Philosophy of Urine Drug Testing in Pain Management

To purchase multipanel urine drug tests click the link below -

http://www.wholesaledrugtesting.com/1/urine-drugs-of-abuse-tests.html

Philosophy of Urine Drug Testing in Pain Management

by Howard A. Heit, MD, FACP, FASAM

& Douglas L. Gourlay, MD, MSc, FRCPC, FASAM

Expert authors received compensation from Janssen Pharmaceuticals, Inc. for their contributions to PrescribeResponsibly.com

Urine drug testing (UDT) is a useful tool in pain management that provides valuable objective information to assist in diagnostic and therapeutic decision making.³⁶ Results of a UDT provide confirmation of the agreed-upon treatment plan (adherence/compliance). They can diagnose relapse or drug misuse as early as possible, and they also can be used to advocate for the patient with third-party interests.³⁷

To assess compliance, the healthcare professional may look for the presence of prescribed medications in the urine as evidence of their use. Finding no presence of the prescribed drug or finding unprescribed or illicit drugs in the urine merits further discussion with the patient. At the same time, it is important to recognize that laboratory error and test insensitivity can result in misleading data. Bingeing by the patient can result in unexpected negative urine reports if the patient runs out of medication prior to urine sample collection. Therefore, these results by themselves cannot be relied upon to prove drug diversion and may be consistent with addiction, pseudoaddiction, or the use of an opioid for nonpain purposes—so called chemical coping.³⁶

The purpose of UDT should be explained to the patient at the initial evaluation. UDT can also enhance the relationship between healthcare professionals and patients by providing documentation of adherence to mutually agreed-upon treatment plans.³⁶

In the pain management setting, the presence of an illicit or unprescribed drug does not necessarily negate the legitimacy of the patient’s pain complaints, but it may suggest a concurrent disorder such as drug abuse or addiction. The patient must be willing to accept assessment and treatment of both disorders to receive adequate outcomes in either. Thus, the diagnosis of a concurrent addictive disorder, when it exists, does nothing to negate a legitimate pain disorder; rather, it complicates it.³⁶

Specimen Choice

Urine has been the preferred biologic specimen for determining the presence or absence of most drugs. This is, in part, due to the increased window of detection of 1 to 3 days for most drugs and/or their metabolites.³⁶ Table 3

Whom to Test and Frequency of Testing

The question of whom to test is made easier by having a uniform practice policy either in a pain or primary practice that would help reduce individual stigma. Any risk of patient profiling based on racial, cultural, or other physical appearances is eliminated. Careful explanation of the purpose of testing normally allays patient concerns.³⁶

Healthcare professionals sometime find the subject of drug testing a difficult one to explore with their patients, especially those who have been in the practice for many years. Often, a healthcare professional's perception is that requesting a urine sample for drug testing may be seen as mistrusting the patient and, consequently, potentially damaging to the healthcare professional-patient relationship. In fact, when approached in a respectful, patient-centered fashion, most patients are more than willing to do their part in managing risk in order to receive the care that they need.

Testing Strategies

The healthcare professional must know the drugs for which to test, appropriate methods to use, and the expected use of the results obtained.³⁶Immunoassay drug tests are most commonly used. They are designed to classify substances as either present or absent and are generally highly sensitive. In pain management, specific drug identification using more sophisticated identification tests is needed.³⁶ Techniques such as Gas Chromatography/Mass Spectroscopy (GC/MS) and High Performance Liquid Chromatography (HPLC) are used for the identification of a specific drug and/or its metabolites.³⁶

Immunoassay drug tests for natural opiates are very responsive to morphine and codeine, but do not distinguish between the two. UDT by immunoassay also shows a low sensitivity for semisynthetic/synthetic opioids such as oxycodone and fentanyl.³⁶ Even though an immunoassay may be negative for consumed oxycodone, it should be positive on GC/MS if the drug was used within the window of detection. The clinical importance of this fact with UDT cannot be overstated, because compliant patients may have been dismissed from pain management practices secondary to a false-negative immunoassay test when looking specifically for prescribed oxycodone.³⁶Specific drug identification by chromatographic testing (ie, GC/MS) also is necessary to identify which member of the detected class is responsible for the positive screen.³⁶ Drug-specific immunoassays presently on the market and under development will identify semisynthetic/synthetic opioids.³⁷ The healthcare professional should always know the limits of the UDT ordered.³⁷

A routine UDT screening panel suggested for the following drugs/drug classes is listed in Table 4.³⁶

