Profits, not patient care, may be a driving force behind the soaring number of drug tests given to people with chronic pain, according to a pain sufferer and patient advocate. In an article published in the Journal of Pain & Palliative Care Pharmacotherapy, author Mark Collen claims that widespread drug testing may be partially motivated by money.
“The paper takes a retrospective look at drug testing and presents Medicare data which shows a meteoric climb in drug screens,” said Collen, who cites evidence that doctors and drug laboratories could make as much as $200 by ordering a single drug test. “I was very surprised when I saw the numbers, which show that between 2000 and 2009 the number of all Medicare laboratory services increased by about 48%, while the number of drug tests conducted in physicians’ offices increased over 3,000,000 percent.”
The number of drug tests billed to Medicare by family practice doctors soared from a few dozen in 2000 to over a quarter of a million tests in 2009. Doctors of anesthesiology, internal medicine and neurology had similar increases in their use of drug screens.
An estimated 116 million Americans suffer from acute and chronic pain. Many doctors who treat chronic pain patients require them to submit to random drug screens as a condition for receiving prescription pain medications. The stated rationale is to prevent misuse and possible addiction, but Collen claims there is little evidence to support the value of drug tests on people with chronic pain.
“It would be naive to say that money has not played a role in the dramatic increase in drug testing as noted in the paper,” Collen wrote in an email to American News Report. “I believe profits drove drug testing behavior and behavior drove acceptance of the procedure before there was sufficient evidence of efficacy. Now physicians may be drug testing patients because others are doing it.”
Until recently doctors could charge Medicare and private insurers up to $225 for a urine drug test that cost them a little over $20. Medicare changed its reimbursement rules after the government found evidence that some laboratories and doctors were using questionable billing practices.
Ameritox, a national laboratory that provides drug testing, agreed to pay $16.3 million in fines in 2010 to settle claims that it gave kickbacks to doctors for using its labs. A whistleblower lawsuit filed by an Ameritox sales representative alleged the company made cash payments to physicians for drug test referrals and also placed personnel in doctors’ offices to collect urine samples for drug tests that were then billed to Medicare. Ameritox says its business practices have changed since the settlement. Another testing company, Calloway Laboratories, was indicted by a Massachusetts grand jury for an “extensive” kickback scheme for doctors. Calloway has denied the charges.
Concern about a “lack of boundaries” in drug test billing led the American Academy of Pain Medicine (AAPM) to warn its members about increased government oversight. “The use of clinical drug tests in pain management has become an area ripe for the submission of fraudulent and abusive claims for reimbursement and rampant ‘overutilization’ of laboratory services,” warned Jennifer Bolden, a former federal prosecutor who is a special counsel to the AAPM.
Mark Collen became an advocate for chronic pain sufferers after years of living with neuropathic pain caused by a herniated disc in his lower back. He runs the Pain Exhibit, a website that displays the art work of chronic pain sufferers.
“My pain was under treated for many years and I don’t want others to suffer unnecessarily as I did,” Collen wrote. “There may be an appropriate use for drug screens for individuals with chronic pain but that has yet to be determined. They need to do the research first before it is utilized.”