How to spot a drug seeker

“Chronic pain” patients need to have a urinalysis from time to time too. You may discover a negative screen, *no narcotics detected* since they’re selling drugs instead of using them.

“Chronic pain” patients need to have a urinalysis from time to time too. You may discover a negative screen, *no narcotics detected* since they’re selling drugs instead of using them.”

Just because a patient has a false positive or false negative result does *not* mean they are not taking their meds or abusing them, let alone diverting them. A suspect result on a urinalysis test is *not* prima facie evidence of diversion.

Particularly with urinalysis, the potential for a false negative is high, because the urine may be too dilute depending on the patient’s intake of fluids, or the threshold of detection of the test may be set too high. The threshold for most urinalysis tests is usually set high enough to avoid false positives for things like eating poppy seeds, but at that level someone taking a low dose narcotic on a prn basis is very likely to get a false negative unless he took the drug within hours of taking the test and even then, may still get a false reading. So if you prescribe 30 5mg Vicodin a month and expect to consistently get a positive reading from a $1 a pop urinalysis, maybe the problem is you, and not the patient. Any suspect reading should be followed up by a blood test which is far more accurate and reliable than urinalysis.

http://www.cpmission.com/main/Fblood.html

Once the decision has been made to withhold pain medication from a chronic pain patient based on your ignorance of drug testing, be sure to discuss other treatment options for your patient’s pain, many of which are actually more effective at relieving pain then narcotics. These include, but are not limited to:

1. Shotgun
2. Revolver
3. Falling from a high place
4. Ingesting poisonous substance
5. Standing in front of a moving train

Be sure to discuss the pros and cons of these options with the patient, and remind the patient of his legal and moral obligation to make arrangements for paying his bill before exercising any of these options.