Healthcare professionals also must understand the basic metabolism of commonly prescribed drugs, especially opioids, so they will be able to explain a UDT result that is positive for the prescribed medication and/or its metabolite(s). Figure 1³⁷

Dealing With Unexpected Urine Toxicology Results

UDT in clinical practice must be used to improve patient care. Unfortunately, these test results may come back unexpectedly negative for a prescribed drug or positive for an unprescribed one. The first step in interpreting these results is to contact the lab to ensure that no clerical errors have been made.³⁷ If unexpected results are confirmed, there must be a process in place that should include discussing the unexpected result with the patient.³⁶

Conclusion

UDT is an effective tool in the assessment and ongoing management of patients who will be, or are being, treated chronically with controlled substances. Most importantly, a healthcare professional should have a relationship of mutual honesty and trust with the patient when using UDT in the clinical practice, as well as maintain open communication with the testing laboratory. The use of UDT should be consensual; it is designed to improve patient care and to assist the healthcare professional to advocate on the patient’s behalf.³⁶

TABLE 3: Windows of Detection in Urine Drug Testing³⁶

Drug	Approximate Retention Time
Amphetamines	48 hours
Barbiturates	Short acting (eg, secobarbital): 24 hours Long acting (eg, phenobarbital): 2-3 weeks
Benzodiazepines	3 days, if therapeutic dose is ingested Up to 4-6 weeks after extended dosage (ie, 1 or more years)
Cocaine Metabolite	2-4 days
Ethanol	2-4 hours
Methadone	Approximately 3 days
Opiates	2 days
Propoxyphene	6-48 hours
Cannabinoids	Moderate smoker (4 times/week): 5 days Heavy smoker (smoking daily): 10 days Retention time for chronic smokers may be 20-28 days
Phencyclidine	Approximately 8 days Chronic users: up to 30 days  (mean value = 14 days)

Note: Interpretation of retention time must take into account variability of urine specimens, drug metabolism and half-life, patient's physical condition, fluid intake, and method and frequency of ingestion. These are general guidelines only.

TABLE 4: Suggested Screening Panel³⁶

A routine UDT screening panel should test for the following drugs/drug classes:

• Cocaine
• Amphetamines/Methamphetamine
• Opioids
• Methadone
• Marijuana
• Benzodiazepines

FIGURE 1. Metabolism of Opioids³⁷

Permission use granted by Dr. Howard Heit and Dr. Douglas Gourlay.

References Used in the Section:

• 36Heit HA, Gourlay DL. Urine Drug Testing in Pain Medicine. The Journal of Pain and Symptom Management. 2004; 27(3):260-267.
• 37Gourlay D, Heit H, Caplan Y. Urine Drug Testing in Primary Care: dispelling the myths & designing strategies. Monograph for California Academy of Family Physicians. 2006.

Thank You,

What is Peripheral Neuropathy?

What is Peripheral Neuropathy?

Sample Screening Instruments for Substance Use Disorders

Purchase At Home Urine Drug Tests Today By Clicking Link Below -

http://www.wholesaledrugtesting.com/1/urine-drugs-of-abuse-tests.html

To Sign Our Petition Please Click here - 

Short URL:http://wh.gov/icesP

Save and Share this URL:      https://petitions.whitehouse.gov/petition/support-insurance-assisted-drug-testing-give-familiesparents-assistance-purchase-drug-tests-drug/6xDYgq98

How to Know if Someone in Your Household Might Be Abusing Drug 

Exhibit 4-1 Sample Screening Instruments for Substance Use Disorders

The CAGE Questionnaire (amended for drug use) C Have you ever felt the need to Cut down on your drinking or drug use? A Have you ever felt Annoyed by people criticizing your drinking or drug use? G Have you ever felt bad or Guilty about your drinking or drug use? E Have you ever had a drink or used a drug first thing in the morning to steady your nerves or get rid of a hangover? (Eye-opener) Scoring: If the answer is "yes" to one or more questions, the responder should receive a formal alcohol and drug assessment. Answering "yes" to one or two questions may indicate alcohol and drug-related problems. Answering "yes" to three or four questions may indicate alcohol or drug dependence.83 UNCOPE U Have you spent more time drinking or Using than you intended? N Have you ever Neglected some of your usual responsibilities because of alcohol or drug use? C Have you ever felt you wanted or needed to Cut down on your drinking or drug use in the past year? O Has your family, a friend, or anyone else ever told you they Objected to your alcohol or drug use? P Have you found yourself thinking a lot about drinking or using? (Preoccupied) E Have you ever used alcohol or drugs to relieve Emotional discomfort, such as sadness, anger, or boredom? Scoring: Two or more positive responses indicate possible abuse or dependence and a need for further assessment by an SUD treatment provider.84

Thank You,

WHAT IS COCAINE?

