[*Laurie*]

Today I went to my first appointment with a new psych (medication management). I had an hour-long intake, part of which involved her asking me about any smoking, drinking alcohol, or substance/drug use. I told her I have no history of any substance use, which is true. I don't even drink wine or beer because I don't like alcohol.

The last thing the psych said, at the very end of the intake, was that I would be taking a urinalysis (tox screen). I agreed to it, but I felt odd...I mean, if they don't trust me why should I trust them? I've never had a pdoc drug screen me before. I'm wondering what others' experiences are with this?

[DisorganisedMind]

I've never had it either and I have dabbled in substances (weed anyway - and I did try a few other things as a teen but only once or twice out of curiosity). I just told the doctor or psychiatrist or whoever was asking the question the truth if they ever asked. It's not something I feel entirely ashamed of, or at least not too ashamed about to be able to talk about it in the right company, as it all felt necessary at the time. There's things I'm more ashamed of.

If you're clean anyway then I don't suppose it matters. If the trust thing bothers you then just assume this pdoc has a system of screening everyone as a matter of course rather than selectively picking you out through lack of trust. I notice a lot of companies are starting to do that in the job market. Good thing my old work never or they'd have no staff.

[LiteraryLark]

What makes you think they don't trust you? This is exactly why people with mental health issues don't ever get to a "normal" level and just remain spinning in circles...because they don't trust their doctor and go against their doctor's wishes or do things that eventually hurt themselves because they try to self-medicated or don't follow the directions from their doctors or the labels on the bottle. Please...trust your doctor. It's JUST a pee test. Seriously, it's NO BIG DEAL.

I've done pee tests before. They are looking for anything that might conflict with your medications.

[amandalouise]

Originally Posted by LauraBeth

Today I went to my first appointment with a new psych (medication management). I had an hour-long intake, part of which involved her asking me about any smoking, drinking alcohol, or substance/drug use. I told her I have no history of any substance use, which is true. I don't even drink wine or beer because I don't like alcohol.

The last thing the psych said, at the very end of the intake, was that I would be taking a urinalysis (tox screen). I agreed to it, but I felt odd...I mean, if they don't trust me why should I trust them? I've never had a pdoc drug screen me before. I'm wondering what others' experiences are with this?

many mental health agencies and states in the USA are requiring drug testing. its not a situation of not trusting clients.

many states have or are legalizing medical and recreational marijuana use. many psychotropic drugs (in other words antidepressants\anti anxiety\anti psychotics ...) cause problems for some people.

the result of these new legalizing laws is that some mental health agencies are now required by law to administer drug testing as a precaution and in order to keep their certifications as a mental health agency.

think of it like going to a medical doctor, no matter why you go in to see the doctor there are some things that the medical doctor has to do every time you go in.

thanks to legalizing marijuana more and more mental health agencies are required by state law to do a drug test as a preventative care\ basic care situation.

some medications also require periodical blood or urine testing, to keep the dosage levels on track. not over dosing nor under dosing.

my suggestion talk with your treatment provider, they will be able to explain why they drug tested you even though you answered no to the basic questions concerning drugs.

[Nammu]

That would alarm me, a micro management style...don't like a holes like that.. Therapy is based on trust, without that there is nothing.

[googley]

A pdoc is the same as your medical doctor. The pdoc is a medical doctor. The pee tests usually test for a number of things in addition to checking for substances. The doctor needs to make sure you are medically healthy for the medication. If they don't they aren't doing their jobs. Given that pcps and pdocs don't communicate, often pdocs have to order their own tests instead of going off of what you would have been tested for when you went in for your annual physical with your doctor.

[yagr]

Originally Posted by LauraBeth

I agreed to it, but I felt odd...I mean, if they don't trust me why should I trust them?

100% agree.

[Noca86]

Can't remember if I ever had urine tests done for pdocs before but I did twice for my pain management doctor, which didn't show anything abnormal. I wouldn't really care if they ask me and I would be happy to provide evidence to back up any claims I make, and I would expect the same from them.

If a doctor wants to question whether or not I am still struggling to sleep with 6+ different sedating drugs in me, I would be more than happy to video tape my nightly struggle along with providing a smart watch digital readout of how ****** my sleep is. That way they can't come up with any excuses to argue with me. If they want to make a claim, like blaming something on just anxiety, I would require them to show me the evidence. I don't trust them and if they don't trust me, they better tell me which forms of evidence they require to prove my argument or position. If they can't offer any or refuse to look at any evidence I provide then I don't even care to see them ever again because I don't have any patience left for close minded ignoramuses.

