#24 Who Should Discuss Drug Testing with Patients

I sincerely hope all of you had a wonderful, relaxing and restful Thanksgiving holiday.  I am wondering how many reading this shared with others the well known and repeated “fact” that the L-tryptophan in the turkey you ate yesterday is what made you crash after the Thanksgiving meal.  Sorry to disappoint, but that “fact” is a myth.  Yes, you read that correctly, I said myth.  Turkey is not any more sleep-inducing than other foods.  It is true tryptophan is a component of the brain chemical serotonin, however, chicken and many other foods also contain tryptophan in similar amounts to that found in turkey.  In reality your post Thanksgiving meal “crash” more likely occurred as a result of your pancreas releasing large amounts of insulin as a result of those wonderful carbohydrate loaded yams smothered in marshmallows, your grandmother's bread stuffing, those wonderful homemade rolls, mashed potatoes slathered in homemade gravy and finally multiple utterly delicious sugar-filled desserts.  OH MY!  (Sorry, got a little carried away fantasizing about food)

Interesting how the longer and louder you say or repeat something, the more it has the likelihood of becoming a “fact”.  It is for this exact reason ILDP is very strict about who should discuss drug testing with patients.   I am aware of a former director of a lab that claimed he educated his collectors well enough on drug pharmacology that they were able to discuss in-depth drug testing with clinic patients.  In my opinion, this should never happen.  Although I write these blogs to help educate, ILDP collectors should never discuss drug pharmacology or test results with patients.  Doing so not only supersedes the authority and expertise of the provider who ordered the testing but also depending upon what is said, is on the verge of practicing medicine without a license.

 Licensed professionals, whether an addiction specialist or medical personnel, ordered the drug test for a purpose and they are the only ones who should be discussing such tests with patients.  Although many collectors, having held that position for some time may have some basic or even advanced knowledge of drug testing, it is not their place to discuss or interpret any part of a patient’s drug test.  There is already way too much incorrect information regarding drug testing being delivered to patients as fact by friends, family, and the internet.  ILDP would never put one of their employees in the position of assuming expertise when it comes to the health of a patient.  Drugs and drug test results should only be discussed by trained, licensed professionals.

Industry Lab wishes all of you a wonderful month of December as we approach Christmas and the New Year.  I have said before it is easy to become jaded in the business we are in.  As this special time of year approaches never forget we are dealing with human beings who have lives they are trying to live as well as they are able to.  Take that extra moment to respond, rather than react.  You may be the one who makes the difference which path that patient takes.  You want it to be the correct one.

Thank you all for your business and your trust in us.

Lance Benedict
President/CEO Industry Lab Diagnostic Partners
11/29/2019

#23: Do You KNOW What Your Patient is Taking?

Recently I read an article which had the following statement within the content, “A UDT policy and consistency is critically important because clinicians’ predictions of UDT results are frequently inaccurate.”  In other words providers who insist they “know” the patients who would not abuse controlled substances are many times just plain wrong.

Ordering drug tests removes the subjectivity from the equation and if done as a clinic policy gets the provider “off the hook” so to speak.  Recent studies have shown among patients under Chronic Opioid Therapy, the percentage with aberrant UDT results is between 9-50%.  That same study showed that appropriate risk based testing reduced the occurrence of aberrant behavior considerably. 
When aberrant behaviors occur, or there are unexpected results on the UDT, it is usual, customary and expected that corrective action be taken.  Regardless of what the corrective action is, there is not a one shoe fits all, a critical component is providing complete documentation of the plan in the patient’s chart.  Additional documentation on subsequent visits should clearly define how the patient is progressing or not progressing and what changes will be made, including additional drug testing.

 Although all providers are schooled in the necessity of appropriate charting it is even made more critical with patients on controlled substances.  Several states have mandated that providers cannot prescribe controlled substances if they know or should know that their patient is using drugs for a nontherapeutic purpose.  There are simply too many peer reviewed studies determining patient self-reporting is not accurate, or that many physicians still work under the “truth bias”; that is, they have no reason to not believe their patients.  Sadly these well meaning providers are many times easily manipulated by highly motivated individuals seeking their drug of choice.  With the increase in morbidity and mortality related to the abuse of drugs, the proactive use of UDT is critical.
 
Did you know teenagers getting together and indiscriminately mixing drugs together in a communal bowl and then proceeding to grab and take handfuls, has been termed Pharming or Skittling.  Many times the pills are washed down with alcohol.  Most of the pills come from the family medicine cabinet.  Another popular practice by teens wanting to escape from reality is called “Robo-tripping” which consists of drinking massive amounts of cough suppressants such as Robitussin, containing the drug dextromethorphan, which produces a high if the quantity is high enough.  Since you now know the rest of the story it may be wise to inform your patients who have, or will have, teenagers.  Perhaps an educational session or pamphlet discussing the importance of locking up their prescription medications is appropriate?

I hope you all have a tremendous Thanksgiving with family and friends.  I know we at ILDP are thankful you have chosen us to be your lab.  Thank you for your business.

Lance Benedict
President/CEO Industry Lab Diagnostic Partners
11/15/2019

#22: We are all Human Beings

There are two sides to every story.  Within the telling of each side there are typically some grains of truth in order for that argument to maintain some legitimacy.  The founder of PROP (Physicians for Responsible Opioid Prescribing), a self proclaimed expert on Opioid addiction, beats the drum so loudly for his side of the story many in America cannot hear the other side.  Dr. Andrew Kolodny, a licensed psychiatrist founded PROP and became the co-director of Opioid Policy Research at Heller School of Brandeis University without returning to academia to further his learning of opioids, pharmacology, or intractable pain and its effect on the body.  He has never treated a single patient with intractable pain, or written a single prescription for any opioid other than buprenorphine (which by the way is a very powerful opioid).  Starting in 2005 through the end of the 2000’s Dr. Kolodny traveled throughout the US convincing Physicians, hospitals and even prisons to change from using Methadone to Buprenorphine and made a lot of money doing so. 

In 2015, a secret panel led by Dr. Kolodny, among other PROP members, helped develop the CDC guidelines for chronic pain management without any proper vetting by an appropriate peer group.  A letter written that year and signed by the U.S. Pain Foundation, the American Chronic Pain Association, the American Academy of Pain Management, as well as several other chronic pain groups, questioned the lack of transparency in how the guidelines were developed and then presented. Pain News Network reported that at least five board members of PROP were on the CDC panels involved in developing the guidelines.  

As mentioned in a previous blog these “guidelines” have been walked back due to the abuse of legitimate chronic pain patients who were suddenly “left out in the cold.”  Also of interest is the fact that Dr. Kolodny was the main expert for the state of Oklahoma during the Johnson and Johnson trial in which the state won a $572 million judgment for which he was paid upwards of $500,000.  Just saying!  All evidence suggests one of the most sought after “experts” on Opioid addiction may have some underlying motivations for his rigid stance. Dr. Kolodny is on record stating that chronic pain patients are in the same category as drug addicts. You and I know this is just not true.

I am hoping reading this will make you stop for a minute and examine your take on the obvious problem the United States has with mood altering substances.  This problem is an extremely complex one and it would take months of blogs to examine its multiple facets.  My main motive is all of us remember we are dealing with human beings and that we remain careful to remind ourselves there are two sides to every story.

Kiss your babies, connect with someone you haven’t seen in awhile and remember to live in the moment.  Thank you all for your business.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners 

11/01/2019