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Family Physician
Family Physician, Board Certified MRO
Category: Drug Testing
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Experience:  Medical Review Officer - Physician Trained and certified in drug test interpretation
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Is mandatory random drug testing at a doctors office constitutional?

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Is mandatory random drug testing at a doctor's office constitutional?

Before I had brain surgery (coiling on the basilar artery), I was an independent truck driver contracted to a very large trucking concern. In the capacity of an over-the-road driver, I understand the need of employers and the US DOT to hold all of us in the trucking industry to a higher standard--whether we are under a load or just driving a car recreationally. I had no problem with the random testing, along with the yearly physical, which also included drug testing. My years on the highways clearly "rattled my cage" at the horrific auto accidents, some of which were caused by people either under the influence of prescribed or illegal substances. On the other hand, just as many accidents were caused by simple neglect, or, most recently, texting or talking on cell phones or other communicative devices.

Tomorrow I must return a questionaire to my doctor's office, be evaluated for a second time by a "pain management specialist"--which in my opinion is a very loose description for a ARNP who only sees chronic pain patients in the particular clinic where I am seen monthly. I am on disability, permanently, and am well-educated, and do extensive research on my own, extensive exercises to try and find new ways to make my brain and my body at least as good as it was before my brain surgery.

Before I had to leave my home because of an abusive spouse, I was doing very well--my pain was under control most of the time, and my medications did not interact in any way that impaired my physical ability. Now, with two of my medications taken from me--for the simple reason that the meds I was taking made me "look like a drug addict". I assure you, I do not present clinically as a drug abuser, and now I do have a difficult time managing my pain and functioning to the best of my ability every day. For the present, and until my divorce is filed and finalized this year, I am out of my area for most treatments, which significantly raises the amount of my co-pays, particularly for specialists. I do not like having to take narcotic pain medicine, but I am allergic to NSAIDS, and I simply cannot afford to see a chiropractor and a physical therapist three days per week. I think that this pain contract at the very least violates my fourth amendment rights and perhaps others, but in order to get my medicine, I am forced to sign this document. Do I have any choice in this matter?

It concerns me that the government is interfering in the medical profession--particularly with people like me who are on medicare and are receiving state funding to help me pay for my insurance and high co-pays with my medication. With the federal government telling doctors how to practice medicine is like having a plumber functioning as our president. To me, it's ludicrous and demeaning. The facility also wants me to agree to pay for these random tests as well, which will add a hardship to me financially, since I am on a low fixed income. I cannot even afford to get half of the medical treatment I truly need, and my medicare and social security pay little to nothing for most of the alternative treatments at these chronic pain facilities. Sorry that this question is so long. Thanks for your opinion.
Sincerely,

Bonnie
Submitted: 2 years ago.
Category: Drug Testing
Expert:  Family Physician replied 2 years ago.
Thank you for your question. First let me start by saying that I am a physician and not an attorney. I can answer this question from the medical/drug testing perspective, but I can not give you a formal legal opinion.

Drug testing in the setting of pain management has not be made "mandatory" for patients prescribed opiate pain medications - however, the FDA and most medical professional organizations involved in pain management guideline development support the use of such testing to help physicians in the treatment of chronic pain. There are a number of potential benefits of such testing including: detecting and deterring abuse of prescription medications (including "doctor shopping" - getting multiple drugs from multiple doctors), and allowing physicians to prescribe opiate medications with more confidence.

WIthout such testing, many physicians would just plain refuse to prescribe - fearing that they are being "scammed" by drug addicts or those who are faking pain to get prescriptions that they can sell.

I hope this gives you some insight into drug testing patients on chronic opiate medications.

(I will be offline for about 1/2 hour - if you have any follow up question, please be patient, I will be back ASAP)
Customer: replied 2 years ago.
I know that I am in an area with a high--quite high--number of drug-related deaths or overdoses; both fatal and non-fatal. With that being said, I understand the side of the medical profession, understand the lack of trust issues. This facility has been treating me for two years, and not once have I had an x-ray or test of any kind to see if my condition is deteoriating (it IS a deteriorating condition), and I don't understand why this is all necessary now. I would rather pay for a set of x-rays on my back than pay for random drug tests, and the extra co-pays that will arise from a random pill count. Why is this my responsibility, anyway?
Expert:  Family Physician replied 2 years ago.
Who would you propose pay for drug tests if not the patient?
Customer: replied 2 years ago.
If drug testing is deemed so important by so many agencies, why won't my health insurance pay for it? I know my insurance coverage has declined terribly since I can no longer pay for the most expensive and comprehensive coverage, but still, is this not a function of insurance companies--to pay for tests that are ordered by my primary care physician? I don't mean to be difficult, but it's already a stretch every month to make ends meet.
Expert:  Family Physician replied 2 years ago.
Obviously, each insurance policy may have a different view of this. It may depend on how your physician is billing this (or what diagnosis he/she is using).

You may want to discuss this with your physician or the insurance company.
Customer: replied 2 years ago.

Thanks for your time and input. Though I am still a little frustrated, I will sign the papers, hope that I don't get any false-positives when I get tested. If I accept answer, will I then be billed $40? Again, thank-you for your time.

Bonnie

Expert:  Family Physician replied 2 years ago.
As for the false-positive issue

There are two types of drug tests. The immunoassay (dipstick, on-site and home tests) technology can give false positives. HOWEVER, when the specimen is sent for confirmation testing (GC/MS), the tests will be reported without false positive concerns.

If you are told that you tested positive for something that you did not take, you would need to ask for the specimen to be sent for GC/MS confirmation.
Family Physician, Board Certified MRO
Category: Drug Testing
Satisfied Customers: 12613
Experience: Medical Review Officer - Physician Trained and certified in drug test interpretation
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