A brief bit of background, I am a chronic pain patient. I have been prescribed scheduled narcotic drugs since 2003. Currently I am using morphine, percocet and amphetamine (the later to keep me awake during the day as the other two make me so tired). In the past I have been prescribed everything from Fentynal to Vicodin. So I was somewhat confused at my last doctor appointment.
I have a great relationship with my doctor that could be described as a friendship. This is important as it would be very hurtful to think he had a reason to not trust me. I went for my monthly appointment to get refill prescriptions for my medication (they can’t be called in). At each of these appointments I always bring in my current prescriptions so the doctor can visually see how much I have left and so he knows I am taking the meds as prescribed. This time at the end of the appointment he casually said, “Next appointment I need you to submit to a drug test. It is a DEA requirement that patients getting the drugs you are on be tested to make sure that they are being taken and not sold”, he then went on to say that this is something that we should have been doing all along, but “I know you’re taking them so I haven’t bothered”. He then went in to explain that he wanted to make sure that all his paperwork was in order in the event of an audit by the DEA.
So, no big deal, I have no problem peeing in a cup and being tested as I take my meds as prescribed and would never even think of selling even a single pill. (besides, I wouldn’t even know who to sell one to even if I wanted to. The same with pot. I don’t smoke it, but even if I wanted to I wouldn’t have a clue where to get it. Yeah I’ve become old and boring). The thing I want to know is does the DEA require those of us on these powerful narcotics to do an occasional drug screen? I have never been asked to do this, nor have I ever heard of it. I do know that the doctor does have to submit paperwork to the DEA regarding his prescriptions. I live in Central Florida and apparently the buying and selling of prescription drugs is a huge problem here, so on the surface it sounds plausible. I would really hate to think the doctor who I trust so much and have developed a friendship with over the years suspects me of something and is using this story to cover his suspicion. But then again, he gave me advanced notice of the test, which would totally go against that line of thinking. By giving me notice, that tells me he knows I am doing what I should be doing and he had no worries. If he did, then it would stand to reason that it would be a surprise test to confirm something.
I apologize for the long post, but I thought it was important to give as much detail as possible. If this really is a DEA requirement doesn’t it just sound like it is a violation of some sort of civil right? I mean how can it be legal for the DEA to randomly test an individual without any shred of wrongdoing? Kind of funny though, first time I have ever heard of anyone being tested to make sure they are using drugs!:dubious:
I can’t say I’ve ever heard of something like that. Besides, you have a 30 day notice, so even if you were selling the drugs, all you’d have to do is take them for a few days before the appointment.
I almost have to wonder if the doctor is (currently?) under some kind of investigation. Either he over prescribes and needs to prove that his patients aren’t dealers or maybe it’s something routine and the DEA picked some of his patients that are taking more controlled substances then normal and asked him to submit a test from them.
If have a decent relationship with your pharmacist, you might ask him. There’s a good chance he has an idea as to what the DEA is up to in your neck of the woods. He might tell you it’s totally normal or something more along the lines of “Yeah, I’ve heard/read about them doing that in X types of situations” or “Nope, that seems really odd, I deal with the DEA all the time and I’ve never heard of that”
Not DEA mandated, but an example of someone (private practice) doing it on her own…and charging the patients. She was doing it to (mainly as far as I can tell) to make sure the drugs weren’t being diverted. www.jenniferschneider.com/articles/PPM_Jan08_Schneider_UDTests.pdf
Interesting thought although I doubt it. My doc is a family practice and not a pain clinic practice. Most of his patients are there for the sniffles and routine stuff. I have chosen to have him manage my pain because he has done an outstanding job at keeping it under control, while at the same time working with me to get the right combo of medications and with his help I have drastically reduced the amount of medication that I am taking every day. It is rare to find a doctor who is willing to take all the time necessary to listen to your concerns and then take the time to research the most obscure things to help. Hell, I have asked many questions here about my pain and asked for suggestions on how to control it. When I get a good suggestion I share it with my doc, he never blows it off and takes the time to investigate the suggestion. If anything, he has encouraged me to reduce the amount of drugs I’m taking and try alternative methods of pain relief, such as a tens unit.
