Passing a Urine Toxicology (drugs of abuse) before treatment policy?

[Soul-ution09]

Hi, I'm new to the forum, and new to what I should expect. I was diagnosed with hep c about 2 months ago, and had to have had it for at least 20 years. Now, ready to start treatment, I learn I must first submit a urine sample to look for drugs of abuse.  I was even more shocked when I had an escort accompany me to the restroom. Can someone fill me in as to why they do this? Is it for insurance reasons? I mean I've been reading some of your stories and seems like a lot of differences in who gets what and why. Kind of has me worried as to how sick I have to be before my insurance will help me. I can't possibly pay for what I've been hearing is the cost of these treatments.

I don't have anything to hide or worry about, but what if I did? What happens to people who have positive results? Do they not get treatment or something? Have to go to rehab, first?
I just think that is wrong, denying treatment for someone with a deadly disease, just because he has weed or coke or whatever in his system. I do have a history of drug abuse...that's how I got hepc. But the last time I was involved with that lifestyle was 23 years ago.
I have legal prescriptions for the drugs I use (not abuse) now. I hope that doesn't go against me, since one of them I have to pay for... and it is a drug that has many land in jail for being under the influence.

Anyways, I'm sure I'll have a lot of questions as this is the beginning of an unexpected journey I know little about. Thank you for being here, too, as I have no other support.

[gnatcatcher]

Soul-ution09, my hepatologist (the go-to HCV guy in a large hospital system) and his nurse informed me last May that they have the lab test everyone for drugs because "the insurance companies expect it." Whether every single insurance company expects it is something I have wondered -- my hepatologist & nurse seem to do the maximum insurance preparation on everyone just in case a particular insurance company wants it. The drug screens were a one-time thing prior to insurance approving my Harvoni. The lab I went to didn't have anyone accompany me to the restroom -- that must've made you feel even more stigmatized.

You can't know ahead-of-time how easy or difficult the insurance approval process is going to be. Should your insurance company turn out to be $%#@*, you'll get plenty of tips on these forums on how to appeal and/or how to get help with treatment costs. One step at a time. Good luck!

Gnatty

[Soul-ution09]

Thank you gnatcacher, you've helped me to better understand why they do it ....but, yea, they should lighten up on how they do it. I even said to the lab lady, "What?? Is this? A new government enforcement team...Doc Cop?"

Creating new jobs doesn't get much better. Yikes!

Well thank you for the tips...and support. These days ahead are gonna be just fine with all the help around here. But, it's going to have to be one step at a time, even a few stepping back over steps again. I have to go back to the lab today, so I can try again what I was unable to do yesterday...pass a urine sample, to the lady. 

[lporterrn]

It is a policy that horrifies me because it is discriminatory and not medically based. Be sure your medical provider knows what meds may show up before you take the test - there are less likely to be problems if there are no surprises.

Here is what the HCV Guidelines say about treating injection drug users, and it could be applied to all questionable tox results:

Ideally, treatment of HCV-infected persons who inject drugs should be delivered in a multidisciplinary care setting with services to reduce the risk of reinfection and for management of the common social and psychiatric comorbidities in this population. Regardless of the treatment setting, recent and active IDU should not be seen as an absolute contraindication to HCV therapy... there are no data to support the utility of pretreatment screening for illicit drug or alcohol use in identifying a population more likely to successfully complete HCV therapy. These requirements should be abandoned, because they create barriers to treatment, add unnecessary cost and effort, and potentially exclude populations that are likely to obtain substantial benefit from therapy.

http://www.hcvguidelines.org/full-report/when-and-whom-initiate-hcv-therapy

[Mike]

Regarding drug urinalyses: It is a standard protocol in many testing facilities to have a supervised urine sample/draw. The reason for this is simply that  there are many ways to "cheat" the test, which I wont go in to.

The urine is also checked for color and temperature and can be rejected or deemed "dirty/invalid" by these measures. This is because of use of products that "mask" certain drug metabolites or watering down the sample.

Weather right or wrong, this is how the drug testing system works.

Best wishes, Mike

. 

[Soul-ution09]

It is a policy that horrifies me because it is discriminatory and not medically based.

I am not sure how to quote someone...

I totally agree. People should not be made to go untreated (for a life threatening disease)because their personal behavior patterns are labeled under the Criminal Justice Department. It's inhumane...it's unfair...it's discrimination...it's a double standard and it goes against the grounds on which our Medical Health System was built.

But then again, the disease of addiction has never been treated as a health issue. But rather a Crime.

Not everyone who has been diagnosed with Hepatitis got it from sharing needles, but all of us seem to be treated as if we did.
As for myself, there is no denying that is how I got it. But THAT was well over 20 ago...in fact, now looking back, it has been closer to 30 years. I don't keep track of how long it's been..because I know those days will never be again.
So I'm not worried about my urine having something illegal showing up. I just feel strongly about the way people infected with HCV are being strictly treated. Just my personal opinion.
In the meantime, I sit infected while I wait to hear from, whoever is in charge, if I am going to have help with paying for the meds I need to survive. And, hopefully cure this monster before it gets the best of me. It also, is unfair that I might have to get even sicker before I can get any help. But it is what it is and I remain positive regardless.

