In The Land Of Unintended Consequences

The recently implemented regulations arising from the new prescription drug bill are being misinterpreted. Doctors all across the Commonwealth are doing required urine testing, and the results, in many cases, are being used to justify the withholding of medications from patients. The Doctors claim that if they don’t withhold these medications based solely on the urine test, they will lose their jobs or licenses. The regulation they say that requires them to do this is 201 KAR 9:260 Professional Standards for Prescribing and Dispensing Controlled Substances, Page 12, line 19, through Page 13 line 4.

The regulation reads:
(4) The Physician shall obtain and document a baseline urine drug screen to
determine whether the medications that are being prescribed are in the patient’s
system and to determine whether any un-prescribed or illegal controlled
substances are in the patient’s system.
(5) If, after screening, the physician determines that the controlled
substances prescribed to the patient will be used, or are likely be used other
than medicinally or other than for an accepted therapeutic purpose, the Physician
Shall not prescribe controlled substances to that patient.

As anyone can see the regulation only requires the withholding of medications if the physician determines that the medication will not be used properly. It does not require the withholding of medications if illegal drugs are present, only if the Doctor thinks the medicine they are prescribing will be misused.
Based on this misinterpretation Doctors are withholding medications because of the presence of THC, the active ingredient in marijuana. Many of these patients use marijuana in combination with their prescribed drugs and have been using this combination for decades. In many cases, with the approval of their Doctors. Now they are being told to chose between two drugs when the effectiveness lies in the two drugs working together. For example, marijuana works very well in controlling neuropathic pain, but it works best in combination with a small amount of pain meds usually in the evening before bed. Now these patients will have to give up either their medical marijuana or their pain medications. Many patients when faced with this choice have said that the marijuana works too well to give up and if they lose their pain meds they will get them on the black market. The fear of addiction from using pain medications alone is a major factor in their decision. Patients are being told the Doctor will help them experiment to find a pharmaceutical drug to replace the withheld pain medications but that requires them to become guinea pigs to the Pharmaceutical industry all over again.
No one doubts the need to get a handle on our prescription drug problem but what the patients are hearing and what the regulation says are two different things. In this interpretation of the regulations we are creating more problems than we are solving.
I wonder if the Doctors are making these decisions about their patients or the bureaucrats are? I suspect since some Doctors cited losing their jobs, it’s the bureaucrats, the absolute last people who should be making medical decisions. Unintended consequences, when not addressed can neutralize any good that might have been accomplished.

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