Ethical Issues Surround Rise in Doctors’ Use of Urine Drug Testing to Prevent Abuse

As a growing number of doctors use urine drug tests in an effort to detect prescription drug abuse in their patients, they face ethical questions about the tests, according to The New York Times.

These questions include how accurate the tests are, what doctors should do with the results, and whether doctors are benefitting financially from the tests. This year, sales at diagnostic testing labs that offer urine drug tests are expected to reach $2 billion.

Urine tests indicate many pain patients are not taking their prescribed painkillers, or are taking substances not prescribed to them by a doctor. If patients are not taking a prescribed medication, it could mean they simply stopped using it, or it could mean they are selling it.

Dr. Roger Chou, who helped develop urine-screening guidelines for the American Pain Society, says that while he believes the tests are valuable, he is concerned doctors may use the results as an excuse to drop patients, instead of sending them to addiction treatment or other pain management programs.

There are two basic types of urine drug tests. A patient taking a qualitative test leaves a urine sample in a cup that is imbedded with strips designed to detect drugs such as opioids, cocaine, amphetamines and barbiturates. These tests have both high false-positive and false-negative rates, meaning they often indicate a drug is present when it is not, or they fail to detect a drug that is present in a person’s urine. The tests detect methadone but not oxycodone, the article notes.

Qualitative tests are being used in states that have passed laws requiring welfare recipients to undergo drug screening.

A more sophisticated and expensive urine drug test used in pain patients is called quantitative analysis. A patient can beat the test by taking their prescription medicine for a day or two, and selling the rest.