UTS Companies

[101N]

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Hi:

I'd like to get some recommendations on UTS companies. I've used Ameritox and Millenium. If you have experience - good or bad - with a big national provider of UTS I'd appreciate hearing about it. Thanks.

 

[RUOkie]

Sorry, I send them all out to a reference lab down the street who does detailed urine/serum testing. I get actual blood levels of all identified suubstances. I cannot have my office hassled with the chain of custody crap.

 

[101N]

Sorry, I send them all out to a reference lab down the street who does detailed urine/serum testing. I get actual blood levels of all identified suubstances. I cannot have my office hassled with the chain of custody crap.

You raise a good point about chain of custody. We don't do that. My understanding is that it's only necessary in an occ health setting. I'm thinking routine UTS for patients on COT. Chain of custody isn't mentioned in FSMB or any other 'pain' guidelines that I am aware of.

My thinking has always been that true random UTS, with temperature validity and Cr dilution testing, will eventually catch someone who is gaming the system. Adding the cost of chain of custody seems to me to be overkill.

 

[PMR 4 MSK]

Chain of custody is not important. Not giving the patient time to alter the sample is.

You tell a patient to go down the street to give a urine sample for drug testing. He shows up there 2 hours later. Why? He says, "We stopped for a burger" when he actually meant "I drank a 12 pack of coke to dilute the MJ outta my urine" or "I went home to get that frozen urine sample I keep in case of a job interview." Or he could have taken any one of a number of substances to obscure drug test results. Google "bladder cops" or "how to beat a drug test".

If the patient leaves your office for any reason after being asked to give a urine sample, they have a chance to alter the urine sample, even if they have not produced it yet.

 

[PMR2008]

What are some things you have seen people do to cheat on the UDS? Do you ever use hair or saliva testing?

Chain of custody is not important. Not giving the patient time to alter the sample is.

You tell a patient to go down the street to give a urine sample for drug testing. He shows up there 2 hours later. Why? He says, "We stopped for a burger" when he actually meant "I drank a 12 pack of coke to dilute the MJ outta my urine" or "I went home to get that frozen urine sample I keep in case of a job interview." Or he could have taken any one of a number of substances to obscure drug test results. Google "bladder cops" or "how to beat a drug test".

If the patient leaves your office for any reason after being asked to give a urine sample, they have a chance to alter the urine sample, even if they have not produced it yet.

 

[101N]

What are some things you have seen people do to cheat on the UDS? Do you ever use hair or saliva testing?

I occasionally use an 11 panel saliva test in urgent situations. It's not CLIA waived and I eat the cost ($10.00). But I've found it useful.

 

[RUOkie]

Chain of custody is not important. Not giving the patient time to alter the sample is.

You tell a patient to go down the street to give a urine sample for drug testing. He shows up there 2 hours later. Why? He says, "We stopped for a burger" when he actually meant "I drank a 12 pack of coke to dilute the MJ outta my urine" or "I went home to get that frozen urine sample I keep in case of a job interview." Or he could have taken any one of a number of substances to obscure drug test results. Google "bladder cops" or "how to beat a drug test".

If the patient leaves your office for any reason after being asked to give a urine sample, they have a chance to alter the urine sample, even if they have not produced it yet.

we tell them that they have to go straight there. If they do not, the lab calls us, and they are terminated.

Thus far, every patient I have terminated for violations have been because their tests come back with nothing (including what they are being prescribed). Diversion is the big issue here.

Oh, and I do a lot of occupational medicine. If I started doing UDS for my opiate patients, the companies would ask me to do it as well.

 

[101N]

If I started doing UDS for my opiate patients, the companies would ask me to do it as well.

?

 

[RUOkie]

?

they would want me to do the pre employment testing which requires chain of custody.

 

[101N]

they would want me to do the pre employment testing which requires chain of custody.

"They" need a talking to. As you know, we should all be performing random UTS on COT patients as it is standard of care. If your clinic administration is effectively preventing this with the unnecessary requirement of a cumbersome chain of custody demand then they need to be called out on the matter. It sounds to me like someone in Occ Health at your facility wants to keep the $ from UTS to themselves.

I would talk to one of the big national labs if I were you. COC isn't required for routine UTS for COT patients. However, UTS is another matter and if you are flying without it you are assuming a lot of risk.

 

[PMR 4 MSK]

What are some things you have seen people do to cheat on the UDS? Do you ever use hair or saliva testing?

Pour water into the cup and give it to us as urine.
Dilute their urine with water.
Drink lots of water or soda to dilute the urine.

As UDS requires a certain threshold of drug concentration, dilution can work.

Other things that they can do - take an oral supplement meant to hide MJ in the system.
Add a chemical to the urine to dissolve MJ metabolites and hide it.
Using a prosthetic penis attached to a urine sample tied to their leg. You can buy these on the internet in different colors.


There are the excuses - I just went to the bathroom before you asked me. I can't pee now.

One guy was a quad in a w/c. He said he doesn't urinate. I pointed out his leg bag. I asked if we could have a sample of that. When he reluctantly agreed, he wrote under that "SUD" when asked what that was he said "Signed under duress" I fired him then and there. I ran the sample anyway, and he was doing coke, MJ and amphetamines.

I tell anyone who claims not to be able to pee that we will offer them water, coffee or soda of their choice, and they can wait in the waiting room until they can urinate. They are told if they leave the waiting room for any reason, they will no longer receive opioids. Many leave anyway.

Another one, a paraplegic, did this routine, left, and then came back the next day with a urine sample in hand for me to test. It gave me a good laugh. He could not understand what was wrong with that idea.