A second safeguard is a state pharmacy board monitoring system. They exist in over 30 states, and help to ferret out patients who are “doctor shopping”. 

One of the main methods of safeguards for a doctor prescribing narcotics is drug testing, and here are 3 reasons why it is very important:

1.     Protecting Yourself:   A significant number of patients receiving narcotics, over 20% in fact, will divert their prescription medication. This may seem surprising, but even retired individuals sometimes need to supplement their fixed income by selling their prescriptions. Drug testing helps ensure patients test positive for the medication they are actually being prescribed. If the patient is selling their medication and one of the buyers is involved in a fatal car accident, that prescription may be traced back to the prescribing doctor. Assuming the patient has been compliant with their pain contract, the state pharmacy monitoring board history is checked, and the urine drug screening has been copacetic, it would be extremely difficult to find fault with the prescribing doctor.

2.     Protecting Your Practice:   As pain management increases as a medical specialty, more state medical boards are recommending urine drug screening for patients receiving narcotics. Eighty percent of narcotic prescriptions are written by primary care doctors, so this recommendation does not just apply to pain specialists.

3.    Protecting Your Patient:    Patients will sometimes trade their narcotic medications for illicit substances such as cocaine, ecstasy, or LSD. Unfortunately, this may degrade their condition and place their life at risk with potential overdose or cardiac reaction. One of the best ways to protect against this is urine or saliva drug screening. The test encompasses both the major prescribed medications along with the most prevalent illicit substances. One trick patients will utilize is taking some of the prescribed medication the morning of their appointment with the doctor. The way to detect this is to send the sample into a laboratory for confirmatory testing of metabolites. It takes time for metabolites to appear, and patients often do not know this. Another trick patients will try is utilizing bleach or other adulterants to cheat a positive illicit substance test. Sending the sample in for confirmatory testing will evaluate for these as well. 

The overlying theme for why it is appropriate to drug test your patients in one word is:  PROTECTION. Ensuring compliance with a narcotic treatment program will allow better outcomes for one’s pain management patients along with implementing appropriate safeguards for the doctor and his or her practice.