Category: Drug Testing

Sessions Advisor Ramping up Drug War, Profiting From Drug Tests

The swamp is still in place.  Trump just broght did not get rid of it but just added more.  This war on drugs and the corruption surrounding it must go…

Read more in this article by DAVID BIENENSTOCK, February 9, 2018 in LEAFLY:

Dr. Robert DuPont, seen here testifying before Congress in 1975, was President Richard Nixon's drug advisor. Now he's talking directly to Attorney General Jeff Sessions. (Henry Griffin/AP)

The phrase “Green Rush” is often used to describe the flood of fortune seekers pouring into the cannabis industry, a reference to the gold rushes of the 1800s. But you may not be aware of another gold rush happening right now, right under our noses. Read more

A $17,850 urine test: Industry boom amid opioid epidemic

Drug testing can be very expensive when measuring opiods, benzodiazipam and others

(Originally published by Fred Schulte, Kaiser Health News for CNN February 19, 2018)

After Elizabeth Moreno had back surgery in late 2015, her surgeon prescribed an opioid painkiller and a follow-up drug test that seemed routine — until the lab slapped her with a bill for $17,850.

A Houston lab had tested her urine sample for a constellation of legal and illicit drugs, many of which, Moreno said, she had never heard of, let alone taken. “I was totally confused. I didn’t know how I was going to pay this,” said Moreno, 30, who is finishing a degree in education at Texas State University in San Marcos and is pregnant with twins.

Her bill shows that Sunset Labs LLC charged $4,675 to check her urine for a slew of different types of opioids: $2,975 for benzodiazepines, a class of drugs for treating anxiety, and $1,700 more for amphetamines. Tests to detect cocaine, marijuana and phencyclidine, an illegal hallucinogenic drug also known as PCP or angel dust, added $1,275 more.
The lab also billed $850 to test for buprenorphine, a drug used to treat opioid addiction, and tacked on an $850 fee for two tests to verify that nobody had tampered with her urine specimen. Total bill: $17,850 for lab tests that her insurer, Blue Cross and Blue Shield of Texas, refused to cover, apparently because the lab was not in her insurance network. The insurer sent Moreno an “explanation of benefits” that says it would have valued the work at just $100.92.

Elizabeth Moreno was billed $17,850 for a urine test. After Moreno’s insurer declined to pay any of the bill because the lab was out-of-network, her father, Dr. Paul Davis, paid the lab $5,000 to settle the bill.

Moreno’s father, in a complaint to the Texas attorney general’s office about the bill, identified the Houston surgeon who ordered the costly test as Dr. Stephen Esses. His office told Kaiser Health News the surgeon would have no comment.
Sunset Labs is part of a network of pain clinics and other medical businesses founded by Houston anesthesiologist Phillip C. Phan, according to Texas secretary of state filings and court records. Court records say Phan’s companies also own the facility where Moreno had her operation.

Three experts interviewed by KHN said the lab grossly overcharged; they also doubted the need for the test.
“This just blows my mind,” said Jennifer Bolen, a former federal prosecutor and lab and pain management consultant. “It’s very high and incredibly out of the norm. Dan Bowerman, a medical fraud expert, called the lab bill “outrageous” and “unconscionable” and said it should have prompted an investigation.

“Sounds real fishy,” added Charles Root, a veteran industry adviser. He wondered if the lab had “misplaced the decimal point,” because such a test should cost a few hundred dollars, tops.

The lab disagrees. Sunset’s billings “are in line with the charges of competing out-of-network labs in the geographical area,” lab attorney Justo Mendez said in an emailed statement. Mendez said pain doctors agree that extensive urine testing is “the best course of action” and that a lab “is not in the position” to question tests ordered by a doctor.

Urine testing for patients with chronic pain has grown explosively over the past decade amid a rising death toll from opioid abuse. Pain doctors say drug testing helps them make sure patients are taking the drugs as prescribed and not mixing them with illegal substances.

Yet the testing boom costs billions of dollars annually and has raised concerns that some labs and doctors run urine tests needlessly — or charge exorbitant rates — to boost profits.
Some insurers have refused to pay, which can leave patients like Moreno threatened with ruinously high bills they had no idea they had incurred.

“Surprise bills larded with unexpected expenses and little explanation inflict sticker shock on vulnerable patients,” said James Quiggle, communications director of the Coalition Against Insurance Fraud, whose members include insurers, consumer groups and government agencies. Quiggle said many “puffed-up bills straddle a fine line between abuse and outright fraud.”