Hmmmm. Don't like that idea at all; but, as I'm so nonconfrontational I would find myself just doing it without saying anything.

[avlady]

doctors have to be worried about being sued and such, they have to take every precaution before they give meds.

[IrisBloom]

A urine test can tell many things about your health, not just test for drugs.

[*Laurie*]

Originally Posted by Nammu

That would alarm me, a micro management style...don't like a holes like that.. Therapy is based on trust, without that there is nothing.

Exactly how I felt. Micro-managed. I suppose if the pdoc would have told me right from the start that she routinely does tox screens, and explained why she does them, I would have felt more at ease. As it was, we finished the long intake and *BANG* she steps outside her office and calls a nurse over, nurse hands me a test cup and the doc says, "You'll need to do a tox screen before you leave." It was like HA. WE GOTCHA NOW!

It felt more like law enforcement than psychiatry to me. Part of the problem is how I feel about the pdoc's whole style...she was very rough around the edges, suspicious...intuitive, but well...she really reminded me more of a cop than a pdoc.

All in all, there was a sense of mistrust on the part of the pdoc from the moment I stepped into the office, and her odd attitude put me on the defensive. I found myself becoming very anxious and unable to tell her some of the things that are really bothering me these days. Since I have never had a substance use problem and am not in treatment for that reason, I was dismayed to find that the approach of the clinic seemed to be based on deception.

The pdoc ordered blood work and I'm absolutely fine with that. As for "checking my health" - if that was her intention, I could have done the pee test at the same time I do the blood test. No, the pee test after the visit was most definitely about checking to see if I substance abuse - to catch me in case I was lying about drug use. I'm a really fragile person these days and I need a therapy situation that is nurturing, not one that causes me more stress. I'm pretty sure I'm going to continue to check around in my healthcare plan and see if I can find another pdoc (I was seeing a wonderful one, unfortunately, she left her position...I really miss her.)

Thanks very much for all of your input. I appreciate it.

[(JD)]

This came in with the crackdown on drugs, narcotics specifically.... the closing of pain clinics and the farming out of patients to government approved facilities.

EVERYONE has to have urine tests periodically if they are taking certain meds.

IF you are on the up and up with taking the medicine as prescribed and not taking anything not prescribed, it's not going to harm you. (Other than the breech of privacy that the Constitution says we have!)

They can verify that you are taking the drug...and not selling it.
They can verify that you are not taking non-prescribed drugs to augment your reality.
They can help analyze how much of the med is being used by the body (they ask when you last took some and how much, right?) and if you say you need more, the urine can help them realize that you might just need a different dosing.

The government makes them do this. It's a hassle to say the least. I would rather do the urine test than the mouth swab thingy... it stays in your mouth until it has enough saliva to register the drug level...but my mouth dries up and I can't even swallow and then I can't talk and then I can't breathe because the whole way is dried! UGH.

[Thunder Bow]

Those tests are to authoritarian, and seems more like law enforcement. Testing for a medical condition is OK, but a drug test is not OK. Beside a pdoc can tell if you are on drugs just by doing therapy with you. Then if the therapist suspects drug use, then he can order a drug test.

[*Laurie*]

JD, the pdoc didn't ask me anything about when I last took my medication. I've never had any other pdoc I've seen (I've seen many) do a urine test. Your post makes plenty of sense...I guess I just would have felt better if the doctor told me right off that we'd be doing a pee test, rather than me trusting her with my history and such, then she has some nurse come out of the shadows and escort me to the bathroom like I was most certainly up to some kind of criminal activity and they wanted to find out what it was

[*Laurie*]

Originally Posted by Thunder Bow

Those tests are to authoritarian, and seems more like law enforcement. Testing for a medical condition is OK, but a drug test is not OK. Beside a pdoc can tell if you are on drugs just by doing therapy with you. Then if the therapist suspects drug use, then he can order a drug test.

I agree with you. I guess overall I would feel better about a pdoc who uses her experience and intuition rather than springing a test on me at the very end of an intake session, a test that is more about law than medicine.

I just had a session with my therapist (whose office is literally right next to the pdoc) & I told the therapist how I felt at yesterday's appointment...like I was being accused of substance abuse, or like I was drug-seeking, when I have absolutely no history of either. The therapist was kind, but she said that a lot of people do come in looking for drugs, etc.

Ahhh....I just resent the whole situation.

