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Drug Screening & Your VA
Have You Been "Drug Screened" By Your VA Clinic?
The Veterans Health Administration (VHA)has a little known (and apparently unenforced)
policy that requires practitioners who are authorized to order laboratory tests to give you informed
consent prior to a drug screen. VHA HANDBOOK 1004.01 Page 7; "(b) Information about certain
tests must be considered “information that a patient in similar circumstances would reasonably
want to know” because these tests are particularly sensitive and may have consequences
that the patient might reasonably want to avoid.
These tests include, but are not limited to, specific tests to identify illicit drug use..."
In April 2017 VAWatchdog asked the Secretary to explain the VHA policy for screening
veterans for illicit drug use. Read the reply as a web page here. Note that the VHA
Handbook has been updated for distribution after we inquired.
Bottom line: You have a right to be fully informed before any drug screen. The ordering
practitioner must document that you were given informed consent for a drug screen.
If you have been drug screened and not fully informed as to the reasons for the drug
screen, you can have that removed from your medical record.
Read all of this as a full web page.
Do You Take Opoid Pain Medicine?
Listen up!
Have you had prescriptions for Codeine, Fentanyl, Hydrocodone, Hydromorphone,
Meperidine, Morphine, Oxycodone or Tramadol to treat your pain? Have you been
notified that your doctor isn't going to refill your prescription?
We are being inundated with emails and messages from you about how VA won't refill your
pain medicine prescriptions. Most of you are very angry. Some of you have already started
calling your Congressperson or a local VSO for help getting a refill on your Vicodin. Quite
a few want me to tell you who you can complain to at VA to ensure that your refills of narcotics
continue uninterrupted, just like always. You all blame this on the damned VA.
The facts aren't all that elusive. This is happening to you because the law has changed. The VA
didn't change the law, the push for the change happened at the Drug Enforcement Agency (DEA).
The DEA decided the potential for abuse and risks required tighter restrictions than in the past.
This affects every doctor across America, not only VA doctors. When you tell me that your
civilian doctor always refills your narcotic prescriptions, that lets us know you haven't been to
a civilian doctor lately. The DEA controls their license to prescribe. If the doctor doesn't
follow the new rules, he or she may quickly lose that privilege. Many doctors have decided
they will no longer write any narcotic prescriptions. The narcotics prescriptions of the future
will be written mostly by surgeons for short term treatment of pain caused by operative
procedures. Chronic and long term pain relief won't generally be treated with narcotics.
One problem you're confronting is that the more you ask for your narcotic prescription to be
refilled, the more you appear to fit the profile of "drug seeking behavior". Once you display
anger because you ran out of Vicodin, you get that label and you're even more unlikely to
get any sympathy. Our advice? Talk with your primary care doctor. Be open about it if you
may be dependent on narcotics and you need some help to leave them behind. Don't get angry.
The VA isn't putting up with your anger these days. Before you raise your voice, look around. The VA
police are serious in their work and will have you on the ground before you can say much.
If you want to complain, give the DEA a call. Tell them that you have the right to get narcotics free
from VA. Get really pissed with the agent. They'll be happy to hear from you.
The Pain Contract
Your VA and many civilian providers today will insist that you sign a "Pain Contract" if you
are on any sort of pain medicines for more than a very brief period.
The reasoning behind this is controversial.
There is a common misconception that veterans who receive any sort of pain
medicine are likely to resell it at a very high profit. Like most of the rumors
that are published about the American "War On Drugs" there is little truth to this.
The majority of veterans who receive pain medicines from VA are just like you and
they have no reason to want to sell their medicines. The bulletins would have
you believe that every pill is worth an enormously inflated price
and that vets can get rich by selling their medicines.
The result of all this is that you are likely to be tested to ensure that you're taking
your medicines. Once you sign the pain contract you give VA the authority to test
you at any time. They are not required to tell you that you're being tested for drugs.
If you aren't taking your drugs at the time of the test, your provider may not
extend any more refills.
If other drugs (such as marijuana) are seen during the test, you may or may not be
counseled. That depends on the individual provider.
Pain contracts threaten the doctor-patient relationship
Pain contracts can undermine patient trust
The VHA Directive on Pain Management
Drug Tests
http://en.wikipedia.org/wiki/Drug_test
Much of the testing in both civilian and VA and military settings is done with a
standardized 4 drug detection kit. The test of your urine would show the presence
of narcotics (Vicodin, Oxycontin, morphine, etc.). marijuana, cocaine (or crack) and
amphetamines. In some tests benzodiazepines (Valium and similar) may be detected.
Therefore, if you are tested to ensure that you are taking your prescribed medication
and you have been smoking marijuana, you'll likely get a call from your doctor.
Some VA doctors won't tolerate your marijuana use at all. Others don't pay it any attention.
The Department of Veterans Affairs doesn't
care much about you smoking marijuana.
You won't lose a benefit if you're smoking marijuana.
The only people who are concerned are in the health care arena of the VA...your doctors.
Most enlightened physicians recognize that marijuana has some medicinal benefit
and that there is no evidence of harmful side effects other than the obvious...inhaling
hot smoke. Most agree that the single most devastating side effect of recreational
marijuana use is that it remains illegal and you may be arrested for it.
Having said that, your doctor may feel differently. If your doctor makes a decision
that you shouldn't be smoking, he or she has the right to ask you to stop. Few people
will try to help you with that sort of problem as the doctor is the
clinical authority and makes those decisions.
Most mental health providers will ask that you refrain from all recreational
substance use. If you are diagnosed with any mental health problems, your doctor
will want your head to be as clear as possible during treatment. You should comply.
Doctors who treat your chronic pain with narcotics may also tell you to lay off the
recreational marijuana. They want to be able to judge the effects of the
treatments they offer you without any other substances interfering.
Orthopedic doctors today are often refusing such surgery as hip and knee replacement
unless the patient gives up tobacco and marijuana. They believe that smoking
anything will displace vital oxygen and interfere with the critical healing process.
Doctors who do transplants like kidneys or other organs also frequently tell the
patient to quit smoking marijuana. This is as much a matter of discipline as anything else.
They know that if you refuse to follow their orders, you may not do as well with your
transplant and they can offer the organ to another patient who will be more compliant.
Although society is undergoing some positive changes in how we view
recreational substance use, marijuana remains an illegal drug. Federal laws
are strict and in some states, even a small amount can earn you jail time.
You do not have any "rights" to smoke pot. If you're smart, and you want to
keep your health care provider happy, you'll pay close attention to what the provider tells you.