Moreno said her insurance covered the disc removal surgery in December 2015. She said the operation went well and she weaned off the hydrocodone pain pills. To her surprise, on a second return about a month later, the surgeon’s office asked her to leave a urine sample.

“I didn’t think anything of it,” Moreno said of the test. “I said fine, whatever.”
More than a year later, she said, the lab phoned while she was driving and asked her to pay the $17,850 bill. The lab then sent her an invoice, dated March 10, 2017, which states: “[B]ased upon information from your health plan, you owe the amount shown.”

Luckily, her father, Dr. Paul Davis, was visiting her in Texas at the time. Davis, 66, is a retired family practice doctor from Findlay, Ohio. Davis doubted the need for the test, not to mention what he thought was a sky-high price. He said the University of Findlay, where he helped train physician assistants, gave applicants a basic drug test at a cost of $174, while the local juvenile courts in Ohio paid $10 for a simple drug screen. Fearing it would ruin his daughter’s credit scores, Davis said, he called Sunset and settled the bill in April 2017 by paying $5,000, which he said he now regrets. The lab sent Moreno a receipt that said it discounted her bill because of “financial need/hardship.

Asked for comment, Blue Cross spokesman James Campbell said he couldn’t discuss a specific case but noted:
“We are disappointed as well as concerned about transparency whenever [any] member is surprised by an excessive charge for a seemingly routine service or received services that may not have been medically necessary.”
Campbell also said the lab was out-of-network and “we do not control how much they charge for services rendered.” The insurer encourages patients to confirm that all medical care they seek comes from medical providers in the Blue Cross network, he added.

Prices for urine tests can vary widely depending upon complexity and the technology used. Some doctors’ offices use a simple cup test, which can detect several classes of drugs on the spot. These tests rarely cost more than $200, and typically much less.

Bills climb higher when labs check for levels of multiple drugs and bill for each one, a practice insurers argue is seldom medically justified. But even labs sued by insurers alleging wildly excessive testing typically have billed $9,000 or less, court records show. One insurer sued a lab for charging $1,845 for a drug test, for instance. Davis said Sunset Labs ignored his requests for a full explanation of the charges. In May, he filed a written complaint about the bill with the Texas attorney general’s office that included a copy of the bill and accused the lab of “price gouging of staggering proportions.”

“Young people just starting out, such as my daughter, may not have the ability to pay and this could result in damaged credit ratings or even bankruptcy,” he wrote.

Davis got a letter back from Attorney General Ken Paxton, who said the office would “review the information.” A spokesperson for Paxton told KHN: “We have received complaints about that business, but we can’t comment on anything else.” Sunset attorney Mendez said the lab is “not aware” of any such complaints.

In an interview, Davis also questioned the need for his daughter’s urine test because she received opioids only for a short period and the results would have had no impact on her treatment. In his complaint to the attorney general, Davis said the surgeon told him he ordered the tests because he feared possible retribution from the state medical licensing board for not testing patients who had been prescribed an opioid. The Texas Medical Board doesn’t require urine tests for patients receiving opioids for short-term pain, said spokesman Jarrett Schneider. That’s a “question of independent medical judgment as to whether the physician believes a drug test should be required,” he said.

Bad Reviews

Sunset Labs has an “F” rating with the Houston Better Business Bureau, which on its website posts an August 2017 complaint from a patient charged $16,150 for a urine test.

“This is not covered under my health insurance so I am expected to pay this excessive bill,” the complaint reads.
A second website that publishes government billing numbers of doctors and medical businesses includes a comment section with more than a dozen negative “reviews,” mostly complaints that the lab slammed patients with thousands of dollars in fees their insurers balked at paying.

In a pair of lawsuits filed in 2015, three doctors seeking to quit working at pain clinics operated by Phan accused the facilities of improper billing practices, including unnecessary urine testing. The doctors said they feared losing their medical licenses unless they severed their ties.

In one suit, Drs. Purvi Patel and Lance LaFleur also alleged that the pain clinics “pressured” doctors to overprescribe medical gear and genetic tests to insured patients “regardless of medical necessity.” The case did not go forward because the doctors did not pursue it. Neither doctor would comment.

In the second legal case, pain specialist Dr. Baominh Vinh said he resigned in April 2015 “based on certain questionable business practices … that are inconsistent with my ethical boundaries.” Vinh also alleged urine testing was overused. In a countersuit against Vinh, the pain clinics called his allegations a “falsehood” to justify violation of his employment contract.

