Controlled Medication Agreements

Controlled Medication Agreements for controlled substances are an important part of pain management. For the patient, they offer informed consent on the dangers of longterm opioid therapy and clearly explain the expectations and monitoring requirements of the practice. For the physician, they can offer significant legal protection. This document is offered for educational purposes only and is provided "as is". It is not intended to provide any legal advice or supplement legal counsel. Before initiating any agreement within your practice, I would run your your agreement by a pain medicine specialist and a lawyer. Click here to download a PDF version of this document. Best wishes!

Detecting Fentanyl on Urine Drug Screen?

This is an awesome tip that I learned from Dr. Carlos Dumois (who is also faculty here at Florida Hospital Family Medicine Residency)... 

Like oxycodone, fentanyl will not typically be detectable on a standard urine drug screen (i.e. opioids will likely be negative). According to the Mayo Clinic Proceedings: it is undetectable not because it has no metabolites (it does), but because the chemical structures of fentanyl and its metabolites differ radically from those of opiates (ie, morphine and codeine).

To screen for diversion, specific confirmatory testing needs to be orders. Confirmatory testing needs to be ordered for oxycodone also.

Alcoholism and high HDL in men?

There seems to be a high correlation (at least in men) between high HDL and alcoholism in my practice. I often ask about alcohol use (and sometimes ask the "CAGE questions" to screen for alcoholism) in men with very high HDLs. This correlation is not always true since many other factors can raise HDL. But the correlation occur frequently enough for me to do a minor screening for alcoholism in my population.

Oxycodone and Urine Drug Screens

Oxycodone (Percodan, Percocet, Roxicodone, Oxycontin) does not show up on most urine drug screens (but at high levels it may show up as positive opoids). To screen for diversion, I specifically order a urine oxycodone quantitative level (NOT qualitative level) for those patient who are taking oxycodone products for chronic pain.