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The contentious and misunderstood world of drug testing

Any time you have to mention urine in a blog post you know it’s going to be a tough one.

There’s a kerfuffle in the world of urine drug testing, one of the more litigious and contentious industries I’ve ever encountered.  The parties involved, Ameritox and Millennium Labs, have been involved in litigation for some time now.  [full disclosure, Millennium has been a consulting client for a couple of years; I work closely with them, and have found them to be great people who do the right thing consistently.]

A while back, Ameritox lost a suit brought by Millennium over alleged deceptive advertising; more recently a jury ruled Millennium had improperly given cups to docs in four states, a practice the jury deemed an unfair trade practice. Ameritox trumpeted their “win”, however the jury’s finding was inconsistent with the opinion of several experts in the area, all other charges were dropped, and the case is on appeal.  And there was a serious legal question raised when one of the key witnesses allegedly provided information that perhaps they had no right to.

Be that as it may, the case was noted by friend and colleague David DePaolo, who opined: 

While medical guidelines recommend drug testing for compliance purposes and to help ensure that drugs aren’t being diverted to the black market, we know those are specific case recommendations particular to a certain set of medical facts, not to be applied universally.

But the way medical suppliers stimulate sales with physician gifting and revenue enhancement programs tests the ethical and moral qualities of the individuals on the front lines, and physicians should not be placed in those positions, and we should not be placed into positions of having to pay for it.

Sometimes drug testing is warranted. Most of the time it is not.

A couple comments.

First, research from various organizations including WCRI clearly indicates there’s far too much testing going on of a small population, and far too little of most.  About a quarter of folks who should be tested are, while some unscrupulous docs test every patient every time, making bank.  I respectfully disagree with David’s statement that “most of the time” drug testing isn’t warranted.


What is correct is to say many more patients taking opioids should be tested, and that testing should comply with accepted evidence-based clinical guidelines; Washington State, Colorado, ACOEM, and others are all excellent sources.

Opioid abuse, misuse, diversion, and related problems have long surpassed crisis status – we’re now in a national disaster with more people dying from this than motor vehicle accidents.  Drug testing is a critical part of the answer.  Yes, there are vehement disagreements among stakeholders, and yes, they can get very contentious, and yes, I have a dog in this fight.  That said, I – and many others – have been working long and hard to bring attention to the opioid disaster, and we need to keep the focus on addressing the problem and not get distracted by tangential issues.

On that all parties should agree.

What doe this mean for you?

There’s a real danger that we over-react, over-simplify this issue, and in so doing make blanket statements that do more harm than good.




One thought on “The contentious and misunderstood world of drug testing”

  1. Thanks Joe,

    I have read David’s post and many others while watching the drug testing game develop overtime as a provider administering substance abuse programs, a direct purchaser as a multistate WC carrier (marketed by both firms) and a guideline editor (full disclosure ODG Advisory Board). the evolution has been mind boggling and disappointing to say the least. I am an absolute believer that truly random drug testing can be an effective deterrent to diversion and if providers participate appropriately based on medical practice and in some cases state guidelines. there has been some erosion in the legality of post accident testing in LA by the supreme court. Basic science supports both screening and confirmation threshold levels but not levels to approximate dose being consumed by the patient. This is a deceptive tactic on the part of some labs to drive GC/MS testing by the providers and bill companies upwards of $2500. Just like physician dispensing it has become a revenue stream for providers and inappropriately utilized. I could pontificate and rant on this all day. Hopefully we can get drug testing to effectively help this unbelievable narcotic problem that continues to grow unabated.

    PS. IAIABC language in there paper “Reducing Inappropriate Opioid Use in Treatment of Injured Workers : A Policy Guide” hit the head on the nail.

    “Drug Testing: Urine drug testing should be conducted to establish a baseline immediately after the treatment agreement has been signed, and then randomly one or more times a year based on risk factors until termination of opioid use. Screening for cause (over and above random testing) should also be done as soon as practically possible after the provider has evidence of misuse, such as over-sedation, accidents, self-directed dose changes, or lost prescriptions. Unless the prescribing physician suspects concurrent use of other drugs that would be harmful in connection with his/her prescription for the patient, the minimally necessary immunoassay screening panel should be used. The panel of screens called for should include any medications or substances that the prescribing physician, based on the patient encounter, deems prudent to include in the test.

    States that have enacted drug testing laws for workers’ compensation and other purposes have generally required that the laboratories be certified by the College of American Pathologists, Substance Abuse and Mental Health Services Administration (SAMHSA, which is a branch of the U.S. Department of Health and Human Services) or by the state health department.9 In addition to this certification requirement for the lab, most states enact rules on testing procedures, safeguarding the chain of evidence, confirmation testing for positive results and other quality control measures. Given the potential for testing and billing solely to enhance physician income, it would be desirable to require that the prescribing physician has no revenue sharing or other economic interests with drug testing labs to which he or she uses.”

    thanks TP

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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