The Centers for Medicare & Medicaid, The Center for Disease Control and many states throughout the United States have published recommended guidelines for controlled substance monitoring and drugs of abuse testing.
Multiple Medicare Administrative Contractor (s) (MAC) published Local Coverage of Determination (LCD) in late 2015 and early 2016 for Controlled Substance Monitoring and Drugs of Abuse Testing – First Coast (L36393), Palmetto (L35724), Novitas (L35006) and CGS (L36029). All LCDs can be found at www.cms.gov and entering LCD in the search function.
In March 2016, The Center for Diseases Control published the “CDC Guideline for Prescribing Opioids for Chronic Pain”. The complete guideline, along with other very valuable opioid education, can be found at the CDC website, www.cdc.gov. Enter CDC Guideline for Prescribing Opioids for Chronic Pain into the search function.
And annually, many states publish state statutes that address controlled substance guidelines to provide directives for prescribers. The state of Florida guidelines are included for your review. The state of FL statues can be located at www.leg.state.fl.us/STATUTES. 2017 are the most current. Enter Title XXXII, Chapter 456 into the search function to locate the document in it’s entirety.
WHO to test:
Patients who are:
- New to your practice and already taking a controlled substance
- May want you to prescribe a controlled substance
- Request specific drugs
- Frequently request refills
- Display aberrant behavior or frequently report loss of medications
WHY to test:
- Influence positive health behaviors after discharge from a hospital or during treatment
- Deplete clinical variance in rehabilitation
- Use as a standard of care when prescribing an opioid
- Decrease hospital visits and re-hospitalization
- Prevent toxicity / overdose
- Identify diversion, abuse and addiction
- Classify risk behaviors (Low, Moderate, High)
- Decrease medical malpractice of wrongful death from overdose in my practice
WHEN to test:
Testing should be considered under the following conditions:
- A patient is newly prescribed a controlled substance
- There is a major change in the patient’s treatment plan
- There is observation of aberrant, drug-related behavior
- Reports from a third-party of drug-related behavior
We have developed a proprietary method of quantitating controlled substance, antidepressants, and psychotropic drug levels for therapeutic monitoring. The SentryPro report provides documentation to support treatment decisions through highly specific and sensitive HPLC MS/MS technology.