Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Opioid cheating is a billion-dollar industry

Giri Venkatraman, MD, MBA
Conditions
September 20, 2018
Share
Tweet
Share

If you search for “how to pass a urine drug test” on the internet, you will get several million results. As physicians, we see and manage the national opioid crisis every day. We see the impacts of this in our practices and our lives. The crisis frankly shows no signs of abating or becoming a less critical issue. Unfortunately, one major reason for our inability to control this issue might be in the testing. Most patients in the throes of addiction or recovery require regular urine testing as part of their treatment (which is much more common than blood, hair or saliva) and that has unfortunately led to widespread cheating. The cheating industry is equally or if not more lucrative than the opioid market.

Once a patient submits a sample for testing, each sample undergoes specimen validity testing. For most samples, this involves pH testing, specific gravity, and creatinine levels. One could easily circumvent the specific gravity and creatinine test by creatine loading — a supplement found very commonly in nutrition stores. Unfortunately, most physicians who do testing and bill for services (CPT 80305-7) in their office or send it to a commercial lab stop testing at this stage (pH, specific gravity and creatinine).

However, the cheating industry is much more technologically and reagent savvy. There are eight possible identified sources of subversion in addition to the pH and specific gravity. We have already mentioned creatine loading. Another method is to add small amounts of oxidant chemicals, glutaraldehyde or zinc (which destroy both the illicit drug and eventually the agents are gone in a matter of a few hours). Most commercial labs have a turnaround time of several hours — this is more than enough time for the oxidant chemicals to work. Artificial (lab-made) urine or freeze-dried human urine are also available and have been used successfully. Some employers have resorted to using cheek swabs or hair, but these are easy to circumvent using specially made chewing gum or mouthwash. The testing is also more costly.

The question on most of our minds is — how is this legal? Well, most of the oxidant chemicals have legitimate uses. Manufactured urine has been deemed illegal to sell in a few states and by some employers (one could lose their job if the employer were to find fake urine or their person or locker). However, the sale is legal to mattress firms, investigation of animal behavior, etc. This is the loophole that many manufacturers use. Such substances are easy to find on the internet.

The implications of such subversion are immense. The true incidence of this is unknown, but organizations such as Substance Abuse and Mental Health Services Administration (SAMHSA) have recognized this as a problem. In 2013, a study by SAMHSA showed a subversion rate of 2 percent. Frankly, subversion is probably much more common than published data, given that this is a lucrative business valued at about a billion dollars. As physicians, we rely on clean data to manage this tough population of patients and prescribe further narcotics or medications like methadone or suboxone appropriately. Further research is underway to understand the scope of the problem and address the various methods used to subvert testing. In the interim, we have to rely on our good judgment and clinical acumen as scientists attempt to defeat the subversion market.

Giri Venkatraman is an otolaryngologist.

Image credit: Shutterstock.com

Prev

Happy National Grateful Patient Day!

September 20, 2018 Kevin 1
…
Next

Looking for the silver lining at supervised injection facilities

September 20, 2018 Kevin 0
…

Tagged as: Medications, Nephrology

Post navigation

< Previous Post
Happy National Grateful Patient Day!
Next Post >
Looking for the silver lining at supervised injection facilities

ADVERTISEMENT

More by Giri Venkatraman, MD, MBA

  • Here’s why this doctor came around to single-payer insurance

    Giri Venkatraman, MD, MBA
  • a desk with keyboard and ipad with the kevinmd logo

    Perioperative team training: Can we learn from basketball?

    Giri Venkatraman, MD, MBA

Related Posts

  • The dangers of opioid addiction in the medical industry

    Anonymous
  • Settlements in the opioid cases need these non-negotiable conditions

    Rosanne Aulino, RN
  • The other opioid epidemic that we ignore

    Hans Duvefelt, MD
  • The opioid crisis: Doctors cannot lose hope

    Linda Girgis, MD
  • Marijuana will not fix the opioid epidemic

    Kenneth Finn, MD
  • Fight the opioid crisis with physician assistants

    James Cannon, PA-C

More in Conditions

  • Why peer support can save lives in high-pressure medical careers

    Maire Daugharty, MD
  • Addressing menstrual health inequities in adolescents

    Callia Georgoulis
  • Healing beyond the surface: Why proper chronic wound care matters

    Alvin May, MD
  • Why specialist pain clinics and addiction treatment services require strong primary care

    Olumuyiwa Bamgbade, MD
  • What a childhood stroke taught me about the future of neurosurgery and the promise of vagus nerve stimulation

    William J. Bannon IV
  • Facing terminal cancer as a doctor and mother

    Kelly Curtin-Hallinan, DO
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Opioid cheating is a billion-dollar industry
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...