If someone is on, let’s say perc 5 tid, and there is occasional ethyl on UDS around 10k or less (not every UDS) do you take away meds? Or just document warning to not combine with opioids? I have a few people that I have written 2-3 times “patient warned to not consume alcohol within 6 hours of taking opioid”, Or something like that. Is this enough? Or am I being too loosey goosey?
Alcohol in UDS
- Thread starter Drd105
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Too loosely goosey.
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Uncontrolled diabetes would be patients only excuse. Im assuming youre getting UDS in normal business hours which means patient is drinking during the day which would be a huge red flag with opioids. I know of a board case where this thing was looked. Patient had diabetes but doc was hounded because they didnt draw blood to confirm alcohol level.
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draw ethyl glucoronide levels.
if positive first time - warning. dont test positive again.
second time - taper opioids.
disclaimer - i do tell them they can have a cocktail or two around major holidays, but hold their prn opioids
(fyi it is National Moonshine Day and National Bubba Day today)
if positive first time - warning. dont test positive again.
second time - taper opioids.
disclaimer - i do tell them they can have a cocktail or two around major holidays, but hold their prn opioids
(fyi it is National Moonshine Day and National Bubba Day today)
But doc it was Arbor Day and i love the green spaces so much. So much better with white claw can’t you just test me again? I won’t drink on flag day
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No.
a beer on your birthday, one regular glass of wine thanksgiving dinner and 1 glass champagne on anniversary and new years.
and as much as you want when you stop taking your opioids for good.
a beer on your birthday, one regular glass of wine thanksgiving dinner and 1 glass champagne on anniversary and new years.
and as much as you want when you stop taking your opioids for good.
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Just make your decision based on how you want the headline to read when this person, who drove to your office on opioids and alcohol, hits someone on the way home.
One or the other, the choice is the patient's to make.
Based on the recent lawsuit, I now tell my patients and document that they should be driving within 4-6hours of taking an opioid.
One or the other, the choice is the patient's to make.
Based on the recent lawsuit, I now tell my patients and document that they should be driving within 4-6hours of taking an opioid.
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Can you point me in the direction of this driving lawsuit?
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Frankly, I don't really care medically if they have low amounts of alcohol metabolites in their urine (not alcohol itself) if they're on low-dose opioids.
However, medicolegally, I forbid the combination. There is a black box warning against mixing the two. Contract says they won't drink alcohol while taking opioids. If positive, it's a violation. Twice means I stop opioids.
However, medicolegally, I forbid the combination. There is a black box warning against mixing the two. Contract says they won't drink alcohol while taking opioids. If positive, it's a violation. Twice means I stop opioids.
Ind. Malpractice Law Covers Man Harmed By Opiate Patient - Law360
The Indiana Supreme Court ruled that the state's Medical Malpractice Act is broad enough to include as a "patient" a man whose wife and daughter were killed by a car driven by an actual patient of a physician and clinic that prescribed the motorist opiates, responding to a question from the...
www.law360.com
something about appeals court allowed the victim (non-patient) family to sue doctor who provided opioids to the defendant that caused manslaughter while opioids were in her system.
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“
Even more concerning is the Indiana Supreme Court’s decision in Cutchin v. Beard, 171 N.E.3d 991 (Ind. 2021). In that case, a patient (Watson) took her prescription opiates before driving with a passenger in her vehicle. As Watson was driving home, she became unable to lift her foot from the accelerator and crashed into another vehicle, resulting in her death and the death of individuals in the other vehicle (the Cutchins). A relative of the Cutchins filed a complaint in federal court (as well as one with the Indiana Department of Insurance) seeking damages for the Cutchins’ deaths. The plaintiff alleged medical malpractice against Watson’s prescribing physician for his failure to warn Watson of the danger posed by operating a motor vehicle while under the influence of prescribed medication and breach of the standard of care due to the physician’s failure to screen Watson for cognitive impairment caused by the medications, reduce medications due to loss of muscle control and report concerns about Watson’s ability to drive to the Indiana Bureau of Motor Vehicles.
The plaintiff reached a settlement for the statutory cap under the Indiana Malpractice Act and then sought excess damages from the Indiana Patient Compensation Fund (the “Fund”). The Fund contended it had no liability “because the underlying claim was not covered by the [Medical Malpractice] Act,” and was granted summary judgment. Since the lawsuit was pursued in federal court, the Seventh Circuit Court of Appeals followed a process to pose the following question to the Indiana Supreme Court: “Whether Indiana’s Medical Malpractice Act applies to claims brought against qualified providers for individuals who did not receive medical care from the provider, but who are injured as a result of the provider’s negligence in providing medical treatment to someone else.”