Purchase urine drug testing cups to setect the presence of cocaine in the urine by clicking the link below -

http://www.wholesaledrugtesting.com/1/urine-drugs-of-abuse-tests.html

WHAT IS COCAINE? 

The word cocaine refers to the drug in a powder form or crystal form.1 The powder is usually mixed with substances such as corn starch, talcum powder and/or sugar or other drugs such as procaine (a local anesthetic) or amphetamines. 

Extracted from coca leaves, cocaine was originally developed as a painkiller. It is most often sniffed, with the powder absorbed into the bloodstream through the nasal tissues. It can also be ingested or rubbed into the gums.

To more rapidly absorb the drug into the body, abusers inject it, but this substantially increases the risk of overdose. Inhaling it as smoke or vapor speeds absorption with less health risk than injection.

“You believe that coke will increase your perceptions, that it will allow you to surpass yourself, that you will be able to control things. It’s bloody nonsense. After a while you don’t pay your bills anymore, you don’t wash yourself anymore, you give up your friends, your family. You will become defenseless and alone.” —Nigel

A DEADLY WHITE POWDER

Cocaine is one of the most dangerous drugs known to man. Once a person begins taking the drug, it has proven almost impossible to become free of its grip physically and mentally. Physically it stimulates key receptors (nerve endings that sense changes in the body) within the brain that, in turn, create a euphoria to which users quickly develop a tolerance. Only higher dosages and more frequent use can bring about the same effect.

Today, cocaine is a worldwide, multibillion-dollar enterprise. Users encompass all ages, occupations and economic levels, even schoolchildren as young as eight years old.

Cocaine use can lead to death from respiratory (breathing) failure, stroke, cerebral hemorrhage (bleeding in the brain) or heart attack. Children of cocaine-addicted mothers come into the world as addicts themselves. Many suffer birth defects and many other problems.

Despite its dangers, cocaine use continues to increase—likely because users find it so difficult to escape from the first steps taken down the long dark road that leads to addiction.

Sign Our Petition for a Great Cause!!!!

To fight for our cause to get urine drug testis in to the parents hands follow the link - 

Short URL:http://wh.gov/icesP

Save and Share this URL:      https://petitions.whitehouse.gov/petition/support-insurance-assisted-drug-testing-give-familiesparents-assistance-purchase-drug-tests-drug/6xDYgq98

Thank You,

The Impact on Childhood Development - Drugs in Homes How it Affects Kids

Purchase Urine Drug Testing Device that detect up to 12 drugs of abuse click the link below -

http://www.wholesaledrugtesting.com/1/urine-drugs-of-abuse-tests.html

Exposure to parental SUDs during childhood also can have dire consequences for children. Compared to children of parents who do not abuse alcohol or drugs, children of parents who do, and who also are in the child welfare system, are more likely to experience physical, intellectual, social, and emotional problems. Among the difficulties in providing services to these children is that problems affected or compounded by their parents' SUDs might not emerge until later in their lives.⁶⁸

This section summarizes some of the consequences of SUDs on childhood development, including a disruption of the bonding process; emotional, academic, and developmental problems; lack of supervision; parentification; social stigma; and adolescent substance use and delinquency.

(Back to Top)

Disruption of the Bonding Process

When mothers or fathers abuse substances after delivery, their ability to bond with their child—so important during the early stages of life—may be weakened. In order for an attachment to form, it is necessary that caregivers pay attention to and notice their children's attempts to communicate. Parents who use marijuana, for example, may have difficulty picking up their babies' cues because marijuana dulls response time and alters perceptions. When parents repeatedly miss their babies' cues, the babies eventually stop providing them. The result is disengaged parents with disengaged babies. These parents and babies then have difficulty forming a healthy, appropriate relationship.

Neglected children who are unable to form secure attachments with their primary caregivers may:

• Become more mistrustful of others and may be less willing to learn from adults



• Have difficulty understanding the emotions of others, regulating their own emotions, or forming and maintaining relationships with others



• Have a limited ability to feel remorse or empathy, which may mean that they could hurt others without feeling their actions were wrong



• Demonstrate a lack of confidence or social skills that could hinder them from being successful in school, work, and relationships



• Demonstrate impaired social cognition, which is awareness of oneself in relation to others as well as of others' emotions. Impaired social cognition can lead a person to view many social interactions as stressful.⁶⁹

(Back to Top)

Emotional, Academic, and Developmental Problems

Children who experience either prenatal or postnatal drug exposure are at risk for a range of emotional, academic, and developmental problems. For example, they are more likely to:

• Experience symptoms of depression and anxiety



• Suffer from psychiatric disorders



• Exhibit behavior problems



• Score lower on school achievement tests



• Demonstrate other difficulties in school.

