Docs ask patients for random drug tests

LEWISTON — Need a prescription for pain pills?

Prescription drugs by the numbers:

1: Maine's ranking for opiate addiction, per capita.

50: Pharmacy robberies so far in Maine in 2012.

262: Newborns with opiate withdrawal symptoms in 2009, up from 13 in 2000.

2 million: Prescriptions for controlled substances written in Maine in 2011.

300,000: Fewer prescriptions for controlled substances written in Maine in 2011 from 2010.

You may be asked to pee in a cup.

In an effort to combat Maine's high rate of prescription drug addiction, doctors are asking patients to sign a controlled-substances agreement that, in part, allows the doctor to ask for a blood or urine sample at any time to ensure patients are taking their pills, rather than selling them, and are taking those pills only.

Patients who don't sign likely won't get prescriptions. And those who fail the test will have some explaining to do. 

"Everybody is under pressure to have policies that do everything they can to tighten up the prescribing of opiates," said Gordon Smith, executive vice president of the Maine Medical Association.

Maine has had a prescription drug problem for years. The state has the highest per-capita rate of opiate addiction in the nation, and more Mainers are seeking treatment for painkillers than for alcohol. The number of babies born with opiate withdrawal symptoms has skyrocketed. And this week Maine had its 50th pharmacy robbery of 2012, a crime that experts say is directly tied to prescription drug addiction. Maine had half that number of robberies in 2011; not long ago it had none.

State leaders and doctors have tried to do something about prescription drug abuse. Most recently, the state created the Prescription Monitoring Program, an electronic database that tracks every patient receiving a controlled substance prescription in Maine. Once a week, pharmacists upload into the system the names of patients getting controlled drugs. Doctors then can go into the database and see whether their patients have more prescriptions from more doctors than they should.

The state also has created a task force to address prescription drug abuse, and MaineCare is working to limit the number of painkiller prescriptions Medicaid patients can get.

The Maine Board of Licensure in Medicine and the Maine Board of Osteopathic Licensure took on the issue of prescription drug abuse as far back as the late 1990s. They created guidelines covering what was expected of their doctors when they wrote prescriptions for controlled substances.

In 2010, the boards reviewed and strengthened those guidelines, and three more licensing boards — for dentists, nurses and podiatrists — signed on. Since then, more medical practices and hospitals have followed that guidance.

The guidelines recommend, in part, that doctors create a controlled substances contract or agreement with their patients at high risk for substance abuse or with a history of addiction. The guidelines provide no template for such a contract, but they do suggest including 14 terms, such as:

* The doctor may call the police if illegal activity is suspected.

* The doctor's office may ask to count the patient's pills at any time.

* Patients may lose their prescriptions for violating the contract.

* The patient must submit to blood or urine tests if requested.

It's up to each medical practice and hospital to design its own contract, determine who must sign the agreement and decide what will happen if a patient refuses.

Central Maine Medical Center in Lewiston wants its doctors to get an agreement signed by all patients whose treatment continues "beyond a few prescriptions," unless it's for end-of-life care. The hospital leaves it up to individual doctors to decide whether to give out a prescription to a patient who won't sign. 

"I think, depending upon your level of comfort with the patient, you might or might not decide to proceed with prescribing," said Ned Claxton, medical staff president. "I think providers are somewhat more reluctant now to go ahead and prescribe."

Across the city, St. Mary's Regional Medical Center adopted an official policy this fall. It requires doctors to get agreements signed by all patients who receive three or more new or renewed prescriptions for controlled substances within six months. It calls the agreements voluntary for patients. However, those who don't sign won't get their prescriptions. 

"It's there to protect the patient and to protect our providers, both; to protect the community," St. Mary's spokeswoman Jennifer Radel said. "You don't want this patient to get addicted to a prescription drug. The doctors wouldn't be doing their job if that were the case. We're doing what we can to prevent it."

In general in Maine, patients or their insurers must pay for any drug test ordered.

Many people involved in medicine and substance-abuse prevention like the shift toward controlled-substance agreements. Michael Kelley, chief medical officer of behavioral health at St. Mary's, believes such agreements help separate narcotics from other prescriptions.

