what do people tell doctors to get drugs

Mississippi's proposed regulations intended to curb the opioid crisis aren't final, just some doctors take already started drug testing patients — the cost of which can fall on the patient.

And it's non just patients on opioids being tested. The proposed regs also comprehend benzodiazepines similar Xanax, Klonopon, Valium and Ativan, used to treat anxiety disorders, insomnia and seizures.

Benzodiazepines are present in roughly 1-tertiary of opioid overdoses, which are killing nearly 100 Americans a twenty-four hours, and the combination of the 2 is particularly unsafe.

While the medical customs grapples with shifting attitudes surrounding the prescription of benzodiazepines, some question the burden new regulations might pose for the 264,895 Mississippians currently prescribed these addictive drugs.

More:With 175 Americans dying a twenty-four hour period, what are the solutions to the opioid epidemic?

$57 to pee

Before prescribing routine medication, MEA Medical Dispensary in Jackson charged a patient $57 out of pocket for a drug test conducted past a contract diagnostic company, LabCorp, in January.

This is despite the fact the State Board of Medical Licensure is still drafting the new regulations.

As proposed, the new regulations only require physicians any time they write a benzodiazepine prescription to conduct a point-of-service urine drug test — which does non require diagnostics from an outside lab like LabCorp.

The latest draft of the regulations would also require patients prescribed benzodiazepines to visit their doctor every iv months (at outset it was every 90 days), at which point staff must check the Mississippi Prescription Monitoring Program.

MEA Main Care Plus Medical Managing director Gene Loper told the Clarion Ledger that MEA headquarters has not given physicians any directive to begin drug testing patients on benzodiazepines, so individual physicians doing and so accept chosen to do then on their own.

The $57 the patient was charged for the drug test in January is in line with what MEA has estimated it will cost to comply with new regulations, Loper said.

"I don't retrieve that's what the licensure lath intended for this to be, but that'southward the outcome of it," Loper said. "It's a monetary expense to the patient. We don't want our patients to incur that just we don't have whatever direction on this."

Licensure board member Dr. Randy Easterling said the drug test is necessary because the prescription monitoring organisation only goes so far. Someone could exist getting drugs from the street, which wouldn't show up as a prescription.

"If they're on benzos chronically, you don't know that they're not on opioids unless they're tested in some manner," Easterling said.

A September report from QuestDiagnostic, a contract laboratory and diagnostic service, shows over half of Americans misused their prescription medications between 2011 and 2016, according to an assay of 3.four million prescription monitoring lab tests.

Of 33,000 samples tested for opioids and benzodiazepines in 2016, over one in v tested positive for the risky combination.

Only the toll of the drug test, and who'due south responsible for paying, illustrates the complexity of the current wellness care landscape. Add in each doctor's estimation of  rules and how they implement them, and the impact on the patient tin can vary greatly.

Cost variation

The clinic where Easterling practices pays $iii.85 for a point-of-service urine test that screens for 10 to 12 drugs. But the clinic charges insurance companies $50, and Blue Cross Blueish Shield, for example, agrees to pay $14.

"This is routine in medicine," Easterling said of overcharging insurance companies only to accept a much lower payment. "It doesn't make any sense."

There is some overhead because the time it might accept a patient to take the exam and the staffing required to read it, but fifty-fifty at the $fourteen insurance charge per unit, the clinic takes in 73 percentage.

Even if patients paid $15 for each test, amounting to an extra $45 a year, Easterling said it would be a small price "if doing this helps forestall some people from dying."

More:Stop the legal fights and curb the opioid epidemic, judge says

QuestDiagnostic charges $250 for a nine-console, point-of-service drug exam. The cost of "confirmatory" drug testing, not required past the proposed regulations, is significantly more expensive because it requires additional diagnostics. At Quest, the cost shoots up to $769.

Medicaid pays for medically necessary drug tests at rates ranging from $72 to $228. Information technology does non comprehend over-the-counter drug tests similar the ones that would be required under the proposed regulations.

The proposed regulations exercise not include specific directions on which urine drug test to use, but require they test for, "at a minimum, for opioids, benzodiazepines, amphetamines, cocaine and cannabis." Inpatient and hospice handling is exempt from the drug examination requirement.

Loper said MEA is even so trying to determine whether an in-house drug test volition satisfy proposed regulations or if they will have to ship it off to a lab at a greater cost.

