There is just one winner when opiates are the only pain management game in town: Big Pharma and related industries. They make money from legitimate patients, addicts, and all sorts of peripheral so-called businesses. I’m sorry, but something is fundamentally wrong when your business model is paradoxically opposed to the stated goal.
This is not a federal regulation. The CDC released a set of guidelines for chronic pain treatment, as have any number of other organizations, but they are just that–guidelines.
The state level is a different story. Most state medical boards have guidelines for chronic opiate patients, and most if not all of them contain recommendations for urine drug testing. In my state, those guidelines have the force of law–the law itself contains guidelines, and it also puts the force of law behind the chronic pain guidelines issued by the state medical board. (Yes, they are in conflict sometimes. Yes, that’s a pain in the ass. The whole thing was done in the dumbest possible manner.)
Those guidelines require me to do urine drug screening on all chronic narcotic patients at least annually for the lowest risk patients, and more frequently for people at higher risk of abuse or diversion. Most clinics just test everybody every three months. What our state guidelines don’t do, however, is tell me what drugs to test for, nor do they even tell me what to do with the results. There’s no rule saying I have to cut people off if they fail the test, or even what it means to fail. I just have to do it.
So how do I know when I’m breaking the rules? If I am ever suspected of irresponsible prescribing, an auditor will come in and audit a bunch of my charts, and that report will be examined by the medical board. It will really be up to them whether I’m being responsible or not. Is it OK to counsel someone with a bad drug test and give them a second chance, or do I have to take a zero tolerance approach? What about marijuana? It just depends on the opinion of the majority of the board.
That’s why so many clinics take a zero-tolerance, zero-nonsense approach–it’s the only way to know for sure that you’re on the right side of the medical board, even if it’s not always fair. To be honest, most of us primary care providers would like to be out of the chronic opiate business entirely.
Why do those requirements call for anything WRT Cannabis, when you are administering an opiate patient?
Because it casts a much wider net to generate more testing revenue.
Yeah, just came in to say that. These guidelines are only guidelines, and I would be surprised if 5% of practicing physicians have ever read them.
Jeff Sessions isn’t making **Morgenstern’**s family member’s doctor act like a cowardly shitbag; it may be the policy of his employer to act in such a fashion, or it may be his own predisposition, but in either case she needs to find a new doctor.
This is such a huge scam. I briefly worked for a drug treatment outfit that tested everyone three times a week for a ridiculous number of obscure drugs…sending all the samples out to their own private lab several states away for maximum billing pleasure. And of course, if you test that much, you’re going to be getting false positives constantly, even if the FP rate of any particular test is very low. So we would just have to use our own judgment to decide if the test results made sense and either bust the patient or not. It would have made much more sense to just test a couple times a week for common drugs of abuse, but that wouldn’t have kept the clinic owners in garish pinky rings. There was a big NYT story about this a few months back, apparently there are a lot of places using this business model.
I do not believe this is a federal requirement but more of a individual network decision. I have been prescribed Tramadol (a scheduled opiod) for 14 years for chronic pain resulting from torn rotator cuff tears in both shoulders (the body wasn’t meant to push a wheelchair). During those years I had the same doctor prescribing this medication and another Schedule II medication (non opiod or narcotic) for almost as many years and never once was I asked or required to take any kind of drug test. Well, other than blood tests to make sure the medicines I was taking weren’t damaging my organs but that was only every 6 months and it wasn’t looking for substances).
I had this doctor up until just a few months ago. I did manage to find a good replacement physiatrist who is much closer to me and who I immediately had good rapport with. However, in order to be prescribed the same medications (surprisingly, the only drug that the doc had any concern prompting the testing was the Schedule IV tramadol and not the Schedule II drug) I had to be drug tested once a freaking month. She explained that the reason wasn’t to make sure I was taking them and not illicitly selling them but rather that the only narcotics in my system were the ones being legally prescribed.
