The National Center for Disease Control and Prevention (CDC) published their "Guideline for Prescribing Opioids For Chronic Pain, United States 2016″ on March 18. In it was a statement of discouragement of urine testing for THC, the psychoactive component of marijuana, and a warning against terminating treatment of patients for having positive results on urine drug tests.
Although the CDC's Guideleines and Factsheet advises physicians involved in opioid therapies to continue using urine testing for "to identify prescribed substances and undisclosed use," the document itself advises a cautious approach to urine testing from both a reliability and a financial standpoint.
Patients are sometimes removed from pain management because of a positive drug test for THC, and that is a problem recognized by the CDC in the 2016 publication. "Urine drug testing results can be subject to misinterpretation and might sometimes be associated with practices that might harm patients (e.g., stigmatization, inappropriate termination from care)."
This screening process is big business. Per the CDC report: " Limited information was found on costs of strategies to decrease risks associated with opioid therapy; however, urine drug testing, including screening and confirmatory tests, has been estimated to cost $211-$363 per test."
Further research is needed to determine the "the cost feasibility and cost-effectiveness of recommended actions, such as use of nonpharmacologic therapy and urine drug testing."
As a result of expense, lack of reliability and other factors, the CDC recommends reducing the frequency and nature of urine drug tests. Only ask for what you really need to know.
"Clinicians should not test for substances for which results would not affect patient management or for which implications for patient management are unclear," the CDC stated. "For example, experts noted that there might be uncertainty about the clinical implications of a positive urine drug test for tetrahyrdocannabinol (THC). In addition, restricting confirmatory testing to situations and substances for which results can reasonably be expected to affect patient management can reduce costs of urine drug testing..."
Dropping patients from treatment programs because of cannabis only makes the situation worse for the patient. "Clinicians should not dismiss patients from care based on a urine drug test result because this could constitute patient abandonment and could have adverse consequences for patient safety, potentially including the patient obtaining opioids from alternative sources and the clinician missing opportunities to facilitate treatment for substance use disorder," the CDC wrote.
As Pat Anson, Editor of Pain News Networks, said, so-called ""point-of care" (POC) urine drug tests, the kind widely used in doctor's offices, frequently giving false positive or false negative results for drugs like marijuana, oxycodone and methadone. One study found that 21% of POC tests for marijuana produced a false positive result. The test was also wrong 21% of the time when marijuana is not detected in a urine sample.
Not mentioned in the CDC guidelines is evidence that opioid overdose rates declined by nearly 25 percent in states where medical marijuana was legalized."
Anson references a letter written by Sen. Elizabeth Warren to the CDC suggesting that the drug agency consider the impact medical and legalized marijuana could have as a solution to the opioid death epidemic.
Source: The Compassion Chronicles