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Urine Drug Screening (March 5, 2014)

I believe that we can all agree that over the last decade, prescription of opioid medications has been on the rise due to a variety of factors – not the least of which is the threat of regulatory sanction for inadequately addressing complaints of pain by patients. However, here are some alarming facts regarding opioid use in workers’ compensation:

  • Narcotics are the #1 cost driver in the workers’ comp industry accounting for 34% of medication expenses
  • 70% of workers’ compensation claimants on chronic opioids are not taking their medications as prescribed
  • Utilization Rate for Medical Services is 8x Higher when opioids are in the mix
  • In 2000, 4 Million Americans used prescription medication for non-medical reasons (Fudin et al. 2003)
  • Opioid overdose deaths 2007: 11,499 (42% of total unintentional drug overdoses in US)

Evidence-based guidelines have developed some criterion for random urine drug screening (UDS) to help the prescriber properly manage and assess patient compliance with their prescription protocol. But some providers and laboratories seem to have identified these recommendations as a revenue generator for their practices rather than its intended purpose. {Claims Eval is aware of a laboratory that is contacting providers, is selling a UDS kit at below cost, and in return simply requests that the sample be sent to their laboratory for confirmatory testing. Claims Eval was (we are not aware whether the practice continues currently) also aware of another laboratory that offered a free phlebotomist to perform blood draws in the provider’s office rather than UDS.}

ACOEM recommends random UDS  2-4 times per year. The Official Disability Guidelines offer more explicit recommendations. First, they recommend a risk profile assessment before initiating opioid therapy. Based upon the results of that risk profile, the proposed frequency is set:

  • Low risk: screen at 6 mos and annually thereafter
  • Moderate risk: screen 2-3 times/year
  • High risk: as often as monthly

Claims Eval assisted one of its clients by performing a random audit of UDS charges. This audit found that 90% of the submitted charges were not medically necessary. Providers were routinely screening for 20-30 reagents for initial screening, followed by confirmatory testing on all of those reagents – regardless of the initial results. ODG also only recommends confirmatory testing of inconsistent results. As a result of discussions with our clients – coupled with our audit results, you will see UDS decisions being written to comply with evidence-based guidelines, certifying a random 10 panel screen with confirmatory testing of inconsistent results only. Frequency of testing will be dictated by the risk profile as well as the documentation of notation of aberrancies.

Should you have questions or concerns, please do not hesitate to contact Dr. Hamby or Dr. Richardson.

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Claims Eval