Alarmingly, the Indiana Supreme Court unanimously answered the question in the affirmative. According to the Supreme Court, the term “patient” falls into two categories: (1) “a traditional patient, i.e., one with a physician-patient relationship with a health-care provider[;]” and (2) “a third party with a claim against a health-care provider under state law[.]” The second category, according to the Court, “refers to a third party whose claim results from a provider’s malpractice to someone in the first category, namely, a traditional patient.” As a result, the Supreme Court was saying that the person in the other car could be considered a “patient” of the prescribing physician, and could pursue a claim for medical malpractice with respect to the physician’s prescription and related practices in treating the primary patient who was driving the car.
This decision will have major repercussions for health care providers as well as for medical malpractice litigation. It creates a new category of claimants (a secondary level of “patients”) seeking to impose liability against a healthcare provider based on that provider’s alleged negligent treatment of someone else causing the plaintiff to suffer an injury. This will have implications for treatment decisions and risk management assessments as well as insurance coverage for providers.”
Even more concerning is the Indiana Supreme Court’s decision in Cutchin v. Beard, 171 N.E.3d 991 (Ind. 2021). In that case, a patient (Watson) took her prescription opiates before driving with a passenger in her vehicle. As Watson was driving home, she became unable to lift her foot from the accelerator and crashed into another vehicle, resulting in her death and the death of individuals in the other vehicle (the Cutchins). A relative of the Cutchins filed a complaint in federal court (as well as one with the Indiana Department of Insurance) seeking damages for the Cutchins’ deaths. The plaintiff alleged medical malpractice against Watson’s prescribing physician for his failure to warn Watson of the danger posed by operating a motor vehicle while under the influence of prescribed medication and breach of the standard of care due to the physician’s failure to screen Watson for cognitive impairment caused by the medications, reduce medications due to loss of muscle control and report concerns about Watson’s ability to drive to the Indiana Bureau of Motor Vehicles.
The plaintiff reached a settlement for the statutory cap under the Indiana Malpractice Act and then sought excess damages from the Indiana Patient Compensation Fund (the “Fund”). The Fund contended it had no liability “because the underlying claim was not covered by the [Medical Malpractice] Act,” and was granted summary judgment. Since the lawsuit was pursued in federal court, the Seventh Circuit Court of Appeals followed a process to pose the following question to the Indiana Supreme Court: “Whether Indiana’s Medical Malpractice Act applies to claims brought against qualified providers for individuals who did not receive medical care from the provider, but who are injured as a result of the provider’s negligence in providing medical treatment to someone else.”
Alarmingly, the Indiana Supreme Court unanimously answered the question in the affirmative. According to the Supreme Court, the term “patient” falls into two categories: (1) “a traditional patient, i.e., one with a physician-patient relationship with a health-care provider[;]” and (2) “a third party with a claim against a health-care provider under state law[.]” The second category, according to the Court, “refers to a third party whose claim results from a provider’s malpractice to someone in the first category, namely, a traditional patient.” As a result, the Supreme Court was saying that the person in the other car could be considered a “patient” of the prescribing physician, and could pursue a claim for medical malpractice with respect to the physician’s prescription and related practices in treating the primary patient who was driving the car.
This decision will have major repercussions for health care providers as well as for medical malpractice litigation. It creates a new category of claimants (a secondary level of “patients”) seeking to impose liability against a healthcare provider based on that provider’s alleged negligent treatment of someone else causing the plaintiff to suffer an injury. This will have implications for treatment decisions and risk management assessments as well as insurance coverage for providers.”
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he will slaughter some doctor careers, thats for sure
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Sargent slaughter’s position after he retired from the Joes
I am actually referring to the glucoronide level in the labcorp UDS, I always see that number if +.
it was clear from your original post
I don't have any patients that I suspect are day drinking- they are all night before or sometimes two days/nights before. I called the labcorp 'scientist' in the past and she confirmed that is possible. Regarding the blood draw- I have only seen the labcorp recommend that when the ethyl sulfate is not present.
I appreciate all of the comments so much. I have actually emailed the Board of Medicine on this topic and they say they have no clearly written policy on it and to just "clearly document your rationale". The valuable input here on so many topics helps give me direction. In this case for example so many people say 'one warning then taper'....okay, perfect, thanks so much guys, and done.
D
deleted875186
What do people here do about marijuana? Would be curious to hear peoples opinion. I will let it slide for tramadol and Butrans but still recommend people not to use it. I typically don’t allow it for more potent opioids.
D
deleted875186
Elaborate?
I give them one warning only on that and it’s always elderly people using a CBD product- I tell them stop using it and they do and next UDS is good. I think DODOCSS means THC is still illegal to DEA who is our boss.
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This has been discussed in other threads in detail.
For a quick answer, we say no THC with opioids. Not only is THC a schedule 1 substance (i.e. illegal by the same people who give you your DEA license), but THC use has also been shown to have many negative side effects. Studies have shown that it does not help with pain in those taking opioids and it puts them at a higher risk.
Besides, the last thing someone taking opioids needs is another CNS depressant.
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I don’t care at all if anyone over 21 uses weed, unless they also want a schedule 2-4 controlled substance prescribed to them.
Then it is a hard pass.
Then it is a hard pass.
