Drug testing ALL patients!

[Jesse]

Important news! A task force of the US Dept. of Health and Human Services has just issued a recommendation that ALL patients over the age of 18 be drug tested for illicit or non-medical use of prescription drugs prior to receiving ANY medical services (specifically, any time diagnosis, treatment, or preventative care may be offered or referred---in other words, ANY medical services).

This is a public health disaster waiting to happen. It's bad enough they're persecuting pain patients to the point of suicide, but now patients who may badly need medical treatment are going to avoid the doctor's office if they've so much as smoked pot on the weekend. We can expect to see preventative care plummet, leading to increases in everything from cancer to diabetes and heart disease.

To make matters worse, these quick-drop urine tests are NOT consistently accurate, as many pain patients can attest after being abandoned by their doctors because they tested positive for a drug they never took. There's nothing in the proposal requiring doctors to conduct follow-up lab tests, which are far more accurate. To be fair, the proposal does not require that doctors deny treatment on the basis of the results, but how easy do you think it will be to get treatment when it goes in your permanent record that you tested positive for a drug that you may or may not have ever even SEEN in your life??

YOU CAN HELP! The proposal is currently open for public comment. Tell them to abandon this insanity before patients avoid life-saving treatment simply because they smoked a joint over the weekend! You can leave public comment by copying this link into your browser and removing the spaces. I purposely have not linked so that they don't get hits from this forum. You don't even have to think up any fancy wording. It's enough to simply click the option telling them NOT to adopt this proposal.

https://www.uspreventiveservicestaskforce.org/    Page/Document/   draft-recommendation-statement/drug-use-in-adolescents-and-adults-including-pregnant-women-screening

 

[DoomKitty]

The "sceening" they are recommending is adding a question to pre-existing screening tools.  Not saying people shouldn't comment to them their thoughts (nor am i saying doctors wont abuse this and false-positive peoples screening and drug test them anyways) but the recommendation is NOT to blanket drug test everyone prior to any medical assistance.  Again, obviously this can be abused, but also mandatory drug testing is already common proctice in many medical situations.  Here is the pertinent part of their statement:

Primary care practices may consider several factors when selecting screening tools. Brief tools (e.g., the six-question BSTAD [Brief Screener for Tobacco, Alcohol, and Other Drugs]), may be more feasible in busy primary care settings, but longer tools (e.g., the eight-item ASSIST [Alcohol, Smoking and Substance Involvement Screening Test] risk assessment–based tool) that assess risks associated with illicit drug use or comorbid conditions may reveal information signaling the need for prompt diagnostic assessment. Tools with questions on nonmedical use of prescription drugs (e.g., TAPS [Tobacco, Alcohol, Prescription Medication, and Other Substance Use]) may be useful when clinicians are concerned about prescription misuse. One study reported that the PRO (Prenatal Risk Overview) risk assessment tool was reasonably accurate for detecting drug abuse or dependence in pregnant women. Some tools that indirectly estimate a patient’s illicit drug use (by asking about the patient’s alcohol or tobacco use or a partner’s illicit drug use) may be useful when clinicians are concerned about patient underreporting of illicit drug use.12

Screening tools are not meant to diagnose drug dependence, abuse, addiction, or use disorders. Patients with positive screening results may therefore need to be offered or referred for diagnostic assessment.

 

[Jesse]

The "sceening" they are recommending is adding a question to pre-existing screening tools.  Not saying people shouldn't comment to them their thoughts (nor am i saying doctors wont abuse this and false-positive peoples screening and drug test them anyways) but the recommendation is NOT to blanket drug test everyone prior to any medical assistance.  Again, obviously this can be abused, but also mandatory drug testing is already common proctice in many medical situations.  Here is the pertinent part of their statement:

True, and my cynical wording was imprecise. The proposal doesn't really impose anything (e.g., it doesn't require doctors to not treat illicit drug users; it doesn't even require that doctors not treat illicit drug users with opioids). But we saw what happened with the CDC opioid guidelines. The guidelines didn't SAY anything even close to: "Don't give painkillers even to dying cancer patients" or "Insurance companies must limit the number of controlled prescriptions they will fill" or "Post-op patients should only be given Tylenol"----but all of those things are now happening on a widespread basis, with the guidelines cited as the reason. To the point where even the CDC has admitted the guidelines are being taken too far.

