Medical providers and patients alike cringe when a urine drug test result comes back with an unanticipated result. Imagine this common scenario (or recall if you lived this) of a patient that is prescribed the following:
hydrocodone 20mg/day [classified as an opiate]
buprenorphine transdermal patch (Butrans Patch) 20mg weekly [classified as an opiate]
Alprazolam (Xanax) 0.5mg three times daily [classified as a benzodiazepine]
Venlafaxine, (Effexor) 225mg every morning [classified as an antidepressant with potential pain-relieving properties]
Results are in!
Patient is negative for opiates, presumably not taking hydrocodone or buprenorphone.
Patient is negative for benzodiazepines, presumably not taking their alprazolam.
You are positive for PCP (an illegal hallucinogen), presumably using street drugs.
You are positive for cannabinoids, presumably ingesting marijuana.
Looks pretty bad right? How do you think the prescriber feels? Pretty annoyed? Potentially liable? In the eyes of many, the patient is not taking the prescribed drug, and if that isn’t bad enough, the patient is taking illegal drugs (PCP) and smoking pot (positive cannabinoids). OMG as they say!
Or is it not what it seems? How do you think the honest patient feels? Falsely accused of wrongdoing by a person they confided in to care for them – the same person with whom they shared their innermost personal thoughts and private medical problems. Then a letter comes in the mail discharging the patient from the medical practice. Where does the patient go? The next person prescribing the medication will likely, and rightfully so, insist on previous medical records. Might this patient end up on the streets buying heroin or black market prescription drugs to avoid writhing in pain? Perhaps.
What a quagmire! And all the while everyone was truthful, at least in this case. It was an unfortunate consequence of misunderstanding, inadequate training, stubborn cost-driven insurance carriers that refuse payment for more accurate chromatographic testing, and an unsuspecting, perhaps even bewildered patient that quite honestly is shocked beyond comprehension.
- After experiencing the inadequacies of UDT by immunoassay, as a professional, year after year;
- After hearing the same or similar stories over and over again;
- After seeing honest well-meaning medical providers being spoofed by dishonest patients;
- After learning of honest patients becoming depressed, angered and in pain;
- And, after answering questions and trying to help people nationwide 24/7, I decided;
- Enough is enough!
It’s about time somebody did something about it.
And so I did…
With the help of two very qualified IT colleagues, I envisioned and laid out the platform for a new, one-of-a-kind urine drug test app (UDTapp) that could help clinicians and patients. The UDTapp was specifically developed as an informational tool to aid medical professionals and clinical/laboratory chemists. Final analysis and recommendations should be evaluated for each individual patient and use of the information for final patient care decisions must be carefully weighed by the treating clinician and should be discussed with the patient before implementing actionable medication changes and/or requiring alternative or additional therapeutic changes or recommendations.
The UDTapp is not intended for punitive action against any patient, but instead to educate and assist clinicians in the appropriate thought process for evaluating and interpreting urine drug screen reports, determining medication compliance, and for selecting more appropriate medications based on individual patient conditions.
Now let’s get back to our original example. If the UDT immunoassay screen results above are entered into the phone/PC app, below are screen shots of what you would learn by the recommendations…
In summary, hydrocodone is a synthetic opioid for which the dose was too low to cause a positive opiate screen by immunoassay (IA) urine testing. The same is true for buprenorphine. Had the “opiate” or buprenorphine screen been positive, the recommendation would have advised that the patient was probably taking a higher dose hydrocodone and buprenorphine than prescribed and/or another opiate. Alprazolam (Xanax) goes through a unique metabolic pathway that precludes it from being picked up on a benzodiazepine screen by IA, so the expectation is a negative result. Venlafaxine was prescribed which causes a false positive PCP screen. The patient was taking omeprazole for their stomach which causes a false positive cannabinoid test. Bottom line: No foul play!
Applicability, education, and good will is also extended to the third party payers who are “frugal” about paying for definitive urine testing by chromatography which is more expensive than the commonly used in-office urine drug screens (or quick send-outs) by IA, the latter of which by comparison to chromatography are inexpensive. How can the UDTapp help here? It could save time for clinicians who are banging their heads against the wall trying to justify the confirmative test to insurance payers to show their patient is innocent; to deny drugs because their patient is in fact guilty of foul play; and to reduce liability. Equally important is that insurance payers can see a clear explanation (or at least the dilemma faced by the clinician) and why it is imperative that they pay for the test. In the end, for those patients that are abusing the system, payment for drugs no longer prescribed because of confirmed noncompliance, substance abuse, or diversion is actually beneficial for all. And believe me, a year’s worth of diverted OxyContin and morphine costs a lot more money than a definitive test panel by chromatography – seems like a bargain really.
Who wins? Everybody.
The insurance company saves money because they shouldn’t have to pay for drugs that are being abused or diverted.
The addicted patient should be referred to a substance abuse program for help.
The person diverting should be reported to appropriate legal authorities.
The prescribing clinician should feel more confident about making fair decisions regarding therapy.
The honest patient is more likely to be treated fairly and with respect, and definitive testing will only be ordered when indicated.
UDTapp by REMITGATE, LLC, will be available April 4, 2015. click HERE.
PATIENTS & PROVIDERS:
Please comment or tell about your UDT disaster here in anticipation of launch day! I want to be certain that patients and providers are aware of the availability and applicability of this important tool.