[The Terminator]

when i was asked about smoking pot i thought i should be truthful,i told them when i was on chemo i smoke for the full 10mons i had medical card,then i had a relapse in 2015 and another major liver operation,i was wasting away so i used medical brownies
for six weeks after operation,they asked when was the last brownie i told them 2weeks ago during the interview to get approved,before the interview i took a blood test for a heart med that interacts sometimes with harvoni and beomes very toxic,i didnt know if they tested for weed,so if they did i didnt want to get caught lying,thats why i told them the truth,they didnt say anything my case was turned over to the hepc panel nxt day they called that day saying im approved and started harvoni nxt day,my partner she smoked a pack of cigs aday and was one of first to get sovaldi,also was on transplant list,towards end of tx she drank everyday,and smoked pot,at eot she was svr cured,but they snuck a drug test on her and kicked her off transplant list,and she knew they would,dont follow her example please,to force someone to take drug test to get tx seems to violate 5th ammendment and possibly 4th, but i guess its up to insurance companys,and court would prob rule in their favor,if you are going to ask for harvoni clean out and test yourself before asking,cause you might be approved quickly and you need 30-60-90 days depending on your usage to clean out,dont take risks like my partner did

[Mike]

That's great news! I'm glad you got approved!


Best wishes, Mike

[sapphire101]

I do not understand why some of us are drug tested before HCV treatment is approved.
Drug testing is not required for diabetic medication, heart medication, chemotherapy and on and on. Why just for the direct acting antivirals? The disease we are trying to get treatment for is infectious and communicable and needs to be stopped before more people get it. Enough said! This drug testing is shaming mentality at its worst. I am sorry that happened to you Terminator and anyone else who had to go through it.

I do understand the need for substance testing before organ transplantation because someone else died (or went to a lot of trouble) to give you that organ...I would not totally kick you to the curb though maybe put you in the back of the line to get cleaned up and start again.

If I could figure out how to quote there would be about 5 of them in this post!

[amell]

I totally agree. People should not be made to go untreated (for a life threatening disease)because their personal behavior patterns are labeled under the Criminal Justice Department. It's inhumane...it's unfair...it's discrimination...it's a double standard and it goes against the grounds on which our Medical Health System was built.

But then again, the disease of addiction has never been treated as a health issue. But rather a Crime.

This is true even at drug treatment facilities. Patients, though called patients are still treated as criminals. Over my heroin using days I went to 6 different treatment places and each and every one of them treated patients like criminals.
I spent over 10 years in methadone treatment, but wouldn't do it again even if I started using again. instead i would use kratom and treat myself at home without all the BS treatment facilities put people through.
I'm not sure there is a thread here about kratom, but if not there should be.

[dragonslayer]

I think one of the reasons testing is done is that, naturally, insurance companies are loathe to pay the high cost of treatment among a population that is at particularly high risk for reinfection. Parenthetically, up until recently, most of us had to jump through hoops to get treatment even if our behavior was above reproach.  Im not sure its as much a matter of  discrimination against IV drug users as  has been postulated here, but discrimination against paying for treatment for a high risk population likely to reinfect.    Certainly, not everybody who has HCV was infected by the needle, but a high enough percentage were so that it's not hard to understand why it would be a concern.  To me, I dont think its such a huge stretch to understand why they might want evidence of being 6 mos clean of IV drugs before agreeing to cover.

[amell]

I think one of the reasons testing is done is that, naturally, insurance companies are loathe to pay the high cost of treatment among a population that is at particularly high risk for reinfection. Parenthetically, up until recently, most of us had to jump through hoops to get treatment even if our behavior was above reproach.  Im not sure its as much a matter of  discrimination against IV drug users as  has been postulated here, but discrimination against paying for treatment for a high risk population likely to reinfect.    Certainly, not everybody who has HCV was infected by the needle, but a high enough percentage were so that it's not hard to understand why it would be a concern.  To me, I dont think its such a huge stretch to understand why they might want evidence of being 6 mos clean of IV drugs before agreeing to cover.

I have to admit that were I to pay a boatload of money for someones treatment I'd want them to show me they're clean, but treating people as automatically suspected of criminal behavior is no way to befriend them.
There has to be a better way, but just asking people to show they're clean isn't necessarily pointing the finger of blame. Sometimes i think people are always looking for excuses to exclude people from treatment. It's still better than what we had several years ago when not having medical insurance was akin to just wheeling folks to the curb.
Believe it or not I found out that if you have no medical insurance and are turned down for treatment at the hospital just tell them you're suicidal over it. They'll sell a wing of the hospital to cure you once they think you might kill yourself. You're not permitted to kill yourself. That's their job.

[Lynn K]

It must also be a difference of insurance providers. Back a life time (38 years) ago I did contract hep c by the highest probability of method of infection back in my Army days when I was 19 years old. Three times but that was enough it seems.

That little nugget of information is even in my medical records. But I was never asked about current drug use or required any testing to confirm my non using status.

It would not be an issue now as I am clean as a whistle for many years but still makes one wonder why I was not asked when so many are.....