The parties settled in March of last year. Terms are confidential, but a lawyer for the pain clinics said Vinh paid money to the company “and not vice versa.”

Rate of transit workers who fail federal drug tests soars by 77 percent

Drug testing rises for transit workers

Investigators have found drug use to a be a factor in several high-profile transportation mishaps

By , The Cannabist Staff  (Published February 8, 2018)

WASHINGTON – As the opioid crisis has mushroomed into a national epidemic, the number of truck and bus drivers, commercial pilots, railroad operators and pipeline workers who failed federal drug tests has jumped by 77 percent since 2006, federal data shows.

Transportation companies with workers who hold “safety sensitive” jobs are required to test at least 25 percent of their workforce each year, although in some industries there is more regular and stringent testing. Nearly a million more workers are now being drug tested as the transportation industry has rebounded from the recession to employ more workers.

The drug testing data was obtained from the Transportation Department by Democratic staff members on the House Transportation and Infrastructure Committee, who followed up on reports in 2016 about drug abuse by railroad workers.

In a letter to Transportation Secretary Elaine Chao and two other administration officials, Rep. Peter DeFazio, Ore., the ranking Democrat on the transportation committee, wrote Thursday that “DOT is effectively carrying out drug and alcohol testing requirements . . . but there are significant gaps . . . that should be addressed.”

The National Survey on Drug Use and Health concluded that 10.9 million people misused opioids in 2016, and the Centers for Disease Control and Prevention put the number of deaths at a record 42,000. The number of deaths that year from synthetic opiates such as fentanyl doubled from the previous year to 19,413.

Although there is no evidence that either engineer was under the influence of drugs or alcohol, a pair of recent Amtrak train wrecks in South Carolina and Washington state have increased scrutiny of commercial transportation.

Investigators have found drug use to a be a factor in several other high-profile transportation mishaps.

– When a container ship collided with a bridge and spilled 53,500 gallons of fuel into San Francisco Bay in 2007, the National Transportation Safety Board found the harbor pilot had taken high doses of three opioids and several other prescription medicines.

– The driver of a tractor-trailers that collided with a bus in Oklahoma, killing four softball team members in 2014, was found by the NTSB to have been high on synthetic cannabinoid.

– Another tractor-trailer driver, this one in Tennessee in 2015, struck eight vehicles, killing six people. He tested positive for amphetamines.

– A hot-air balloon operator who died in Texas, along with 15 passengers, in 2016 tested positive for several drugs, including Valium, oxycodone and a synthetic narcotic pain medication.

– When an Amtrak train outside of Philadelphia killed two members of a crew working on the rail bed, the engineer tested positive for marijuana, and the two dead workers were found to have a variety of drugs in their systems.

The drug test failure rates are computed in fractions that belie the mayhem than can result if a bus driver, rail engineer, pilot or pipeline worker in a “safety sensitive” position is under the influence.

Aviation workers failed the tests in 0.6 percent of cases; bus and truck drivers by 0.8 percent; railroad workers by 0.4 percent; transit workers by almost 10 percent; U.S. Coast Guard licensed operators by 0.9 percent; and pipeline workers by 1.1 percent.

The number of failed drug tests by railroad workers involved in fatal wrecks in 2016 alone was three times higher than a decade ago, and the highest number since the Federal Railroad Administration (FRA) began keeping records in 1987.

The report by House Democratic staff members makes 15 recommendations.

One is that the broad range of testing done by the FRA, including blood tests in addition to urine sampling, be applied by the DOT to all crash investigations.

The Federal Aviation Administration, the report says, should finalize arrangements for testing at offshore maintenance facilities that host the planes of U.S. carriers. The report also recommends creation of a single template for drug testing among all DOT and Health and Human Services agencies, and that it be expanded to include drugs not already covered by the testing protocols.

It also says that a “scientifically valid and legally defensible” means to test for marijuana impairment be developed for the federal testing program.

How Long Does THC Stay In Your Urine?


Knowing how long THC stays in your urine is crucial knowledge for anyone who uses marijuana, regardless of how often or how much.

Original Article: High Times Magazine, November 10, 2017 by Adam Drury

How Long Does THC Stay In Your Urine?

