Number 1, you’re doing a urine test for the patient, not to the patient. It’s to increase communication, not decrease communication. You have to know what question you’re trying to answer with a urine drug test.The test is an important tool but it’s just a tool and you have to know its strength and limitations. The terminology is evolving in the field of urine drug testing. Screening drug testing is now called presumptive testing and confirmation testing is now called definitive testing. The first one is done by immunoassay and the latter, is done by chromatographic studies.
If you have an unexpected positive or negative test result, ask the patient, ‘Could you help me explain these results?’ Give the patient an opportunity to explain, and if the patient is not a candidate for opioid therapy, don’t kick him out of the practice. You could always fire the molecule if you so choose and still care for the patient. We’re holding the pain patient to a much higher standard than anybody else. We call it insulin-dependent diabetes but if the diabetic eats chocolate cake and doesn’t follow the exercise regimen, we don’t call it insulin-addicted diabetes. The pain patient has a higher standard to follow and to be compared to; and so does the prescriber. That is not unfair but it is what it is and you’ve got to deal with it.