More Pain Doctors Require Patients to Take Urine Tests; Behind New Rules Is a Fear of Lawsuits Tied to Overdose Deaths

Updated July 19, 2013, 7:27 p.m. ET

More Pain Doctors Require Patients to Take Urine Tests

Behind New Rules Is a Fear of Lawsuits Tied to Overdose Deaths

TIMOTHY W. MARTIN

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For decades, William Piechal trusted patients who said they were taking their pain medications as prescribed. Now, he is asking them to prove it. The Fayetteville, Ark., physician is one of a growing number of pain doctors across the country requiring patients to submit urine samples to demonstrate they are taking pain medications such as oxycodone as directed. Individuals also are being asked to sign written agreements promising they won’t sell their drugs on the side and will seek prescription painkillers only from Dr. Piechal’s clinic while under his care. If they refuse, he said, he won’t provide them with a prescription.“This is where chronic pain treatment is headed,” said Dr. Piechal, who called the initial urine-sample results he received last year “shocking,” because some failed tests came from individuals he had treated for more than a decade. Failed tests revealed some were taking opioids he hadn’t prescribed or illicit drugs like marijuana or methamphetamine.

Behind the new rules is a growing concern among physicians that they will be held responsible for painkiller-overdose-related deaths and accidents. For years, efforts to stymie the epidemic of abuse had been led by law enforcement and targeted shady operators, called “pill mills,” that supply the black market for oxycodone and hydrocodone.

Last year, the American Society of Interventional Pain Physicians, a professional group with 4,000 members, adopted guidelines that urine tests “must be implemented” from the initial visit to see whether patients are already abusing drugs—or are likely to. At least three other pain physician groups, including the American Pain Society, have endorsed such testing for high-risk patients in recent years. And at least 10 states—including Kentucky and Washington, long hotbeds of abuse—recommend some level of urine-test monitoring.

“Urine tests can give us a lot of information to understand if somebody is taking the medications properly—or if they’re diverting them,” said Hans Hansen, ASIPP president and a practicing pain doctor in Conover, N.C.

The efforts have their skeptics.

 

Monitoring prescriptions and locking individuals into signed agreements infringe on patient rights and can create a dynamic where patients are “afraid to be fired by their doctor,” said Myra Christopher, a pain expert at the Center for Practical Bioethics.

And it is unknown whether these aggressive screening tactics make any difference in actually decreasing abuse or diversion, though it is a hot topic for research, said Edward Michna, an anesthesiologist at Brigham and Women’s Hospital in Boston, who has researched the use of urine testing with pain patients.

Urine tests, manufactured by Quest Diagnostics Inc., DGX +0.20% Ameritox Ltd. and other companies, can cost anywhere from $30 to $3,000 to administer, based on how many drugs are screened. Doctors collect urine samples from the patient and send them to a manufacturer’s laboratory for analysis. Ameritox, based in Baltimore, said it can identify whether a person has the prescribed pain drug in their system. Results take on average about five days, it said.

Typically, insurers cover much of the cost. But for pain patients like Donna Ratliff, of Lithia, Fla., the monthly tests cost an extra $35 apiece and make her feel unduly targeted.

“It makes you feel bad that you’re tested for these prescription meds you’re not on or drugs like cocaine or ecstasy that I’d never even dream of taking,” said Ms. Ratliff, 48 years old, who takes methadone and oxycodone to manage back and neck pain.

Some insurers don’t cover the urine test costs at all. And two of the companies—Ameritox and Calloway Laboratories Inc.—paid settlements since 2010 in lawsuits in which they were accused of paying kickbacks to physicians for unnecessary screening.

Ameritox Chief Executive Scott Walton said those practices were “voluntarily discontinued eight years ago” and the company now has “the most rigorous compliance program in the industry.” And Calloway said its new owners and leadership team are committed to operate “with a high degree of integrity.”

Both companies settled without admitting any wrongdoing.

Drug-test volume totaled 486 million tests in 2011, a 28% rise from 2006’s 380 million, according to Venture Planning Group, a New York-based publishing and management consulting firm. By 2016, the drug-test market is expected to grow more than 21% to 592 million tests, Venture said.

Overdose deaths from painkillers surpass those from heroin and cocaine combined, according to federal data. Pain is one of the most common reasons why people visit the doctor’s office. But physicians receive little training in how to treat pain, and even less on how to identify potential addicts, pain doctors say.

Anand Thakur, a pain doctor from Clinton Township, Mich., a Detroit suburb, regularly administers tests as his main defense against savvy addicts who know how to game the system.

“Unfortunately, we’re in a trust-and-verify situation with prescription opioids,” Dr. Thakur said.

Some patient groups hope that the aggressive screening will eventually create an environment in which patients with clean records can avoid scrutiny both at the doctor’s office and the pharmacy counter.

“It’d be just like the airline pre-check, where the airport identifies people they think they can trust,” said Penney Cowan, executive director of the American Chronic Pain Association, an education group.

About bambooinnovator
Kee Koon Boon (“KB”) is the co-founder and director of HERO Investment Management which provides specialized fund management and investment advisory services to the ARCHEA Asia HERO Innovators Fund (www.heroinnovator.com), the only Asian SMID-cap tech-focused fund in the industry. KB is an internationally featured investor rooted in the principles of value investing for over a decade as a fund manager and analyst in the Asian capital markets who started his career at a boutique hedge fund in Singapore where he was with the firm since 2002 and was also part of the core investment committee in significantly outperforming the index in the 10-year-plus-old flagship Asian fund. He was also the portfolio manager for Asia-Pacific equities at Korea’s largest mutual fund company. Prior to setting up the H.E.R.O. Innovators Fund, KB was the Chief Investment Officer & CEO of a Singapore Registered Fund Management Company (RFMC) where he is responsible for listed Asian equity investments. KB had taught accounting at the Singapore Management University (SMU) as a faculty member and also pioneered the 15-week course on Accounting Fraud in Asia as an official module at SMU. KB remains grateful and honored to be invited by Singapore’s financial regulator Monetary Authority of Singapore (MAS) to present to their top management team about implementing a world’s first fact-based forward-looking fraud detection framework to bring about benefits for the capital markets in Singapore and for the public and investment community. KB also served the community in sharing his insights in writing articles about value investing and corporate governance in the media that include Business Times, Straits Times, Jakarta Post, Manual of Ideas, Investopedia, TedXWallStreet. He had also presented in top investment, banking and finance conferences in America, Italy, Sydney, Cape Town, HK, China. He has trained CEOs, entrepreneurs, CFOs, management executives in business strategy & business model innovation in Singapore, HK and China.

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