Weed is the most popular federally illicit drug in the United States. And employers know it. Indeed, cannabis is the most commonly detected drug in workplace urine drug tests. Setting aside for a moment the totally legitimate criticisms of workplace drug screenings, and debates about the efficacy and accuracy of the tests and the generally humiliating, privacy-invading feel of the whole operation, let’s drill down into one simple question: how long does THC stay in your urine?

Overview: It’s… Complicated

Unfortunately, there’s no simple answer. So let’s simplify things by re-framing the question. Certainly, you’re not here for an academic treatise on cannabinoid metabolism.

More likely, you want to know how long THC stays in your urine because you’re up against a drug test.

So really, the question isn’t how long does THC stay in your urine? The real question is, when will the amount of THC in your urine drop below the threshold for testing positive?

To answer that all-important, make-or-break question, it’s crucial to understand why and how THC ends up in your urine in the first place and the variables that control how quickly your body eliminates it.

How Does THC End Up In Your Pee?

Trick question! THC, or more specifically, the delta-9 THC that gets you high doesn’t end up in your urine at all!

So why fear a urine drug test? Because urine screenings aren’t looking for psychoactive, illicit delta-9 THC molecules. Instead, they detect what your body produces as a waste product after it metabolizes the THC you consume.

That waste product is called a metabolite. THC’s version is THCCOOH, which scientists call a ‘carboxy.’

Your excretory systems are in the business of removing waste metabolites like THCCOOH. To do so, THCCOOH joins up with a uronic acid called glucuronic acid, which passes out of the body in your urine.

Summing up, when you inhale THC in weed smoke, your body rapidly metabolizes it, getting you high just as fast. Your metabolism turns that psychoactive THC into the inactive THCCOOH, which you piss out.

All told, 15 to 20 percent of the THC dose makes its way out of your body by way of acidic urinary metabolites.

How Long Does THC Stay In Your Urine: Examining The Variables

How Long Does THC Stay In Your Urine?

Urine drug tests for weed, then, are essentially trying to detect evidence that your body is still working on eliminating the waste products from your last encounter with THC.

They don’t show when you last smoked. They can’t tell if you were high when you pissed. All they reveal is that someone’s body is still working on eliminating THCCOOH, which means that the body had to have metabolized an illicit amount of THC.

At some point, at least.

With a test so dependent on all of the complex bodily processes involved in human metabolism, no wonder it’s impossible to offer a simple, straightforward answer to the question, how long does THC stay in your urine?

Here, then, are a list of the most influential variables.

THC Dose

As mentioned above, researchers are confident that 15 to 20 percent of a Delta-9 THC dose ends up eliminated via urine. Therefore, the more potent your weed is, the more metabolites will end up in your pee. This also explains how test administrators can correlate the tiny amounts they detect with a real dose of cannabis.

Use Habits

Logically enough, more habitual smokers are vulnerable to urine detection longer than those with more occasional habits. Actually, a lot more.

One-time cannabis users will piss clean in as little as five days, or it could take as long as eight. Smoke just a few times a week? One and a half to two and half weeks and you should be fine. Smoke every day except a couple? It’ll take you a month to a month and a half, or more, to eliminate all the THCCOOH from your system.

And if you’re a daily user, expect a two-month time frame before your urine drug test will come back negative. One major study reported that a subject with daily use habits took 77 days before posting 10 consecutive negative tests.

Here’s a handy table of these average detection windows. Again, these aren’t hard limits. They’re averages. And your body could be extraordinary.

  • 1-time use: clean in 5-8 days
  • 2-4 times a week: 11-18 days
  • 5-6 times a week: 33-48 days
  • Daily use: 50-65 days, up to 77

Inhaled Or Ingested?

How long does THC stay in your urine after you eat edibles compared with smoking or vaping weed?

Considering how different an edibles high can feel next to a high from smoking weed, one might expect the THC levels in urine to vary.

In truth, they do.

Edibles will make THC stay in your urine a bit longer, from several hours to an extra day. But that’s not a significant enough degree to make a real difference in the outcome of your test.

In other words, both methods of administering your THC dose are going to put enough THCCOOH in your urine to make you fail a urine drug test.

But because of the way your body processes THC when you eat it—converting it to a psychoactive metabolite called 11-hydroxy-THC, and then into the inactive THCCOOH the test detects—edibles can leave you at risk longer, based on your use habits, compared to smoking or vaping cannabis.

Physiological Factors

When it comes to your own body, two factors play a key role in how long THC stays in your urine.

The first is your metabolic rate. If you have a higher metabolism, you’ll excrete THCCOOH faster.

