Random Drug Screening and Pill Counts

[Guyton]

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I was recently approached at one of my clinics about enforcing a random drug screening and pill count policy. I was wondering what this community's thoughts were on this.

 

[milesed]

Our state mandates an initial and yearly UDS (more freq if there is a history of drug abuse) before and during treatment with any controlled substance for adults. For other patients, it's done prn. We don't do pill counts as any savy patient would just empty out a few pills to get around it.

 

[doctorpilgrim]

I am interested in hearing the thoughts of our community regarding using levels of buprenorphine/norbuprenorphine and EDDP for methadone etc. So some clinics use these levels to predict compliance and I believe Ameritox uses statistical analysis to predict dosage taken from urine levels of metabolites.
My own opinion is that uds can be used as tools for increasing patient engagement. Suboxone films are individually wrapped and have a batch no on each one.

 

[keifernny2]

Pill counts are useful when you ask the patient to bring in their controlled meds and they say they don't have them. It opens a very useful dialogue about where they went. Now, the patient could always borrow pills from their friend to bring to the pill count, but when it is a surprise, they often don't have time.

 

[doctorpilgrim]

This is what I was referring to.
Urine drug monitoring with Ameritox’s Rx GuardianSM process goes beyond standard urine drug testing and features Rx Guardian CDSM, which is derived from the most comprehensive reference database of pain patients who were clinically assessed as adherent. Patients’ normalized results are compared to the reference database, allowing clinicians to make more informed assessments of whether their patients are taking medications correctly.

 

[smalltownpsych]

Pill counts are useful when you ask the patient to bring in their controlled meds and they say they don't have them. It opens a very useful dialogue about where they went. Now, the patient could always borrow pills from their friend to bring to the pill count, but when it is a surprise, they often don't have time.

They could bring in a friends script but if is good stuff the friend might not get it back. "Oh thanks for helping me out with that but I forgot the pills at the docs and they lost them. Sorry dude".

 

[birchswing]

I had a psychiatrist who prescribed to the front office staff. The psychiatrist gave them the money to fill the prescriptions and then gave him the medications (uppers and downers). If he had only implemented a pill count, he could have caught those sneaky secretaries!

 

[Guyton]

I agree wholeheartedly with drug screening in when prescribing medications with high abuse potential. This clinic is wanting to perform random drug screens on every patient and pill counts on medications like vistaril.

 

[milesed]

I had a psychiatrist who prescribed to the front office staff. The psychiatrist gave them the money to fill the prescriptions and then gave him the medications (uppers and downers). If he had only implemented a pill count, he could have caught those sneaky secretaries!

Wow. Was he caught? If not you should contact the medical board.

 

[smalltownpsych]

I agree wholeheartedly with drug screening in when prescribing medications with high abuse potential. This clinic is wanting to perform random drug screens on every patient and pill counts on medications like vistaril.

That is ridiculous and counterproductive. Too many control dynamics play out when people are confronting addiction. Not surprising since almost everyone is personally affected in some way by addiction. That type of ill-informed response reminds me of the grade school teacher who is losing control of their class and the more they try to control those little buggers, the worse it gets. Eventually the good kids stop obeying the rules too and then you have chaos. Fear leads to need for perceived control leads to increase in undesired behavior leads to more fear and so on. Our government is great at that too. 😉

 

[birchswing]

Wow. Was he caught? If not you should contact the medical board.

Yes, he was caught. Had to go through an education program. I wouldn't have known about it except for the public documents on the board of medicine site.

 

[Ceke2002]

Yes, he was caught. Had to go through an education program. I wouldn't have known about it except for the public documents on the board of medicine site.

Education program, pfft! Like the majority of these Doctors don't already know what they're doing is wrong. 🙄 Out of all of the equally dodgy Doctors I've known down my way, there was only one who seriously didn't seem to understand why flicking pills out like candy, selling drugs of dependence, or accosting patients for sex in exchange for "any script you want" was not only ethically wrong but totally illegal and potentially punishable by jail time. And in his case I don't think education would have helped as much as detox, considering how off his face he was on a regular basis.

 

[Ceke2002]

I agree wholeheartedly with drug screening in when prescribing medications with high abuse potential. This clinic is wanting to perform random drug screens on every patient and pill counts on medications like vistaril.

That is ridiculous and counterproductive. Too many control dynamics play out when people are confronting addiction. Not surprising since almost everyone is personally affected in some way by addiction. That type of ill-informed response reminds me of the grade school teacher who is losing control of their class and the more they try to control those little buggers, the worse it gets. Eventually the good kids stop obeying the rules too and then you have chaos. Fear leads to need for perceived control leads to increase in undesired behavior leads to more fear and so on. Our government is great at that too. 😉

I agree with smalltownpsych, it's one thing to require patients with a hx of drug abuse to abide by certain conditions if they're being prescribed potential drugs of dependence, but to expect the entire clinic to keep count of every patient's medication is just ridiculous. Are they worried about non compliance? I can't think of any other reason why you'd institute pill counts for something like Vistaril otherwise.

 

[milesed]

Yes, he was caught. Had to go through an education program. I wouldn't have known about it except for the public documents on the board of medicine site.

What state was this in?

Jezz, that's getting off lightly. In the 2 states where I've worked he would have at least had his license suspended if not removed.