The following is my response to a professional group's discussion about the fact there is no scientifically reliable or defensible algorithm for accurately testing for drug metabolites in urine. The current testing simply cannot adequately control for the wide variances in individual pharmacokinetics and pharmacodynamics. Scientifically speaking , drug testing is based on "junk" science in its current state.
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I think that we have established that virtually any algorithm employed by a urinalysis service is going to be inadequate to meet the requirements of strict professional science.
However, that said, let us return to clinical medicine. In employing the services of Ameritox to examine the urine of my patients, I have found, with about 100 cases in my database, that the reports have come back reading either "consistent" or "inconsistent", I provide the lab with the regimen I am prescribing and the urine, and they provide me their report.
In virtually every instance they have reported back "consistent. In a few cases they have reported "inconsistent". In those relatively few instances the inconsistency has been the presence of prescribed medications I didn't prescribe, or "street" drugs.
I cannot say that the analyses in all the other cases accurately determined that the urinary metabolites were consistent with the doses of ingested drugs prescribed. But I certainly can argue with the Gestapo that I did the urinalysis and no one can bust ME for failing to test them! In a few instances I have been forced to confront a patient with the fact that the Gestapo compels me to not prescribe opioids for people who ingest street drugs. Although I am not personally committed to policing the inner psyche of others - I do enjoy the privilege of practicing medicine; and if I persist in breaking the rules that have been shoved up my colon I won't be much able to help anyone without a medical license.
We live in a world of relentless follies.
JSH
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