These children may behave in ways that are challenging for biological or foster parents to manage, which can lead to inconsistent caregiving and multiple alternative care placements.

Positive social and emotional child development generally has been linked to nurturing family settings in which caregivers are predictable, daily routines are respected, and everyone recognizes clear boundaries for acceptable behaviors.⁷⁰ Such circumstances often are missing in the homes of parents with SUDs. As a result, extra supports and interventions are needed to help children draw upon their strengths and maximize their natural potential despite their home environments. Protective factors, such as the involvement of other supportive adults (e.g., extended family members, mentors, clergy, teachers, neighbors), may help mitigate the impact of parental SUDs.

Lack of Supervision

The search for drugs or alcohol, the use of scarce resources to pay for them, the time spent in illegal activities to raise money for them, or the time spent recovering from hangovers or withdrawal symptoms can leave parents with little time or energy to care properly for their children. These children frequently do not have their basic needs met and often do not receive appropriate supervision. In addition, rules about curfews and potentially dangerous activities may not be enforced or are enforced haphazardly. As a result, SUDs are often a factor in neglect cases.

Parentification

As children grow older, they may become increasingly aware that their parents cannot care for them. To compensate, the children become the caregivers of the family, often extending their caregiving behavior to their parents as well as younger siblings. This process is labeled "parentification."⁷¹

Parentified children carry a great deal of anxiety and sometimes go to great lengths to control or to eliminate their parents' use of drugs or alcohol. They feel responsible for running the family. These feelings are reinforced by messages from the parents that the children cause the parents' SUDs or are at fault in some way if the family comes to the attention of authorities. Sometimes these children must contact medical personnel in the case of a parent's overdose, or they may be left supervising and caring for younger children when their parents are absent while obtaining or abusing substances.

Social Stigma

Adults with SUDS may engage in behaviors that embarrass their children and may appear disinterested in their children's activities or school performance. Children may separate themselves from their parents by not wanting to go home after school, by not bringing friends to the house, or by not asking for help with homework. These children may feel a social stigma attached to certain aspects of their parents' lives, such as unemployment, homelessness, an involvement with the criminal justice system, or SUD treatment.

Adolescent Substance Use and Delinquency

Adolescents whose parents have SUDs are more likely to develop SUDs themselves. Some adolescents mimic behaviors they see in their families, including ineffective coping behaviors such as using drugs and alcohol. Many of these children also witness or are victims of violence. It is hypothesized that substance abuse is a coping mechanism for such traumatic events.⁷² Moreover, adolescents who use substances are more likely to have poor academic performance and to be involved in criminal activities. The longer children are exposed to parental SUD, the more serious the negative consequences may be for their overall development and well-being.

Child Abuse as a Precursor to Substance Use Disorders

Many people view SUDs as a phenomenon that leads to or exacerbates the abuse or neglect of children. Research also suggests, however, that being victimized by child abuse, particularly sexual abuse, is a common precursor of SUDs.73 Sometimes, victims of abuse or neglect "self-medicate" (i.e., drink or use drugs to escape the unresolved trauma of the maltreatment).74 One study found that women with a history of childhood physical or sexual abuse were nearly five times more likely to use street drugs and more than twice as likely to abuse alcohol as women who were not maltreated.75 In another study, childhood abuse predicted a wide range of problems, including lower self-esteem, more victimization, more depression, and chronic homelessness, and indirectly predicted drug and alcohol problems.76

Source -https://www.childwelfare.gov/pubs/usermanuals/substanceuse/chapterthree.cfm#childhood

Sign WDT's Petition to keep kids off drugs click link below - 

Short URL:http://wh.gov/icesP

Save and Share this URL:      https://petitions.whitehouse.gov/petition/support-insurance-assisted-drug-testing-give-familiesparents-assistance-purchase-drug-tests-drug/6xDYgq98

Thank You,

HELP HELP HELP Prevent Drugs Infiltrating our homes!

Dear My extended family of readers, 

please view and sign our petition to get drug testing in the home, so our children have a reason to say to NO to drugs!  If a child knows that they will be drug tested when they are out a  party they will be more likely to say no.  We are loosing the war on drugs with the phrase "just say no."  Let us try a different approach and make each individual family accountable for the cause.  Yes, it is a touchy subject, but it happens in every family in every economic level in the world.  Drugs are not prejudice, they do not see religion, or color, or sex; they take control of anything in its path.  Help us stop the cycle today by signing our petition. 

