Prescription Universal Precautions

bigstock-A-doctor-holding-a-urine-sampl-34628564When doing a procedure that will expose you to blood or body fluids do you wear gloves? Of course you do. Universal precautions are standard of care and a good idea. If your patient guaranteed you that he did not have any infectious disease would you decide not to wear gloves? Of course not. That’s why we call it universal precautions.
When our patients tell us that they don’t have addiction problems or use drugs do we always trust them? With the amount of diversion of prescription medications that takes place should we trust them? I practice universal precaution when prescribing narcotics and other controlled substances on a chronic basis. I have done so for years. My patients sign a controlled substance agreement and participate in urine drug screening that can be verified by gas chromatography.
When prescribing controlled substances red flags frequently pop up: early prescriptions, lost prescriptions, a report of multiple providers or multiple pharmacies, to name a few. By practicing universal precautions we do not discriminate based on age, sex, religion, or physical appearance. It just makes sense and adds a tool to our ability to safely and responsibly prescribe controlled substances. We can not only verify that a patient is not taking unprescribed medications or street drugs but we can verify that they are compliant with the medications being prescribed. (At least to some degree)
It is important to know the limitations of urine drug screen testing. For example, clonazepam and its metabolites do not always show on urine benzodiazepines. Oxycodone is a synthetic opioid and does not always produce positive results for urine opiates. When discrepancies occur, verification with gas chromatography is vital. When initiating a program of prescription universal precautions be prepared to be surprised at what you will find. Before doing so make sure you are informed and confident in your knowledge of urine drug screening.

CHART

Below is a link to a 96 page guide produced by the US Government.

Drug Testing In Primary Care

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