As far as the possibility of him checking to make sure the meds aren’t being diverted like in your link, that could be a possibility. If it is I can’t think of a single reason why he would even remotely suspect that. If anything I am anal about making sure he visually sees my meds and how many are left and such. I have even turned down refills, knowing I had enough (barely) left until next month. Just recently I mentioned the morphine doesn’t appear to be working as well as it use to. He asked if I wanted to increase my dosage, as we both know my tolerance is building. I declined staying that while it will certainly work, the higher dose now will just increase my tolerance a year down the road. Since I am only 45 and there doesn’t appear to be any surgical fix on the horizon I thought it best to try to keep my dosage as low as possible for as long as possible. Otherwise I might find at 60 nothing will a work to control the pain. While there is no "limit"on the amount odd narcotics one can take, if you get doses high enough eventually you will stop breathing. Granted, that will solve my pain problem, but would be a bit inconvenient. To sum up, I believe I have done everything one can do to instill confidence in a practitioner that the medication they are prescribing is being used responsibly. And as mentioned, I have developed a friendship with my doctor and it would be hurtful to think someone you consider a friend has questions or doubts about your character. But, if so I have nothing to worry about.
I was under the care of a pain doc for a couple of years after a back injury. I was always required to submit to a drug test whenever I was on narcotics. He liked to tweak my meds a lot, so some months I was motrin or tramadol and others on darvocet or norco. I would only get the drug screen when I was on the controlled pills. I only failed once, when my back wasn’t bothering me and didn’t want to take the norco, and had forgotten about the test. He gave me a lecture, and stated the same reasons in the OP: to make sure I was taking them and not selling them. I had a good relationship with him and he refilled my script anyway.
So obviously not an isolated incident, although I have no idea if he was acting on orders from the DEA.
Sounds like you are a high functioning and intelligent user of narcotics, which is atypical at this point. I visit a busy pain clinic for the occasional steroid shot, and since I’m intolerant to narcotics, I’m generally the only person in a packed waiting room who is not zombified and drooling. No offense to those with chronic pain, but to my untrained eye many pain clinic patients are either drug seekers or incoherent from meds. So if you are together, ambulatory, and well-spoken in a region notorious for prescription drug problems, you may stand out. Take that as a compliment, understand that a general practitioner may feel the need to cover his posterior, and continue to enjoy your good relationship with someone who helps you.
Thanks for the compliment. I have done everything I can to avoid becoming “zombified” by the drugs. Thankfully the only serious side effect that seems to plague me is constant lethargy from the opioids. As mentioned above I am taking amphetamine to counter the lethargic effects of the opioids. The addition of the amphetamine has changed my life as I am now able to stay awake all day. The only sad part is I seem to be developing a very rapid tolerance to the drug and unfortunately there are no alternatives once this becomes totally ineffective. Truth be told, the use of the narcotics scares the crap out of me, but I don’t have much in the way of options. Without them the pain is intolerable and if I could find a solution other than drugs I would pursue it. I broke my back while working and am now fused from L3 to S1, a really bad place to be fused. The doctors not only can’t find a solution, but they can’t seem to identify the cause of the pain. Other than, “let us cut you open for the third time and take a look around” they haven’t come up with much. Each surgery seems to leave me in a bit worse shape than before, so I am in no hurry to let them poke around in me without some sort of objective.
As far as the drug seekers, I just don’t get it. For some reason I have never gotten a high off the pain meds (except once in the hospital on Demerol via an IV, sent me to the moon) so I just don’t get the attraction. To me they are an evil necessity and I constantly ponder the damage that is happening to my body from years of taking these things. But it could always be worse. Hell, I could have been paralyzed. I lost my much loved career and the injury cost me a marriage, but today I am married to a wonderful woman and I have much to be thankful for, others aren’t so lucky.
Maybe he heard of a friend or through the grapevine of some doctor being audited and decided he’d better tidy up his practice.
Maybe he’d made the exception because since you were not one of the walking dead, and I presume could carry on a coherent conversation, and did not seem to be asking for more and larger doses, you obviously did not fit the category of users or user/reseller. Nevertheless, he needs to get his shit in order should the DEA look at his records.
I assume the test will notice levels, so at the least you have to take the full prescribed dose for at least a week before the test to look like you are properly taking you meds?
