I thought I would present a case that occurred recently at our practice. For the purpose of anonimity, we can assume that all of the identifying details have been changed.
A very pleasant 68-year-old female with past history of obesity, HTN, HLD, sleep apnea (not using CPAP due to "claustrophobia")Stage 1 COPD, osteoarthritis, chronic low back pain, Type II DM, anxiety and depression is being seen for regular follow-up appointment. She has been receiving hydrocodone/apap 5/325 for 18 months.
Medications are lisinopril, hctz, simvastatin, metformin, advair, albuterol, famotidine, escitalopram and hyd/apap 5/325.
She lives with her grown son and daughter-in-law, and 2 young grandchildren.
She presents today reporting stiffness and tenderness of her fingers and low back. She has not suffered any recent trauma, and has not had any change in her overall condition. She denies fever, chills, weight change, loss of appetite, SOB, CP, dyspepsia, change in bowel or bladder, and reports her FBS has been < 180 when she checks it, which is about 3 times per week.
On exam, you find a pleasant, portly lady who has some difficulty getting to the exam table, and has mild tenderness of hands and low back on palpation. Otherwise, her physcial exam is as expected, and VS are WNL.
She asked for the hydrocone/apap to be increased to "10 mg" (her words).
So, how about that urine drug screeen? How many NP's are doing random UDS in their practice before prescribing opioids?
Initially, she tries to avoid the UDS. "I've never had to do this before. I'm not using any drugs. Why do I have to do this? I just used the bathroom, I can't go right now".
Reluctantly, she agrees.
Her UDS comes back positive for benzodiazepines, negative for opioids.