1. health and fitness

Urine Drug Testing Protocol – Sample
Note: This is a sample. You may use a portion or all of this information in your practice. Any other use of this material is strictly prohibited.
Objective
The staff of _____________ clinic is committed to providing effective treatment to
patients suffering from chronic pain. The treatment of chronic pain may include the
use of opioid analgesics or other narcotic pain medications. Due to the epidemic of
Americans abusing prescription pain medication, as well as other narcotic drugs and
in order to monitor and account for the patient’s compliance in taking their
medication as prescribed, all patients will be subject to urine drug testing.
Definitions
Clandestine
For the purpose of this protocol, clandestine describes any drug that has been
made or manufactured illegally (i.e. heroin, cocaine, methamphetamine, etc.)
Diverting
For the purpose of this protocol, diverting means selling, giving or loaning
medication to another.
Circumstances for Urine Drug Testing
New Patients – Urine Drug Testing
All prospective patients who, if accepted, will be prescribed opioid analgesics or
other narcotic medication must submit a urine sample for drug testing.
Existing Patients Beginning Opioid Therapy – Urine Drug Testing
All existing patients who will be receiving a prescription for opioid analgesics or
other narcotic pain medication must submit a urine sample for drug testing.
Random at Appointment – Urine Drug Testing
All patients who are prescribed opioid analgesics or other narcotic medication for
treatment will be randomly requested to submit a urine sample for drug testing.
Note: See ‘Randomizing Process for Requesting Urine Drug Testing’.
Random – Call Patient to Clinic – Urine Drug Testing
All patients who are prescribed opioid analgesics or other narcotic medication for
treatment will be randomly requested to appear at the clinic to submit a urine
sample for drug testing. Note: See ‘Randomizing Process for Requesting Urine Drug
Testing’.
No Urine Drug Test within a Ninety (90) Day Period
Any patient who has not been urine drug tested within the past ninety (90) days
shall submit a urine sample for drug testing.
Drug Test based on Risk Assessment Protocol
Any patient who has been identified as low, medium or high risk as a result of a
patient risk assessment shall provide a urine sample for drug testing as set out in
the New Patient Risk Assessment Protocol.
Drug Test Based on Prescription Drug Monitoring Program (PDMP) Documentation
The clinic staff may query the name of any patient who is receiving a schedule 2 or
schedule 3 medication, from a clinician at our clinic, through our state PDMP. If
information is found indicating that one of our patients appears to be obtaining
schedule 2 or schedule 3 medication/s from another practitioner, during a period of
time that would run concurrent with the prescription that the patient received from
this clinic, our staff shall verify this information with the pharmacy and/or clinician
identified on the PDMP report. If this report is found to be true, the patient will be
requested to appear at this clinic to provide a sample of urine for a drug test.
For Cause – Urine Drug Testing
Any patient will be called and requested to come to the clinic to submit a urine
sample for drug testing if adequate cause exists. The following justifies adequate
cause:
a. The clinic staff receives information via telephone or in person from an
anonymous or a known person that indicates that the patient is abusing or
diverting their medication.
b. The clinic staff receives information via telephone or in person from an
anonymous or a known person that indicates that the patient is using
clandestine medication or alcohol.
c. Any patient who displays behavior, signs or symptoms consistent with
withdrawal.
d. Any patient who displays behavior indicating a loss of their normal mental of
physical faculties.
Randomizing Process for Requesting Urine Drug Testing
The following process describes the procedure for randomly selecting dates for
patients to provide urine samples for drug testing purposes:
a. One employee will be assigned the task of randomizing patients to provide a
sample of urine for drug testing purposes.
b. The employee assigned to randomize patients will:
1. Make a list of patients, in alphabetical order, scheduled for
appointments on the following day;
2. Divide the list in thirds (making three groups – patient’s whose last
name begins with A through H will be in group 1, patient’s whose last
name begins with I through Q will be in group 2, patient’s whose last
name begins with R through Z will be in group 3);
3. Roll a die to select which group that will be requested to submit a
sample of urine for a drug test; and
4. If the die lands on 1 or 2, group one will be tested. If the die lands on
3 or 4, group 2 will be tested. If the die lands on 5 or 6, group 3 will
be tested.
OR
Examples
1. During the day of the examination, after the patient checks in, but
before the patient is brought to the examining room, the employee will
roll a die to see if that patient will be requested to submit a sample of
urine to be tested;
2. If the die lands on 1 through 4, the patient does not have to provide a
sample. If the die lands on 5 or 6, the patient will be requested to
submit a sample of urine to be tested.
OR
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Or example on next
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1. During the day of the examination, after the patient is brought into the
examination room, the employee will provide the patient a bag
containing one white marble and two black marbles;
2. The employee will present the bag to the patient in a way so that the
patient cannot see the marbles;
3. Upon the employee’s request, the patient shall place their hand in the
bag and remove one marble;
4. If the patient chooses a black marble, the patient will not be requested
to submit a sample of urine to be tested. If the patient selects a white
marble, the patient will be requested to submit a sample of urine to be
tested.