I had a friend in med school many years ago who told be about his volunteer time in a downtown medical clinic. He mentioned there were a lot of “patients” who came in faking describing all the symptoms that called for narcotic muscle relaxants and painkillers (but an exam showed none of the physical symptoms). Usually the only give-away he said was the way their face dropped when they got a prescription for a non-narcotic drug.
Nope, really never heard of it. But since reading about it (when I made my second post), I have. Seems like a combination of two things. To make sure the patient is actually the one taking the drugs as well as to see if they’re taking any other (illegal) drugs. Some reports say that it’s because other drugs may interfere with how well the prescription PKs do their job, but I have to wonder if at least part of it is because it gives the doctor the some leverage to suggest the the patient (at least in the case of non-chronic…‘hey doc, I’m 20 and my back has been hurting for a week’) is drug seeking.
I would think not being “one of the walking dead” might suggest to a doctor that the OP wasn’t taking their meds. Of course, plenty of people can take their meds, especially after growing a tolerance to them over a period of years or months and be perfectly coherent. But, my point is, someone that was ‘the walking dead’ obviously isn’t diverting them.
Not only is this very common (and yes, it’s the DEA’s fault) my understanding is that if they find even cannabis in your urine you will almost certainly be dropped immediately as it will mark you as an illicit drug user.
Of course there are many people who don’t receive enough opiates to deal with their pain, and therefore also self medicate with cannabis, without knowing this, and then get screwed over for life. Potentially if you hand around people smoking cannabis you can yourself test positive. Oh and the tests sometimes come up positive for stuff anyway completely randomly.
Normally there’s an agreement at US pain clinics that you have to sign acknowledging this, I think.
Fortunately this is all completely necessary and effective, because the DEA has managed to entirely prevent illegal drugs from being sold or consumed anywhere in America.
Yes, but a doctor would (should?) know how zombie-like a person would be based on their consumption level. If the profit motive came into play, the person would be asking for higher doses, occsasionally “lose” their meds and need an early refill, etc. I hope the doctor is looking for give-away symptoms.
This may be part of the reason. You will stand out in the doctor’s records from his other patients, as receiving a much higher level of scheduled pain medications. That would be a red flag to any DEA person auditing his records, so your doctor may just be being proactive in getting this drug test into your records.
If he was a pain specialist, you wouldn’t stand out so much. (But then, such drug tests may be standard practice for a pain specialist’s patients.)
I talked to someone who was on fentynal patches, didn’t like the way they felt and asked to quit the patches and go back on darvocet which they did well with before they were escalated to the patches. Big mistake as apparently asking for something in particular was a red flag, even something as laughable as propoxyphene. They got dropped and had to find a new clinic, went to the ER because of their withdrawal etc.
I knew somebody once who was on oxycontin for pain. Or said he was. He told me some story about his having to meet with the DEA and his doc. I didn’t get it and didn’t pursue that line of conversation because it seemed so Out There. So I guess it happens.
The irony is that the latest research indicates that pain sufferers are being under-medicated due to substance abuse paranoia. My reg doc won’t even give me Tramadol so I have to go to a pain mgt. clinic now. But I don’t want meds. I want to be fixed.
At work (where I read medical records ALL day) I’ve never really seen a chronic pain patient that didnt’ have to submit to an occasional drug test. I always figured it was just the doctors covering their asses, though, I’ve never heard of it being a DEA requirement, but it wouldn’t surprise me if that were true.
FWIW, I have seen a lot of chronic pain patients get busted for pot. Most (but not all of the time) their doc will give them a second chance and then dump them if they test positive for it again. What always surprises me is the number of people who get warned after the first positive result and STILL keep smoking it.
I have a great relationship with my doc, and I pee in a cup about once a year. About once a year the office asks me to bring in my bag o’meds. Oddly, the only time I ever got a call about a discrepancy was when I was freshly off byetta and not yet on lantus I got asked why I wasn’t renewing my needle scrip by the pharmacy. :dubious:
I got to chatting with the training nurse because I asked to be taught how to mix insulin/use a standard syringe even though I use lantus - I figured with our traveling, I might have to revert to classic old school insulin sometime. [better safe than sorry]
