Friday, February 14, 2014

Doctors No Longer Allowed to Take Patients' Blood Pressure

Ok, that's not true.  But an analogous and equally dangerous law suit is unfolding in Indiana.

In response to our nation’s prescription opioid epidemic, several states have enacted laws to help stem the tide of opioid misuse and abuse.  Notably, Indiana has passed a law requiring that patients prescribed opioids must submit to urine drug testing at the beginning of treatment and at least once a year thereafter.  This type of testing is best practice, guidelines driven, and in the best interests of patient safety.

The American Civil Liberties Union (ACLU) disagrees.  They’ve sued the state on behalf of a chronic pain patient who has been prescribed opioids for 18 years and doesn’t want to submit to mandatory urine drug testing.  The ACLU claims such testing is a violation of this man’s 4th amendment rights, which bar illegal searches and seizures.

This is like a patient with diabetes suing over a doctor’s assessment of his hemoglobin a1c levels.  Or a patient with high blood pressure suing over a nurse actually putting a blood pressure cuff on the patient to assess his current BP.  Or a patient on warfarin… or a statin… or any other drug that requires constant clinical monitoring to ensure patient safety and efficacy of the medication therapy. 

Urine drug testing isn’t a “gotcha!”  Healthcare providers and patients both benefit from the information collected from such testing.  Important clinical decisions about dosage, efficacy, and side effects are influenced by urine drug testing results.  Though rare, genetic abnormalities involving the metabolism of opioid medications can be discovered through urine drug testing. 

These drugs are some of the most potent and dangerous medications ever devised.  And they are miracle drugs for those who legitimately need them to function on a daily basis or to provide comfort in the waning days of life.  But to ensure safe, proper, and efficacious use of these medications, testing such as that which Indiana mandates is more than just good public policy – its good medicine.

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