Friday, April 19, 2019

#8: “Respond, Don’t React” to the Opioid Epidemic


 “Respond, don’t react”. This sage advice appears to be completely ignored in our country’s urgent desire to “fix” the crisis known to all as the opioid epidemic. A response is thought out, calm and non-threatening. A reaction is typically quick, without much thought, tense, aggressive and many times provokes more reactions, accomplishing nothing. In the eyes of many physicians and chronic pain patients both Federal and State governments have reacted rather than responded, to an acknowledged problem, with at times some draconian measures. Due to a one size fits all regulatory approach; many physicians have opted to cease prescribing opioids leaving their chronic pain patients with few to no options. The fact that there is no clear cut solution enforces my premise; a calm well thought out response is needed, not off the cuff reactions that are masked as solutions. By the end of October of 2018, 33 states had enacted laws with some type of limit, guidance or requirement related to opioids, yet although the amount of opioid prescriptions has decreased, the number of overdose deaths has risen. On March 6, 2019 more than 300 medical experts, including three former White House drug czars, sent a letter to the CDC, contending the guidelines issued by the federal government regarding the over-prescribing of opioid painkillers, were harming patients in severe chronic pain who had been on high doses of opioids for years. Patients who never failed a drug test, always had the correct pill counts and had never abused their medications were suddenly told they could no longer receive the amount of pain medication, or sometimes any pain medication, which had allowed them to live relatively normal lives for years.

“You will never be able to deal logically with an illogical person” is another favorite of mine. It is neither logical nor reasonable taking a punitive approach to chronic pain patients due to irresponsible health care providers or patients with SUD. Most providers are ethical, honest and want to deliver the best care possible to their patients. Using ILDP to drug test the patients for whom they have written scripts is an appropriate, objective way to determine the best treatment plan for the patient. Ironically the government has not approached the labs where the drug testing is performed, to request information regarding drug use by patients. The labs see the pattern of drug use, as well as the pattern of prescribing. Where is the logic in ignoring the business that sees the drug trends around the country on a daily basis? I am not here to say there is a simple solution; however I do know when the government takes the decision making out of the healthcare provider’s control, very little good can come of it. Conversely without appropriate oversight of providers with the ability to write scripts for controlled substances or pharmaceutical companies pushing pills, we are back in the ninety’s when drug use exploded. See, it is not simple.

Ah yes. The struggles we endure today will be the ‘good old days’ we laugh about tomorrow. Thank you all for your trust in us.

Lance Benedict
President/CEO Industry Lab Diagnostic Partners
04/19/2019

Friday, April 5, 2019

#7: Inconsistent Results on Drug Tests



 An inconsistent drug test on a patient’s toxicology report is nothing to be taken lightly. At the minimum an inconsistent report could mean dismissal from the practice and at the worst could mean jail time or even send a patient with SUD (Substance Use Disorder) into suicidal tendencies. After doing our monthly analysis of reports we send out, that have inconsistencies, we have discovered that an extremely high percentage of these reports are a result of one or two things. The clinic is either not reporting the prescribed medication the patient is on, or secondly the clinic reports the wrong medication. A common example is Subutex is reported as prescribed and the patient had been switched to Suboxone. I recently had a discussion with a Suboxone clinic where a patient who was prescribed Suboxone had zero Naloxone on her drug test. This patient’s treatment was court ordered and if she failed her drug test she would lose the right to see her children and would be returned to jail. Although this top notch clinic reported the drug she was prescribed correctly, one can see quickly how important making sure the prescribed drugs written down are correct. If the provider changes a patient to a different medication, the new prescribed medication must be written down.

Although convenient, sending a large list of medications a patient is currently prescribed or was prescribed in the past, is not appropriate. The data entry people at the lab are not healthcare providers. Picking correctly prescribed medications out of a list can quickly become a legal issue. They should only enter what the clinic tells them the patient is prescribed. There are times when they do not recognize the names of different drugs and they can easily miss a medication a patient is on which would then be reported as inconsistent. Just as importantly, the lists we get at times are old and the current meds are either not listed or difficult to interpret. We are unconcerned with medications not on our requisition list such as statins, diabetic medication, heart meds, etc. Prescribed Opioids, Amphetamines, Relaxants, Benzodiazepines, Tri-Cyclic Anti-Depressants, SSRI’s, Anti-Convulsants, Barbiturates, Antihistamines, and Antipsychotics are the only drugs we need listed.

Okay enough already. For those of you who needed scolding, consider yourself scolded. Time for something interesting regarding a question asked about CBD oil. Yes, if used in large does, legal high quality CBD/Hemp oil can produce a false positive for THC (marijuana’s psychoactive and euphoric ingredient) on a drug screen, however that same patient would be negative on a drug confirmation test for THC. Now you know!

As you prepare for your great weekend I share with you some words of wisdom from the great speaker Joe Charbonneau. You can’t teach what you don’t know. You can’t lead where you don’t go. You can’t be what you are not. You can’t give what you ain’t got!!

Thank you all for your business.

Lance Benedict
President/CEO Industry Lab Diagnostic Partners
04/15/2019

#44: Drug Testing is Another Tool in the Provider's Toolbox

  We have all heard the phrase, “The flavor of the moment” which can be roughly translated into one of my favorites, “People buy what is fam...