In an opioid drug crisis, urine testing becomes an $8.5 billion business

urine-sample-cup-263x300With opioid drugs now the leading cause of death for Americans 50 and younger and killing more than 64,000 people last year, was it inevitable that some shady characters are profiteering off the miseries of those struggling to get off potent painkillers?

And is it predictable that key politicians keep talking big but still haven’t backed up their boasts with the money and means to attack a public health crisis that is claiming more lives than cars or guns and at a faster pace than HIV-AIDS did at the peak of that epidemic?

Americans have plenty cause to be — forgive the vulgar word play — pissed off at the doctors and labs that are raking in profits on urine testing for drugs. This business has exploded but with little or no oversight. As reporters Fred Schulte and Elizabeth Lucas have written:

Kaiser Health News, with assistance from researchers at the Mayo Clinic, analyzed available billing data from Medicare and private insurance billing nationwide, and found that spending on urine screens and related genetic tests quadrupled from 2011 to 2014 to an estimated $8.5 billion a year — more than the entire budget of the Environmental Protection Agency. The federal government paid providers more to conduct urine drug tests in 2014 than it spent on the four most recommended cancer screenings combined. Yet there are virtually no national standards regarding who gets tested, for which drugs and how often. Medicare has spent tens of millions of dollars on tests to detect drugs that presented minimal abuse danger for most patients, according to arguments made by government lawyers in court cases that challenge the standing orders to test patients for drugs. Payments have surged for urine tests for street drugs such as cocaine, PCP and ecstasy, which seldom have been detected in tests done on pain patients. In fact, court records show some of those tests showed up positive just 1 percent of the time. Urine testing has become particularly lucrative for doctors who operate their own labs. In 2014 and 2015, Medicare paid $1 million or more for drug-related tests billed by health professionals at more than 50 pain management practices across the U.S. At a dozen practices, Medicare billings were twice that high. Thirty-one pain practitioners received 80 percent or more of their Medicare income just from urine testing…

The KHN story drills down on some  major enterprises that have burgeoned as employers, doctors, and treatment centers seek to determine if users of opioids and other powerful drugs are staying clean. But absent evidence-based, carefully researched standards and guidelines, the huge volume of tests—and the giant sums thrown at them—may be as effective and cost-effective as, well, you know what in the wind …

But the overuse of this purported diagnostic also may be fueled by the rise of so-called treatment centers, which need to show some bang for the big bucks they charge. Too many of them are little more than flop-houses filled with drug abusers or those who get abused by them and abusive operators of such facilities.

They’re rife in Florida, and news organizations are putting out a cascade of investigations, showing how families and individuals—desperate to try to deal with patients’ destructive and lethal cravings for prescription painkillers and even more potent, dangerous, and illicit drugs like fentanyl and heroin — send loved ones off to these facilities, only to learn later of gross exploitations there, including excessive and fatal overdoses.

The outrages worsen, because families, insurers, and taxpayers too often foot the bill. The sums extracted from individuals can be staggering, including one report of one woman who ended up with $750,000 tab for alleged treatment. The financial victims now include labor unions, which try to support members by helping to pay for addiction care.

In my practice, I see the huge harms that patients suffer while seeking medical services, the horrors inflicted on them by dangerous drugs, and their awful struggles with access to affordable medical care. The burdens put on patients and their loved ones by opioid drug woes are formidable, and it is hard to see how any but a wealthy, elite few could shoulder these on their own.

Which is why it is maddening to see politicians and policy-makers talk, talk, and talk without dealing effectively with a big and growing mess. A presidential commission, as duly noted, has gone off, studied the issue, and come back with a list of potential actions. Many are good. But the group whiffed at a crucial concern: How will any remedies get paid for? President Trump, as noted, also has failed to address this fundamental, and analysts have hastened to point out that the nation’s chief executive, in effect, punted to lawmakers on Capitol Hill. And they don’t have a way forward.

The Republicans in Congress and the Administration, instead, have obsessed for weeks now—since their debacle in attempting to repeal and replace the Affordable Care Act, aka Obamacare—about taxes, specifically how to slash them for the rich by hiking them for the poor and middle class. They’ll slide their proposals around complex parliamentary rules in the Senate by promising to gut health care programs to pay for the tax cuts for the rich. Sure, there are differences between Draconian steps proposed in the House versus the Senate. But it’s frustrating that in either tax plan and the GOP budget, Medicaid and Medicare would take whopping hits, as would middle class families seeking to deduct the costs of major medical care for a loved, and tax benefits for companies that develop so-called orphan drugs—medications that treat a disease afflicting fewer than 200,000 Americans.

Just in case someone hasn’t clued in members of Congress or the president—they have privileged health care, by the way—getting people off painkillers or other powerful drugs isn’t a snap. Rehab centers can help. But effective care can be extensive and expensive, including treatments with other meds and psychological therapy. To get this quality, sustained care, Medicaid and other government programs provide a sorely needed option for individuals and families when they have exhausted their savings and insurance coverage. Slashing at these supports during an opioid drug abuse epidemic is not smart.

Instead, lawmakers and regulators need to crack down on the phony sobriety facilities and the costly dribble of urine testing. The president and his chaotic Administration also haven’t wowed the world with a multination Asia tour, which has included Trump’s attempts to jaw the Chinese into cracking down on too easy, sizable online sales and shipments of deadly fentanyl. Even if Trump can get some traction on this issue, he and the Secretary of State have so demoralized and downsized America’s diplomatic corps and other government agencies that it may be hard to maintain any pressure or oversight on this issue overseas.

Meantime, as always, there also should be huge pressure on doctors and hospitals to step up and do more: Despite the tidal wave of hype, marketing, and sales by Big Pharma for opioids, another new study has found that common medications like ibuprofen (Motrin) or acetaminophen (Tylenol) were as effective as more potent opioids in providing short-term relief for emergency room patients with pain from broken limbs.

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