The second is your level of hydration. The more fluids you ask your body to process, and the more urine you thus produce, the quicker THC metabolites will leave your body.

Summing Up: How Long Does THC Stay In Your Urine?

Drug urine tests for weed have all kinds of shortcomings and inadequacies.

But they are good at one thing: revealing whether or not the person being tested has consumed cannabis, in some form, at some point in the past. Unfortunately, for many employers with zero tolerance policies, that’s enough to fire you or move on to the next candidate.

Knowing how long THC stays in your urine, therefore, is crucial knowledge for anyone who uses marijuana, regardless of how often or how much.

The Huge Profits, And Questionable Benefits, Of Urine Testing


Until the feds step in, the profits will keep flowing.

By Chris Roberts, High Times November 20, 2017

The Huge Profits, And Questionable Benefits, Of Urine Testing
 (Original article: https://hightimes.com/health/huge-profits-questionable-benefits-urine-testing/)

There’s really no rational reason to cut Medicare. But what does this have to do with urine testing? Bear with us, we’re getting there.

 America’s limited single-payer healthcare option, available to older and disabled Americans, Medicare provides some form of healthcare to 55 million people. That’s nice, surely—but more to the point, it generates serious profits for the country’s healthcare-industrial complex.

Medicare accounts for about 30 percent of the country’s colossal prescription drug spending, a habit projected to exceed $610 billion a year by 2021. One need not be so ambitious or sophisticated to find a rich vein to tap.

As Kaiser Health News recently reported, one Tennessee-based pain clinic billed more than $1.8 billion a year in charges to Medicare. This fortune was mined by testing Americans’ pee.

The urine-testing factory at Comprehensive Pain Specialists, a drug-screening lab near Nashville, is possibly America’s busiest, but it’s merely one cog in a massive effluvia-examining machine. Between 2011 and 2014, according to researchers with KHN and the Mayo Clinic, Americans spent $8.5 billion a year on urine analysis—an increase of 400 percent during that time period. Medicaid paid for fewer than two million urine tests in 2009, according to data. By 2014, that number had ballooned to nearly 20 million.

(Remember what else has quadrupled in recent history? Opiate painkiller prescriptions. And the two are connected: One way CPS justifies its pee business is the high prescription rates of opiates in the states it services.)

Put into perspective, America spends more on testing pee than it does on the entire Environmental Protection Agency. As KHN reported: “The federal government paid providers more to conduct urine drug tests in 2014 than it spent on the four most recommended cancer screenings combined.”

So what do we get for all this time and effort?

Forgive us, but piddly-squat.

There are no accepted national standards for urine analysis—meaning who gets tested and for what varies wildly. Doctors say that urine testing is necessary to safely prescribe drugs, but “tens of millions of dollars” are spent on screening for drugs that pose a “minimal abuse danger.” More is spent on screening for rare street drugs like PCP. Even more common recreational drugs like cocaine and ecstasy are found “just one percent of the time,” yet they’re included in the urine analysis tests run.

So—why?

 Because it’s lucrative. If you run a pain clinic, you can make your monthly nut by testing for urine—and then some.

“Thirty-one pain practitioners received 80 percent or more of their Medicare income just from urine testing,” KHN reported.

Those are only the most egregious examples of a system where gangs of doctors make more money testing their patients than they do treating them.

It’s also an obvious hustle.

More than 700 urine samples from all over the southeast are received every day at CPS in Tennessee, which may store the urine for as long as a month before it can be run through sophisticated machinery. All this infrastructure is costly—and probably not necessary. Most drug test screening can be done with a $10 kit that includes the following equipment: A cup to pee in and a testing strip that shows what drugs are present within minutes.

But as KHN discovered, once doctors and clinics found it difficult to justify huge bills for these simple screenings, they switched to the machines—and started charging more, and more often. One pain clinic argued in 2008 that patients should be screened for drug use as often as once a week. Why not, when each machine test, KHN noted, can be billed individual to Medicaid.

Charles Root, a lab industry consultant, called it “almost a license to steal.”

The obvious takeaway is that an incredible amount of money is being literally pissed away on screenings that accomplish nothing aside from fulfilling a profit motive. The other point to remember is that this is all legal.

There aren’t federal standards on what to test, how often or through which method. In 2016, Medicaid did begin a “crackdown on urine billing” as part of a review that reset lab fees for the first time in years—but pee tests are still a large part of the business plans of CPS and other clinics. Until the feds step in, the profits will keep flowing.