Now I have no trouble admitting that I am basically a pothead. A pothead who also gets genuine medical relief/help from the pot. The doctor that requires a monthly drug test in order to prescribe me any painkiller that was a controlled substance was totally unconcerned with the presence of marijuana in my system. Which was a relief.
Contrast this with my general practitioner, who works in a network that will NOT prescribe ANY controlled substance if there is any narcotic or marijuana in your system. No debate, no discussion, it’s a rule that can’t be negotiated whatsoever. My legal status (in the eyes of the state, at least) as a card-holding marijuana patient was irrelevant.
Also, regarding how long weed stays in your system, yes, it takes longer than just about any drug to clear from your system because it gets stored in the fat cells. So the amount of time it would take would be dependent on things like extent of usage, amount of adipose tissue, etc. But even with all that said, 11 weeks sounds like hyperbole to me. I’ve had to clear out the marijuana from my system several times over the years and it’s never taken me longer than 3 weeks. Now I don’t know to what extent a person’s bodyfat levels effect the time it takes (I am lean) but that 3 weeks vs 11 weeks seems like a gigantic difference that just can’t be explained by fat differences. But what do I know? Just my own experiences.
They don’t, in my case. They don’t specifically call for anything. The only reason we test for THC at all is that it’s a part of the standard panel of tests from the lab we use. I wish it weren’t, myself.
About how long it takes to clear cannabis from your system on a drug test:
Back when I worked in the treatment field the rule of thumb was the average user would test positive for about 30 days. Note all the averaging/fudging there. It varied a LOT. It doesn’t surprise me that Ambivalid would clear it out in 3 weeks between his exercise regimen, general fitness, and presumed lower than average body fat. Some of our very overweight people, or the folks with trashed kidneys or livers would retain it longer. How much you’re consuming also has an effect - a one-time contact high is going to clear out of your system a lot quicker than a daily toke.
So yeah, for some people it could be detectable for up to 77 days (or whatever), but I’m taking a guess that most of those folks would either have a lot of body fat, were in poor health, or otherwise not functioning terribly well on a physical level. People who are very healthy, low body fat, and exercise a lot will clear it out sooner.
For darn sure it’s detectable a lot longer than water-soluble metabolites like those from opiates, alcohol, or benzos which tend to clear out in 3 days to a week.
Fewer than 5% of practicing physicians prescribe opioids on a long-term basis.
How convenient. Nice how they get to just make it up as they go along, collecting their fees at every turn. Cocksuckers.
Which means what? Translate 4% to a number then multiply by their number of patients. Wanna guess whether or not those same 4% are also the ones running pill mills in places like rural WVA and KY where the opiate problem has reached epidemic levels?
C’mon now - finish the job! 
Because 95% of patients who require long term use are referred to a pain management specialist and not treated in house.
Long term pain management specialist using opiates = Pill Mill.
Right - but that is why 95% of doctors don’t read the guidelines for long-term opiate management.
And you say that based on what broad, deep experience?
Oh. The broad, deep experience you shit out of.
At least I don’t work for a pill mill, sucking the life out of my income stream while simultaneously sucking more patients in on the other end, feeding them hope while living my miserable leech life secure in the knowledge that healthcare non-reform and Government suppression will continue enabling our money-making scam.
OK, you can get into a car wreck, develop serious pain, and manage it without opioids.
No, marijuana isn’t a drop-in replacement.
Oh look - the Fuckwit responded. Too bad I can’t see it. I don’t believe it can even spell it’s own name - seems like it should be “Derelict.”
OK, 0.25%. My point is that very few physicians in ANY specialty are intimately familiar with the Federal guidelines applicable to their area of practice. This is not to say the guidelines are unimportant; the minority that do read them tend to be opinion leaders who write journal articles and produce residency training curricula. Of course, those are highly intelligent people who aren’t going to automatically sign on to guidelines which seem based more on politics than science.
I was trying to calm down those in this thread who seem to fear that these new guidelines, in and of themselves, are going to lead to widespread short-term changes in clinical practice.
4/10, please try harder next time