"Those are things that, quite frankly, I think need to be worked through that take non been worked through with some of these proposals out there right now," Loper said.

For anyone charged significantly above the cost of the $5 drug test, licensure board President Dr. Charles Miles said: "I would encourage them to ask why it's then much."

More than:How the FDA helped pave the way for an opioid epidemic

Questions most the variations in health care costs aside, some individual practice psychiatrists are concerned their offices are not equipped to bear urine testing.

Miles said the bespeak-of-service examination amounts to "putting some urine in a cup, shaking information technology around and writing downwards what information technology tells you."

Beyond logistical problems, others are worried folks seeking psychiatric treatment might be deterred from seeing a doctor if they know they volition be drug tested.

Confusion, misinformation

The proposed regulation changes have caused feet among the medical community and prompted what some phone call an overreaction from physicians.

"I've had people come to me — they have been to other doctors — because of a sudden they've been cut back on their ADHD medicine because of what's coming down," said Jackson psychiatrist Dr. Richard Rhoden. "People are worried about their licenses — that'due south their career, their livelihood. So what's going to happen is some doctors are not even going to take these patients."

But the proposed regulations don't make any changes to the prescribing of amphetamines or other types of ADHD medication — that's just another misconception.

Lawmakers did innovate House Bill 131 and Senate Bill 2817 this session requiring doctors to check the Mississippi Prescription Monitoring Plan earlier prescribing a large swath of medication, including cough suppressants like codeine. The bills died without any fanfare.

The board has said repeatedly that it is not trying to prohibit opioid or benzodiazepine prescriptions, every bit long as they're prescribed accordingly and in a way that identifies if they're being abused.

What's more than, null in the proposed regulations requires doctors to cut off patients using these medications.

Much of the public controversy surrounding the licensure board's activity is less about attempts to curb overprescribing and more a result of widespread defoliation and misinformation nearly the state's approach to addressing the opioid crunch — like conflation between the regulations and state statute.

Mississippi police force enforcement agencies have been involved in addressing the epidemic, merely regulations by the Medical Licensure Lath are not laws. They are rules physicians must follow or chance losing their license. The rules only apply to physicians licensed by the board, not other prescribers like dentists.

No bills to change the state statute regarding the prescription of painkillers or anxiety medication remain alive this session.

Cousin Xanax

Dr. William Rosenblatt, who called Xanax the "first cousin" of opioids, said when he came to Mississippi from New Hampshire, he was surprised at how often doctors here prescribe benzodiazapines — 1,312,976 prescriptions written in 2017.

"The question people don't seem to exist asking is why is this number of people on benzodiazepines?" he said. "Let'south not forget that benzos are not first-line drugs for feet or insomnia."

Rosenblatt said he sees patients everyday who take been taking Xanax and were never told of its addictive nature or even about alternatives.

"They often greet me with open up arms when I tell them there are other options," he said.

If the new regulations should accomplish anything, Rosenblatt said, it's to get doctors to recall twice when prescribing benzodiazepines and consider alternatives like anti-depressants.

Of grade, Rosenblatt said, some people with severe anxiety and panic disorders will benefit from remaining on drugs like Xanax, merely those make up a small percentage of the more than 250,000 Mississippians on them now.

Rosenblatt also said the proposed regulations present no more than of an inconvenience than what many ADHD patients currently face up. (Some doctors cull to drug exam patients prescribed Adderall or other amphetamines to ensure they're taking their medication, though information technology'south not required by the regulations).

"Until nosotros go rid of that (overprescribing) situation and figure out how to accordingly treat anxiety disorder, I don't call back we can then talk seriously almost the inconvenience of a drug exam," he said.

The proposed regulations don't specify how doctors are to movement frontward if a patient's drug test comes back positive for other potentially harmful medications, to much consternation from doctors. Miles said it's supposed to prompt a conversation.

"I can sit downwardly with someone if the drug screening shows a combination of drugs in their urine that could be lethal. I'd say what have you been on that I haven't known almost. Let'south talk about what medication yous're on," Miles said. "You can't stop everyone from being on it, but if you don't know they're on something, you tin't sit downwards."

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Source: https://www.clarionledger.com/story/news/politics/2018/02/04/doctors-drug-testing-people-prescribed-anxiety-medication-anticipation-new-rules/1058751001/

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