Basically, when it comes to controlled prescriptions, especially opioids, I think we can safely assume policies will be taken to their most extreme and draconian conclusions. I fully expect if this is implemented, clinics will be piss testing patients all the damn time. It'll get sold to them as a "liability" issue....that they can't really TRUST patients to tell them the truth....so if a patient dies and they didn't test, they'll be responsible, etc., etc. And pretty soon they'll be piss testing before every check-up.

I hope I'm wrong! But they already ASK now, at least at intake, whether you smoke, drink, or use illicit drugs. And all of these tools that are mentioned rely on patients truthfully self-reporting. If they don't trust us to tell the truth now---and, frankly, I've come to treat doctor appointments like getting pulled over: Answer only what I have to and never confess to anything they don't already know---then why would these "tools" help them ferret out illicit/non-prescription drug users? The only real solution is to go to all-piss-tests-all-the-time. 

 

[DoomKitty]

I totally agree with your anxieties and frustrations, i just wanted to clarify what the proposal was actually saying instead of an imminent doom situation.....Anyways, thanks for bringing this to peoples attention and sorry if i detracted from the potential scariness of this recommendation....

 

[Jesse]

I totally agree with your anxieties and frustrations, i just wanted to clarify what the proposal was actually saying instead of an imminent doom situation.....Anyways, thanks for bringing this to peoples attention and sorry if i detracted from the potential scariness of this recommendation....

No, no, you're totally right! Accuracy is important, and I asked people to take action on something without explaining it accurately. Thank you for the correction, so people who do respond can get it right!

One friend of mine, who has medical expertise, sent them a comment and then sent me a copy of his comment. He outlined the problems with the screening tools they suggest, the BSTAD, ASSIST, TAPS, and PRO. I wasn't familiar with any of them. For example, they assume that tobacco smokers are more likely to use illicit/non-prescribed drugs, but there's no evidence that's true. (Even on its face, it's not a logical surmise, but one based more on negative stereotypes about cigarette smokers. Wanna bet they've extended that to their new demon, vaping, now, too?)

In addition, these tools confuse addiction with tolerance and dependence, and the "PRO" treats pregnant women like, if they aren't doing absolutely everything 100% "right" for a healthy pregnancy, then they're more likely to be using illicit/non-prescribed drugs, and there's no evidence that's true either. Nor does it pass the smell test on its face. The most common reason a pregnant woman doesn't do everything 100% "right" for a healthy pregnancy, such as eating aggressively nutritious foods and attending all her pre-natal doctor visits, is because she's poor.

These tools are not well studied. They've shown SOME ability to predict illicit drug use, but not nearly enough to gamble people's medical care on them. I'm not even clear from the proposal what happens if I fail this alphabet soup of tests. "Patients with positive screening results may therefore need to be offered or referred for diagnostic assessment." Does that mean they send me to a drug counselor for assessment? What if my insurance won't pay for that? Many policies don't. What if I'm telling the truth and I actually DON'T use illicit/non-prescribed drugs, but the tool insists that I'm lying? If I'm a pregnant woman, are they going to call CPS? In most or all states, using illicit drugs during pregnancy is cause to have the baby taken straight into custody off the delivery table.

The really sad part is I don't even think these are extreme or paranoid questions. The medical system seems to have forgotten that we're fully functional adults who have a right to self-determination about our bodies. If my doctor can't just ASK ME what I'm taking and expect an honest answer, then maybe the problem is that the doctor hasn't earned my trust. I used to be one of those people who never, ever, lied to a doctor. That was before the War-on-Opioids turned the medical system into a paternalistic, quasi-correctional system. If the doctor's going to act like a parole officer, then I'm going to act like a parolee in order to survive and get my needs met.

If they aren't piss-testing every patient within a couple of years, I'll eat my hat. I don't see how this can end any other way.