Short URL: http://wh.gov/icesP
Save and Share this URL: https://petitions.whitehouse.gov/petition/support-insurance-assisted-drug-testing-give-familiesparents-assistance-purchase-drug-tests-drug/6xDYgq98

Thank You,

petition@wholesaledrugtesting.com
888.506.8690 ext 101

COCAINE: A SHORT HISTORY

Purchase urine drug tests that detect cocaine in the body click Below- 

http://www.wholesaledrugtesting.com/1/urine-drugs-of-abuse-tests-spanish.html

COCAINE: A SHORT HISTORY

What began as a religious tradition in the Andes has turned into abuse throughout the world.

Coca is one of the oldest, most potent and most dangerous stimulants of natural origin. Three thousand years before the birth of Christ, ancient Incas in the Andes chewed coca leaves to get their hearts racing and to speed their breathing to counter the effects of living in thin mountain air.

Native Peruvians chewed coca leaves only during religious ceremonies. This taboo was broken when Spanish soldiers invaded Peru in 1532. Forced Indian laborers in Spanish silver mines were kept supplied with coca leaves because it made them easier to control and exploit.

Cocaine was first isolated (extracted from coca leaves) in 1859 by German chemist Albert Niemann. It was not until the 1880s that it started to be popularized in the medical community.

Austrian psychoanalyst Sigmund Freud. (Photo credits: Freud Museum Photo Library)

Austrian psychoanalyst Sigmund Freud, who used the drug himself, was the first to broadly promote cocaine as a tonic to cure depression and sexual impotence.

In 1884, he published an article entitled “Über Coca” (About Coke) which promoted the “benefits” of cocaine, calling it a “magical” substance.

Freud, however, was not an objective observer. He used cocaine regularly, prescribed it to his girlfriend and his best friend and recommended it for general use.

While noting that cocaine had led to “physical and moral decadence,” Freud kept promoting cocaine to his close friends, one of whom ended up suffering from paranoid hallucinations with “white snakes creeping over his skin.”

He also believed that “For humans the toxic dose (of cocaine) is very high, and there seems to be no lethal dose.” Contrary to this belief, one of Freud’s patients died from a high dosage he prescribed.

In 1886, the popularity of the drug got a further boost when John Pemberton included coca leaves as an ingredient in his new soft drink, Coca-Cola. The euphoric and energizing effects on the consumer helped to skyrocket the popularity of Coca-Cola by the turn of the century.

From the 1850s to the early 1900s, cocaine and opium-laced elixirs (magical or medicinal potions), tonics and wines were broadly used by people of all social classes. Notable figures who promoted the “miraculous” effects of cocaine tonics and elixirs included inventor Thomas Edison and actress Sarah Bernhardt. The drug became popular in the silent film industry and the pro-cocaine messages coming out of Hollywood at that time influenced millions.

Cocaine use in society increased and the dangers of the drug gradually became more evident. Public pressure forced the Coca-Cola company to remove the cocaine from the soft drink in 1903.

By 1905, it had become popular to snort cocaine and within five years, hospitals and medical literature had started reporting cases of nasal damage resulting from the use of this drug.

In 1912, the United States government reported 5,000 cocaine-related deaths in one year and by 1922, the drug was officially banned.

In the 1970s, cocaine emerged as the fashionable new drug for entertainers and businesspeople. Cocaine seemed to be the perfect companion for a trip into the fast lane. It “provided energy” and helped people stay “up.”

At some American universities, the percentage of students who experimented with cocaine increased tenfold between 1970 and 1980.

In the late 1970s, Colombian drug traffickers began setting up an elaborate network for smuggling cocaine into the US.

Traditionally, cocaine was a rich man’s drug, due to the large expense of a cocaine habit. By the late 1980s, cocaine was no longer thought of as the drug of choice for the wealthy. By then, it had the reputation of America’s most dangerous and addictive drug, linked with poverty, crime and death.

In the early 1990s, the Colombian drug cartels produced and exported 500 to 800 tons of cocaine a year, shipping not only to the US but also to Europe and Asia. The large cartels were dismantled by law enforcement agencies in the mid-1990s, but they were replaced by smaller groups—with more than 300 known active drug smuggling organizations in Colombia today.

As of 2008, cocaine had become the second most trafficked illegal drug in the world.

Thank You,