Refusing or Cannot Provide Urine Sample for Drug Testing
Patient Refuses to Provide Sample
Any patient who refuses to provide a urine sample for drug testing shall be
terminated from this practice. See Patient Termination Protocol.
Patient Unable to Produce a Urine Sample for Drug Testing
The following applies to any patient who verbally indicates that they are unable to
produce a urine sample for drug testing:
1. The patient’s clinician shall refer the patient to a Nephrologist or Urologist to
be examined for a potential kidney disorder prior to being prescribed their
normal course of medication. The patient’s clinician shall provide the patient
a prescription medication that would be less detrimental to a potential kidney
disorder. The patient’s clinician shall provide the patient this prescription for
the amount of time practicable for the patient to receive a final report from
the Nephrologist or Urologist. The patient may receive a prescription for their
normal course of medication only after the Nephrologist or Urologist provides
their clinician with a report indicating that the patient’s kidneys are
functioning normally.
2. The patient shall be offered the opportunity to provide a sample of their
saliva for drug testing. If the patient refuses, see ‘Patient Refuses to Provide
Sample’.
Urine Drug Testing Procedures
Staff Duties
One employee will be assigned to:
1. Request urine samples from patients;
2. Receive the urine sample from the patient;
3. Complete and submit all documentation required by the clinic and the urine
drug testing laboratory;
4. Place all samples in a secured area;
5. Maintain the chain of custody on all urine samples;
6. Package and distribute urine samples to the laboratory;
7. Receive all laboratory conformations; and
8. Provide clinician with laboratory results.
Use of Point of Care Results
1. If the urine drug test ‘point of care’ results are consistent with the medication
the patient had been prescribed, the patient may be prescribed up to 30 days
of schedule 2 or schedule 3 medication. The sample will subsequently be sent
to the laboratory for conformation. This does not apply to patients who have
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been evaluated as being low, medium or high risk (see Risk factor Scheduling
Protocol).
2. If the urine drug test point of care results are inconsistent with the
medication the patient had been prescribed (i.e. clandestine drugs, other
prescription drugs or alcohol found or no drugs or alcohol are found), the
patient may be provided a prescription for no more than seven (7) days of
medication. The sample will be sent to the urine drug testing laboratory for
conformation.
Use of Laboratory Conformation Results
1. Laboratory conformations will be received by the employee assigned to
collect and secure urine samples. This employee will document and place all
of the conformations in the appropriate patient’s medical file. This employee
will also identify any conformation containing negative results and
immediately bring this information to the attention of the patient’s clinician.
2. Negative results
a. During New Patient Assessment Process
If the laboratory conformation report identifies clandestine drug/s,
illegal narcotic/s, alcohol, other prescription medication or any
medication that was not expected to be present in the person’s
system, the person will not be accepted in the practice.
b. Est. Patient – Clandestine Drugs, Rx Drugs and/or Alcohol Found
If the laboratory conformation report identifies clandestine drug/s or
illegal narcotic/s, alcohol, other prescription medication or any
combination of the three, the clinician will place the patient on a “high
risk” schedule (See Risk Factor Scheduling Protocol). If the patient
subsequently provides urine containing any clandestine drug/s or
illegal narcotic/s, alcohol, other prescription medication or any
combination of the three, while on the high risk schedule, it will be up
to the discretion of the clinician to either refer the patient to an
addiction specialist to be evaluated for an addiction disorder and work
with the addiction specialist to treat the patient’s pain or terminate
treatment for this patient. The patient’s medical record shall reflect
the information found in the conformation report and the patient’s
treatment.
c. Est. Patient – Aberrant Behavior
If the laboratory conformation report identifies an excess amount of
the prescribed drug (with no signs of any other drug or alcohol) in the
patient’s system, the patient’s clinician may explore the potential of
pseudoaddiction and potentially adjust the patient’s medication or
admonish the patient regarding their aberrant behavior. If the patient
subsequently demonstrates aberrant behavior within the next six (6)
months, the clinician may refer the patient to an addiction specialist
to be evaluated for an addiction disorder and work with the addiction
specialist to treat the patient’s pain or place the patient on a “medium
risk” schedule (See Risk Factor Scheduling Protocol). The patient’s
medical record shall reflect the information found in the conformation
report and the patient’s treatment.
d. Est. Patient – No Drugs or Alcohol found
If a patient is receiving daily opioid theory and the laboratory
conformation report identifies no prescription medication, alcohol or
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clandestine drugs in the patient’s urine sample and the clinician
examined the patient and found no sign of withdrawal symptoms, it
would be reasonable to believe that the patient is selling or otherwise
diverting their medication. The clinician shall terminate the patient
from this practice without providing the patient a prescription for any
schedule 2 or schedule 3 medication/s. The patient’s medical record
shall reflect the information found in the conformation report as well
as the termination.
Note: Scott Huckabee is not a lawyer and he is not attempting to provide you legal advice.
Feel free to use this material in your practices. Any other use of this material is strictly
prohibited. Be sure to gain advice from your attorney prior to establishing any of this
information as your policy or practice.
© 2012 Huckabee Consulting Inc.
DoctorsSafeguard.Com
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