"It re-emphasizes the fact that these are serious medications that actually have a strong addiction potential," he said. "I actually want my patients to be a little scared of these medications."

Smith, at the Maine Medical Association, believes the contracts and drug-testing stipulation can help start potentially uncomfortable conversations between doctors and patients about addiction.

"These are good doctors," he said. "But they're trained to believe their patients. I can show you case after case where I, as a lay person, go through the medical record and say, 'What a red flag, and you didn't react to that?' And it's just because they've got 30 patients in front of them a day and they're just trying to do the best they can and some of them have unfortunately not paid as much attention to this and the risks. They've erred in favor of believing their patient in the face of all evidence to the contrary."  

But some patients chafe at the idea of drug-testing and feel mistrusted by their doctors. Guy Cousins, director of the Maine Office of Substance Abuse, has heard from some of them. He equates random drug-screening to a medical test. 

"There are so many chronic conditions out there that, because of the medication that you're on, you have to have lab tests done, you have to have liver function tests done," he said. "These are just kind of like normal medical procedures that help ensure that the care that's being instituted is done in a way that looks out for the person's best interest."

It's unclear how often patients are drug tested by their doctors or how many are being tested in Maine.

"It depends on the patient and the medication that's being given," Kelley said of St. Mary's. "Certainly, some medications are far more abuseable than others. So I think doctors prescribing, say, OxyContin, which has got a massive street value, tend to test a little bit more often than something lower, like codeine. And of course patients have vulnerabilities. So if you've got a patient with three relatives with heavy substance abuse, you're going to be a little more cautious."

It's also unclear whether controlled-substances agreements and random drug tests are doing any good. Maine's addiction numbers remain high, as do the number of babies born with prescription opiates in their systems.

But Smith said the state's Prescription Monitoring Program shows that doctors wrote about 300,000 fewer narcotics prescriptions in 2011, the first time he's seen a decline. The number still hovers around 2 million, he said.

Smith called the agreements "one essential element" in an overall plan to address addiction in Maine.

"I believe it's getting better," he said. "I think there's a lot of attention being focused on it."

ltice@sunjournal.com

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Comments

Wendi Ward's picture

They are talking about pain

They are talking about pain medication contracts like ther are something new. I signed one after I was 2 head on collisions in a week, that was over 8 yrs ago. I really think it is for the sake of the drs. not the patients. I am aware of maines prescription drug problems, but signing these contracts isn't working. While I was under contract I fell and broke several ribs and puctured a lung was taken to the ER and admitted, the ER doctor sent a report to my PCP and since I was given morphine in the hospital my contract was broken amd she refused to fill the prescription! I no longer require narcotics to relive my pain thankfully. What really scares me is that people won't be getting the medication they need, because drs. Are too scared to prescribe them.

Wilma Turcotte's picture

Drugs

Its high time something is done and not stopped because someone believes they are "being discriminated against". There is always some idiot who is gonna say its a good idea to do but not for them and that they are being singled out. No one in their right mind wants to be hooked on any drug and they better start looking into these drs. that keep writing the prescriptions. I can't even get a prescription to far ahead to save me a trip cause the pharmacist will say "its to early to refill" If someone is taking anything that they end up getting hooked on then someone ain't doing their job. You have to pass a drug test in order to get some jobs so if you don't want to be tested then you got something to hide. Its the same with ID's. If you got one why would you be against showing it. To me its a dead giveaway if you refuse. Your not being singled out. GET IT?

Diana Currier's picture

;

it is costing 700.00 per test, those on mainecare too. I can't see THAT part.

Robert McQueeney's picture

That is a boondoggle

I am hard pressed to believe regular blood or urine testing is going to actually cost that much. Sure, it they are testing for every imaginable substance on the planet. How about a little commonsense on the testing and costs associated with it. Test for the drugs readily available in the area. If it is to confirm a patient is taking their particular drug, they only need to test for that one drug, as well as screen for commonly abused drugs.

