As a member of the editorial board of the Journal of Pain & Palliative Care Pharmacotherapy, an author of numerous scholarly articles about chronic pain (some of which are cited here), and a person who lives with chronic pain, I would like to comment on “Is it time to drug test your chronic pain patient?” (J Fam Pract. 2010;59:628-633). Drs. McBane and Weigle recommend the use of pain agreements and drug testing for every patient with noncancer chronic pain, but fail to mention that there is insufficient evidence of the efficacy of both adherence monitoring tools.1 In addition, a recent article in The American Journal of Bioethics recommends against the “universal application of pain agreements” and suggests that they can harm the patient/physician relationship.2 Consent for drug testing often comes from the pain contract3—agreements that have been called “unconscionable adhesion contracts” and may be unenforceable.4
The authors also suggest that urine drug testing is noninvasive. Nothing could be further from the truth. Drug testing of people with pain may be considered a suspicionless and warrantless search of bodily fluids and in certain cases may be unconstitutional.5 There is no question that drug misuse, abuse, addiction, and overdose are devastating to individuals, families, and society. However, using unproven risk management tools that may cause greater harm than good is just bad medicine.
Mark Collen
Sacramento, Calif