[FutureThinker]

I have posted on this forum under several different topics, sometimes angrily, regarding the misunderstanding this country & our medical "professionals" have about substance use/abuse/addiction/mental health. We have got to change this criminal approach and treat this problem for what it is: a health issue! We need to help people figure out why they want/need to take drugs, what personal needs are present that lead them to take drugs and help them learn how to have a more fulfilling and happy life w/o drugs. For many, how HCV was contracted was a tiny, thin chapter in one's life (as Lynn mentions above), but people are often treated w/ very little empathy. The stigmatization has got to change, and luckily it appears there is more conversation happening now about changing how addiction is approached.  But it's going to take some time, as most change does. In the meantime, let's be thankful that HCV treatment coverage is finally getting easier and more available to more people, because unfortunately, there is currently an epidemic of heroin use in this country. FT

[Baxter]

This is true even at drug treatment facilities. Patients, though called patients are still treated as criminals. Over my heroin using days I went to 6 different treatment places and each and every one of them treated patients like criminals.
I spent over 10 years in methadone treatment, but wouldn't do it again even if I started using again. instead i would use kratom and treat myself at home without all the BS treatment facilities put people through.
I'm not sure there is a thread here about kratom, but if not there should be.

One of the things I received in my "new patient" packet was a list of natural supplements that supposedly should be avoided during treatment with Harvoni, and kratom was on that list. Apparently there is some research suggesting that it can cause abnormal liver function, although the PA said that some of the substances were not necessarily known to be problematic - there just isn't enough information on them yet to know for sure. I remember passionflower was another on that list; I noticed it because my wife sometimes uses it for sleep. Several of the supplements, I'd never even heard of before, but I was surprised to see some of the ones that were listed.

Most of those (including kratom) would never show up on a drug screen anyway, though. To steal a line from "Pirates of The Caribbean," it's probably more of a guideline than a rule.

[Baxter]

It must also be a difference of insurance providers. Back a life time (38 years) ago I did contract hep c by the highest probability of method of infection back in my Army days when I was 19 years old. Three times but that was enough it seems.

That little nugget of information is even in my medical records. But I was never asked about current drug use or required any testing to confirm my non using status.

It would not be an issue now as I am clean as a whistle for many years but still makes one wonder why I was not asked when so many are.....

What I found surprising was that when they drug-tested me on my initial appointment, I tested positive for two abusable substances (a pain medication that I occasionally take for an arthritic back, and a benzo sleep aid) and they never even asked me about them. The doctor went over the results with me and said, "Oh, I see you take such-and-such and this-and-that," and then went on to the next page. Never even asked me if I had a prescription for either one. I thought, "well, what the heck was the point of that, then?"

[General Hamilton]

A lot of insurance companies require it, but you can still get the treatment even if you fail.

[Endless77]

I agree with both sides on this one. There is no need to drug test every person seeking treatment, but it does make sense to be concerned that IV drug users are at a higher risk of reinfection than others with HCV. DAAs are expensive as hell, and for insurance companies bearing the lion's share of the cost, why pay so much for treatment on someone who might end up infected again? Btw, I was infected as a result of past IV heroin use.
That being said, it makes absolutely no sense to test for marijuana for anyone seeking treatment. I'm not sure what panel the insurance companies are using for their tests, but I would think only positives for heroin or meth would raise alarm. Marijuana does nothing to prove risk of non-compliance/reinfection risk.

[Mugwump]

On the issue of drug abuse: I see the problem lying in the fact that socially we have a history of blaming the victims. Much of today's drug problems begins with a willy nilly approach to the over prescription and overuse of over the counter pain medications.

Long before substances like pot became illegal our ancestors understood well that the long term abuse of this substance could indeed effect us. Hashish was give to thuggees to help them overcome guilt as they murdered for their bosses. So strong versions of this drug do effect us in ways that are criminal. Even alcohol can be used as a tool by criminals. Mafia chicken hawks do this all the time to recruit prostitutes. 

Cocaine, it's variants and strong uppers were used as stimulants to spur on both workers and soldiers during the second world war. BY BOTH SIDES IN THE CONFLICT! One of the worst junkies was Adolf himself. 

We were not exactly sainted in our doings to say the least. I am ashamed to say that Canada went along with what the CIA did to some people with drugs even up to the Vietnam conflict.

So it does not at all surprise me that we have developed a culture of blaming the victims of drug abuse, instead of a "war on drugs" the truth is we have a war on victims.

Anyway I think I will go have a smoke (tobacco type) then write some more music instead of trying to preach on this subject.  I have lost good friends to both drugs and this disease and in truth had to pull myself out of the drug scene in 1970 or I might have become a victim of street drugs as well as HCV which is most likely when I acquired the disease. I have never regretted dumping the drug scene and stopping association with those who are in it, it was the best decision I ever made.

To those who do have drug problems to deal with as well as HCV, I can tell you that it does take changes in relationships sometimes to overcome street drugs. And it is certainly not a selfish act to end abusive drug relationships.

Eric   

[andrew j]

Sometimes I think about the huge cost of drug and alcohol abuse.