I am certain that people smarter than me can work out some way to bring testing costs in line.

Lorraine Burnham's picture

prescription meds

I THINK ITS ABOUT TIME SOMETHING LIKE THIS WAS DONE. I AM ALL FOR IT.

Robert McQueeney's picture

It happens too often

I am all to aware of people who get their meds (thru government programs, no less) who sell half of them off. It's not too different than folks who would sell half their food stamps for 50 cents on the dollar. Then they'd use the money for... other things, who knows.

I see nothing wrong with a doctor monitoring how his/her patients are responding the meds he is prescribing, making sure they are taking the prescribed amounts and monitoring their effects. Sadly, due to the black market on these meds, many of them are not getting into the body of those who are supposed to be taking them.

FRANK EARLEY's picture

It can't always be a nice neat little package......

I always love reading these articles, I find myself asking, who is trying to convince who of what?
First, I wish these articles would use the correct terminology. A person can become addicted to medications. A person can become dependent on a medication. A person may on occasion build up a resistance, or tolerance to a medication. These terms are everyday parts of my vocabulary. When does "addiction" differ from "dependance"? What is the difference between the two? there is a difference. Unfortunately news stories don't sell if someone is dependent on a medication, It sells if their addicted to a drug.
I know that prescription drug abuse is out of control. I also realize the importance of responsibility for both the patient and doctor. A patient needs to be honest and accurate when talking to the doctor. In return the doctor is able to properly and accurately treat the patient. That's not always as easy as it sounds. I've been dependent on numerous medications over the years. I just finished a three month weening process to switch medications. This isn't the first time and it won't be my last. I have a incurable degenerative disease. One that causes many side affects as well as severe chronic pain. The word " incurable ", means I have it for life, and it isn't going to get better. These stories rarely mention people like me. Yet I still suffer the same accusatory remarks from people who put me in a group that includes every person who ever received pain medication. I take several strong medications now, they all do their job. One thing I have learned from experience is, they will stop working some day. It may be next week it may be five years from now. At that time I will be dependent on it. Something a lot of people don't realize is, you can take a medication for years. All of a sudden it stops working, absolutely no relief. Even though you get no therapeutic help at all. Your body is still dependent on it. You still need to go thru the process of withdrawing all over again. Withdrawal could be considered one of the side affects of my disease.
That's my life, it ain't easy, and certainly isn't fun. I just don't want to be grouped together with the addicts, and drug abusers out there. I guess sometimes its just easier to put everyone into one nice neat little package. It just makes everything so much easier.....

Licia Kuenning's picture

Oh, good grief

The government should stop asking doctors to do their dirty work for them.

And doctors should stop telling patients that the impositions are for "your own protection," when they are for the doctor's protection.

DANNY FITZSIMMONS's picture

test

ya they ask you for a pee test yeah then they hit you with a 500.00 bill for the test (which you can go to the store get the test kit for 20.00). they yap and yap about this stuff and all the things the patient does but not that it costs 20.00 for an penny asprin in the hospital. or that a drug brought here can cost 500% more than the same brought overseas made by the same manufactuer, or blood tests which take a person hardly any real time put into a machine for a min. or two then are given results I had one that they wanted a thousand dollars for, did research found that it took 15min of thier time to feed the sample in the machine get results then sent them to the doctor, they cry bloody murder about the costs of mainecare and try to get those in real need off it yet they dont complain about the costs of care WHY?....... WE DONT PAY OFF THE POLITICIANS THE MEDICAL SYNDICATE DOES!

Diana Currier's picture

try

700.00 a bill...

Diana Currier's picture

.

Someone is lying here somewhere, this has been going on for a LONG time now. The signing contracts, I know quite a few people that have been on this contract now FOR YEARS ! So as long as your on the contract they will kill you with the pills legally ! BS! Who is trying to cover for who now? The meth clinics need to go TOO. It's too long of a story to get into, but if a hard working person can't get a pain pill, the druggies don't need their fix either! And Maine care pays for all that crap. I pay for my meds myself! So GO FOR IT DOC'S kill em all legally !! ERRRR

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