By MigraineFreeLiving Staff

The Scenario

“I don’t do drugs. I TOLD my doctor that. Does she not trust me??”

“Marijuana is legal and it helps my headaches. Why did they test me for it?”

“I have a prescription for Vicodin for back pain. Now anyone who looks at my chart is going to think I am a drug addict!”

Any of this feel like YOU? I’m sure it does. It can feel patronizing. It’s invasive. It’s stigmatizing. As a physician, I hate that most laboratory assays still refer to this test as a “urine drug screen” or “drug screen”. Such a negative connotation. A better title for the order would be “Urine toxin screen” or “urine metabolite assay”. Using the word DRUG immediately brings back memories of drug lords in Sicario or the meth lab in Breaking Bad. And I’m a doctor who is keenly aware of his implicit biases!

FIRST, I would like to just say, don’t be upset with your doctor or treatment team for checking your urine for recreational substances. Especially if you come into the hospital with significant pain, dizziness, or an array of other symptoms. As a physician who orders this test on a regular basis, I find solace knowing that when I order this test, I am NOT selectively testing patients based on any of my own implicit biases. I test everyone. Imagine if I practiced medicine using personal judgment rather than evidence to base my medical recommendations. Selectively testing the young woman with housing insecurity and chronic pain for urine toxins as a means to “explain” her social or medical situation is inherently wrong. Similarly, not testing the affluent White business executive on the basis of his race or access to resources is wrong because, in fact, the cocaine he uses could be directly contributing to his headaches!

SECOND, this test would not have been made available to physicians were it not of use. A patient might think they are taking just tylenol for their headaches when they are actually taking a combination pill of Tylenol + a barbiturate, which can lead to dependence and medication overuse headache much more quickly than over-the-counter Tylenol! Also, maybe that mixed drink they had at a party last night was laced with something other than Tito’s. And yes, sometimes providers simply cannot trust their patients. Of course patients are going to withhold some (if not most) of the truth! I mean, what sensible person would confess to using recreational substances if they felt that information would bias the treatment team into thinking “oh, this lady is just trying to mix some oxy with her alcohol”?

The counterargument

You could argue that simply NOT testing patients for urine toxins is as unbiased as testing for urine toxins for ALL patients. However, I would argue that this information is useful when it is appropriately contextualized. A quick review of urine toxicology screens by a primary care provider when trying to decide as to whether a patient should be prescribed a short course of tramadol for arthritic pain may result in that provider seeing a positive screen for fentanyl. If that provider does not check to see if the patient was given fentanyl in the hospital for a broken bone before the tox screen was done, they might conclude “this patient uses fentanyl recreationally.” This is NOT the goal here people!

What next?

If you use recreational substances, it’s always a good idea to share this information with your doctor. Be honest. Hiding this information from them will only fragment the therapeutic alliance you develop with your treatment team. And if you take something which may not be approved by the Food and Drug Administration, legal or illegal, it’s better for your doctor to know. As a physician, it doesn’t bother me if your chronic neck arthritis gets better with marijuana gummies or if it gets better with glucosamine and feverfew. What matters to me is how YOU feel. The facts are simple.

Doctors are NOT allowed to notify the police or other authorities that you use recreational substances

This is a violation of HIPAA
If the substance use can lead to harm of others, it may be included in a safety report

Recreational substance use will not affect your health insurance premiums, or your ability to get health insurance (to the best of our knowledge)
THC and its derivatives have some evidence they can be effective for many conditions, including treating chronic pain
Testing of your urine should not affect the way you are treated by medical professionals!

And if you are shopping for new ideas, here is some food for thought:

Tired of NSAIDs? Try topical CBD oil or feverfew.