The Stress of Being Drug Tested by My Own Doctor
/By Crystal Lindell
I went for one of my regularly scheduled appointments with my primary care physician yesterday, and as soon as I got there the nurse plopped a urine sample cup and a new drug contract on the table.
I had not been drug tested in a while, and actually started to wonder if they had seen the light and stopped doing them. Alas, that was not the case.
Drug testing causes stress and anxiety for patients, even when we’re doing everything right. It also erodes the patient-provider relationship and makes it harder to be completely honest with them about our substance use.
And then they also have the audacity to bill you for the privilege!
The whole thing gives criminal probation vibes so strong, I half expected a police officer to show up and watch me pee.
They also don’t tell you in advance what they are even testing for – or how the results might affect your care. Like, will they immediately cut you off if you test positive for kratom? Are they even testing for kratom?
What happens if you get a false positive? Do you get another chance to take a drug test? And who pays for it?
Asking anything like that in advance only makes you sound super suspicious.
Mostly they want to make sure you are taking the drugs you are prescribed, but beyond that you have to hope you haven’t accidentally taken anything that could make you fail, like poppy seeds.
Thankfully, I passed. And when the results showed up in MyChart, I saw that they did not test for kratom.
In addition to testing for stimulants and opioids, they also tested for naloxone and naltrexone – which was strange. Naloxone is used to reverse opioid overdoses, while naltrexone is primarily used to treat alcohol and opioid use disorders.
It seems odd that they would check to see if either drug was in my urine, and I have no idea how my doctor would respond if they had turned up positive. Would he think I was having issues managing my opioid use? Or perhaps hiding an overdose from him? I really don’t know.
But peeing in the cup is only half the stress. They also have a new patient contract I had to sign, which lists 21 specific conditions for my treatment to continue.
No. 14 reads in part: “I will not ask for early refills. I understand that lost or stolen prescriptions will not be replaced.”
It ends with, “I will report stolen medicines right away to my clinician and to the police. This report does not mean that my stolen medicine(s) will be replaced.”
I was surprised to see that stolen prescriptions might not be replaced. Even with a police report?
That’s very disheartening to read, especially since I recently had my cell phone stolen, so I know how easy it is for a theft to occur.
No. 14 also includes a demand that I keep "my controlled medicines in a safe and secure place, such as a locked cabinet or safe."
No. 18 gives them permission to conduct pill counts: “I authorize my clinician to order counts of my controlled medicines to check that I am taking them properly. I agree to bring in my medicines in their original containers to be counted.”
What if I get robbed on the way to the doctor? What then? I’m just completely screwed for the rest of the month? Am I supposed to travel with my locked cabinet or safe in this hypothetical situation?
Then there’s No. 11, which reads: "I may not use emergency or urgent care visits to get more controlled medicine for my chronic pain. If I do, my clinician may decide to stop prescribing controlled medicines."
Early on in my chronic pain journey, I would often have horrible breakthrough pain that was only resolved when I went to the emergency room. They would give me a shot of Dilaudid to get the pain back under control.
Apparently, I’m no longer allowed to do that. It’s not a huge issue for me these days because my pain is now well controlled and I have learned lots of ways to manage it. But my heart goes out to other pain sufferers who may not be so lucky.
The contract also specifies in No. 8 that, "I will get my controlled medicines from one pharmacy."
God forbid there’s a drug shortage or the pharmacist tells me they’re out-of-stock, an all too common experience. I can’t go to another pharmacy?
I have been with my primary care physician for over a decade now, and we have a relatively strong relationship. So if I ever actually needed exceptions to any of these rules, I would hope that he would be accommodating. But that's a lot of faith to put in a doctor, and it’s not something most patients can count on.
While I understand that opioid hysteria has led a lot of providers to respond with drug tests and patient contracts over the last few years, I think it’s time we got rid of them.
If you actually want to know if your patient is using forbidden substances, or if they aren’t taking all of their prescribed medications, the best solution is the one nobody wants to do: Build a trust-based relationship with them so they feel comfortable telling you themselves!
As it stands, with urine drug screens and intimidating contracts that feel like criminal probation requirements, the only real result is that patients will see their doctors as cops. And everyone knows you never, ever talk to cops.