[Serzen]

Well I agree with the people that say it's a good thing for you. I don't think they're not trusting you, isn't that statement a bit immature?

Although it may be tedious, it's always good to do a check-up.
I should do one, too.

[*Laurie*]

Originally Posted by Serzen

Well I agree with the people that say it's a good thing for you. I don't think they're not trusting you, isn't that statement a bit immature?

Although it may be tedious, it's always good to do a check-up.
I should do one, too.

I need to make it clear in this post that the urine test was not done for health purposes, it was done to check for drug use.

Obviously, I am all for a urinalysis or blood work to check on my health. That's not what this was about, however.

[Serzen]

Originally Posted by LauraBeth

I need to make it clear in this post that the urine test was not done for health purposes, it was done to check for drug use.

Obviously, I am all for a urinalysis or blood work to check on my health. That's not what this was about, however.

Ok sorry and thanks.

[Nammu]

Except for benzos I can't think of anything a Pdoc is going to prescribe that is drug seeking! If the pdoc is so uncertain of her ability to recognize those who are drug seeking benzos maybe she should switch to being a GP where they are no longer prescribing any addictive meds, just handing out referrals. This is a Pdoc office not a pain management clinic. The pain management clinic I went to was very upfront about it all. This just seems sneaky and judgmental.

After I read your comment about how they approached the whole thing by nabbing you after the fact to "get" you before you left the whole thing stinks of Nazism.

[IrisBloom]

I'm pretty sure that they have to let you know if they are doing a drug screen in advance. It was probably routine for that doc/clinic, but still sneaky. You should be told the process before hand and then you can decide to go through the whole thing or not. I could be wrong.

Add: I don't think I would trust them after that either.

[*Laurie*]

Well, that she sprung the urine test on me at the very last second, with absolutely NO discussion of it beforehand was so odd. I mean, I was literally leaving her office, going through the door when the nurse appeared with a plastic cup and the pdoc said, "Time for your tox screen!"

This pdoc, btw, is ADAMANTLY opposed to benzos. Before she said anything else during the intake she looked at my paperwork and announced, "Well, I can tell you right now that we're getting you off that Klonopin!" Scared the crap outta me...I DO want to withdraw from Klonopin, BUT I've been on it for about 20 years...she was so weird about the Klonopin, like she was immediately accusing me of drug-seeking. I did tell her how I felt about her approach and that I was very anxious and shaken up by the way she acted about me being on Klonopin - especially because I have never, ever abused it. She assured me that we'll go off the Klonopin slowly, and that I shouldn't be so scared...still made me uptight.

[yagr]

Originally Posted by LauraBeth

She assured me that we'll go off the Klonopin slowly, and that I shouldn't be so scared...still made me uptight.

My experience has been that it is reasonable to be scared of people who tell me how I should or should not feel.

[(JD)]

I resent it too, immensely. And no, the government requires them to do this and they don't have to give us any warning as to what visit it's done.

Without getting into the political side of things, this is just another area when the government is in essence punishing those of us who keep the law. On this topic, IF the government had been the watchdog over us that it was supposed to be over the pain clinics, there would not have been a mess. Of course those who were shady created "pain centers" and connected with "insurance" fraud cons and dispensed at will...no real oversight. So to stop them, the government took over the pain clinics...errr .... closing most of them and even forcing good, caring, LICENSED medical doctors to stop prescribing because of all the hoops/red tape and transfer all their pain patients over to a few places... which are supposedly highly watched by said government. Meanwhile the meds are sold illicitly on the streets by the shady people.

And we have to succumb to long waits in crowded waiting rooms like cattle and submit to drug testing. Go figure.

[*Laurie*]

Originally Posted by (JD)

I resent it too, immensely. And no, the government requires them to do this and they don't have to give us any warning as to what visit it's done.

Without getting into the political side of things, this is just another area when the government is in essence punishing those of us who keep the law. On this topic, IF the government had been the watchdog over us that it was supposed to be over the pain clinics, there would not have been a mess. Of course those who were shady created "pain centers" and connected with "insurance" fraud cons and dispensed at will...no real oversight. So to stop them, the government took over the pain clinics...errr .... closing most of them and even forcing good, caring, LICENSED medical doctors to stop prescribing because of all the hoops/red tape and transfer all their pain patients over to a few places... which are supposedly highly watched by said government. Meanwhile the meds are sold illicitly on the streets by the shady people.

And we have to succumb to long waits in crowded waiting rooms like cattle and submit to drug testing. Go figure.

Good post, JD. Go figure is right