain management specialist without having a contract on file. And outright shocked if you don’t have one, if you’re going through either a hospital or HMO.

They’re good for a year, in most cases, so you may have signed it some time ago. It’s a series of forms that are usually required for all pain patients, regardless of diagnosis, prognosis, or treatment. It’s generally a few pages, and you rate your pain on 1-10scales for various activities for most of the form. At the bottom (or top) it includes a list of things you agree to; including both scheduled & random blood and urine samples. Failing to provide a blood or urine sample within 24hours upon request usually results in your immediate dismissal as a patient (as does failing to comply with any of the other terms of the contract). Signing the contract ALSO gives them permission / signed consent to drug panel any blood or urine sample they have on hand or drew for other purposes.
 
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I have been seeing a pain specialist for 5 years. They used to drug test me once a year, now it's every three months, and since I'm trying to reduce the amout of drugs I take, it's down to every 6 months. They have to abide by the CDC standards.
 
So my question: I thought drug tests were for those who had already been prescribed opiods or something

Nope. Been on pain medication since my accicdent on 2009 (different State, different rules) and before anything was prescribed and I was technically a pain management patient, I was given a drug test to ensure I was not on any outside drugs whether it be street drugs or not prescribed bought illegally pain medication. They cannot give you pain medication, pure the DEA, without ensuring you don't already have pain medication in you first to ensure that there isn't an overdose or a interaction. That's how pain management works both in Kansas and in Florida. They also keep that up. Even now with an internal pain pump. My Dr does it every 3 months but some I've been to does it monthly. To ensure that you are not on illegal drugs and are on the right amount of prescribed drugs. Too much or too little and there is an issue. Too little and they may say you don't need it and pull you off of it, ensuring you aren't selling them.

The reason I am suspicious about it is because the lab technician I talked to said it was strange they were looking at a liver function panel as well as a comprehensive metabolic panel, because the comprehensive metabolic panel already gives you the numbers you need for the liver function panel so it's redundant

Not redundant. I was tested for liver issues and I was having a metabolic panal done and they also ordered a seperate liver panal as they said there are things the metabolic panal doesn't show that the liver panal does and so, even though there are technically two testing your liver, they are testing differently.
 
Are you on pain contract? I would be deeply surprised if you could even schedule an appointment with a pain management specialist without having a contract on file. And outright shocked if you don’t have one, if you’re going through either a hospital or HMO.

I'm going through an HMO to a pain management specialist that is affiliated with the hospital that I'm going to? They rent their office out of one of the hospital buildings, is the way it was explained to me. My PCP had requested the drug screen in September, not the pain specialist, that's why I was super confused.

The pain management specialist had me sign some sort of contract about that I have to do regular drug screens if they give me medications or treatment in, November, I think. I can't remember exactly but I remember signing some huge paperwork like you describe.

I have been seeing a pain specialist for 5 years. They used to drug test me once a year, now it's every three months, and since I'm trying to reduce the amout of drugs I take, it's down to every 6 months. They have to abide by the CDC standards.

Thank you. I appreciate more information. :)

even though there are technically two testing your liver, they are testing differently.

Thanks for the clarification. :)

Update: I'm actually even more confused with having called my primary care doctor's office. They first couldn't explain where the tests came from or why I had to take them, then said that I came in for an appointment the day the tests were assigned (even though I hadn't been told about them).

Then, they said I had a Physical that day, but I told them had a regular appointment. I didn't even know if my insurance actually covers a Physical for free. They later confirmed that I had had a regular appointment, and that the doctor had ordered those tests for a Physical that were not part of the regular appointment so the lady cancelled them, but said that my "insurance would cover a regular Physical" and that I "HAVE to come in."

I haven't confirmed with my insurance whether or not I get a free physical, because it didn't say so on the insurance paperwork.

I asked again separately about the drug test and the lady I talked to was extremely confused. I told her I was seeing a pain management specialist since November (I have only had three appointments with the specialist so far. The meeting one and two nerve blocks).

She was still extremely confused about the drug test and took it off and said I didn't have to reschedule that one.

So I don't have to do them but I have to do them but they don't know why?

Forgot to mention the appointment the labs were from was from September.
 
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The pain management specialist had me sign some sort of contract

It's a pain contract stating, basically that you will not get any pain medications filled by any other Dr. VERY important to know that. Hospitals like to prescribe small amounts of pain medication. It is ok to get them in the hospital but if they (or any Dr) tries to prescribe pain meds tell them you are on a pain contract. Every Dr here in Florida knows what that is as Florida now has a centeralized pharmacy system. You will also likely have to take surverys. I have to like every 6 months. "Do you have suicidal thoughts. Have you ever counted medication. Have you taken more medication then prescribed. Have you have feared of running out of medication. Do you have sexual abuse in your childhood". It is to test for possiblity of abuse and that I lie on. My pain Dr knows I see a therapist as I had to tell him where the Seriquel XR came from but he has no idea of my trauma or any abuse in my past and he will never know about it. The pain contract is rather important though so be sure to read it as if you break it you could be released and released from a pain dr, good luck finding another.
 
Good pain management is a team approach. In my pain doc's office is a poster that says pain meds are not pain management, they are a part of pain management. I have a pain therapist/trauma therapist, a medical doc, a psychiatric nurse practitioner who has a PhD in nursing, a neurosurgeon, and a pain doctor. I used to have a physical therapist and acupuncturist, but physical therapy said they didn't want to do anything more because it could paralyze me, and acupuncture is no longer covered. My pain contract allows the hospital to give meds and prescribe enough to get to my pain doc's, same with surgery. When I have surgery, I tell my pain doc the date, and they make an appointment for me within a week, so the surgeon gives me enough for how ever many days it is until my appointment. They all work through the same medical community, so they can look up all my appointments.
 
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