The Powerful Impact of Drug Screening on Claims Management

Urine drug screens have become an essential component in the landscape of workers comp claims management. In this Expert Insights episode, "The Powerful Impact of Drug Screening on Claims Management," MEC’s Medical Management Consultant, Jeff Pack, RN, BSN, provides his unique perspective on how these tests serve multiple purposes throughout the lifecycle of a claim and can significantly impact treatment decisions, safety protocols, and claim outcomes. 

Jeff breaks down the science behind drug testing methodologies and the way these approaches function as safety tools across various industries. This includes pre-employment screening, workplace accident investigations, and ongoing treatment monitoring. He shares compelling real-world examples of how drug screening is invaluable for: 

• Use in safety-sensitive industries to enhance workplace protection
• Determining if substances contributed to workplace accidents
• Monitoring injured workers' compliance with prescribed treatments
• Revealing dangerous behaviors such as exceeding the prescribed dosage 
• Helping to prevent risks of overdose from medication interactions

Listen now to get essential insights into a tool that Pack describes as “the cornerstone of modern healthcare and safety practices” and why trained professional interpretation of drug testing is vitally important to avoid false positives. 

Chapters

• 0:00 Introduction to MEC Expert Insights
• 0:32 Jeff Pack On Urine Drug Screening
• 1:17 Types of Urine Drug Screens
• 2:41 Drug Screens in Employment and Claims
• 4:30 Challenges and False Positives
• 6:49 Key Takeaways and Conclusion

Transcript

Speaker 1: 0:02

Hello, this is MEC Connect Expert Insights, a companion series to our main MEC Connect podcast for Midwest Employers, Casualty. I'm Sarah Hans and in these Expert Insights episodes, you'll hear from subject matter experts as they share practical tips and strategies on a variety of topics related to workers' comp and claims management. Today, Jeff Pack, medical management consultant, will discuss urine drug screening. Now let's hear from Jeff.

Speaker 2: 0:32

Hello, my name is Jeff Pack. Throughout my years as a nurse and in my position as a medical management consultant at Midwest Employers Casualty, I have found urine drug screens to be a valuable tool in workers' compensation claims. These tests are designed to identify substances such as opioids, cannabis, cocaine, methamphetamines and many other illegal and prescribed medications. They can be used for different purposes throughout the life of a claim and even before the claim is filed. Before I get into the roles urine drug screens play in workers' compensation, I want to discuss the different types of urine drug screens. There are two types of urine drug screens that are typically used. They are immunoassay and gas chromatography. Immunoassays are the most common method for initial screenings. They're cost-effective and provide rapid results. The immunoassay tests use antibodies to detect the presence of specific drugs or metabolites. Immunoassay tests are qualitative tests, which means they identify the presence of a drug or a drug class based on the amount exceeding a predetermined detection level. Grass chromatography tests convert the liquid sample to gas vapors in a non-destructive way to separate and detect different compounds, whether drugs or certain medications. Grass chromatography tests are considered the gold standard. These tests can be both qualitative and quantitative. As mentioned before, qualitative tests just detect the presence or absence of a drug where a quantitative test measures the level of that drug. Urine drug screens play a crucial role in detecting the presence of various substances in our bodies, providing essential information for employment, screening, medical treatment and the identification of potential abuse. Urine drug screens are sometimes used in the employment process as part of pre-employment screening. Other employers go a step further and require drug screening for continued employment. This is done in safety-sensitive industries such as manufacturing and transportation, and is done to enhance the safety of all employees and the general public. With workers' compensation claims, urine drug screens can be used when an injury initially occurs to determine if illegal medications or illegal substances may have contributed to the accident. While it will vary between jurisdictions and additional confirmatory tests may be necessary, Urine drug screens can be used as the initial indicator as to whether an employer can potentially deny a claim Once a claim is accepted and treatment has begun.

Speaker 2: 3:41

Urine drug screens are used to monitor injured workers' prescribed controlled substances, ensuring their compliance with treatment plans, as well as the detection of potential misuse or diversion. These tests not only help treating physicians ensure the injured worker is using the medication as prescribed and not engaging in harmful behaviors. Many pain management, physicians have the injured worker agree to and sign a pain management contract which explicitly notes acceptable and unacceptable actions and behaviors. While qualitative drug screens can be used to detect the presence or absence of a prescribed medication and detect the presence of non-prescribed medications, quantitative urine drug screens can do this plus determine if the injured worker is exceeding the prescribed dosage. For example, in one claim, a quantitative urine drug screen detected an excess of prescribed medications. When questioned, the injured worker admitted to taking pain medication prescribed prior to the date of injury that they had received for a non-work-related surgery. This put the injured worker at greater risk of overdose, which could lead to additional injury or even death. In another file, multiple repetitive negative drug screens led to the discontinuation of a medication, reducing the annual spend for the claim.

Speaker 2: 5:16

While urine drug screens are invaluable in workers' compensation claims, they are not without challenges. Factors such as false positives, which can occur due to certain medications or foods, need to be carefully considered and interpreted by a trained professional. It is also important that the injured worker disclose all medications they are prescribed. Many of you may have heard that eating one or more poppy seed bagels or muffins has the potential to trigger a false positive for morphine or opioids, but certain prescription medications can also trigger false positives. Promethazine, which is prescribed to relieve nausea and vomiting, has the potential to trigger a false positive on an immunoassay test for amphetamines or methamphetamines. It should be noted that this is the metabolites and not the parent compound that triggers a false positive.

Speaker 2: 6:13

In one claim, an injured worker's urine drug screen showed a level of naloxone or Narcan, but the injured worker denied using the Narcan. It turns out that the Movantik prescribed to the injured worker for opioid-induced constipation triggered a false positive on naloxone. This is why it is important for trained professionals to interpret the findings and sometimes dig deeper to get the true answer. However, as technology and standards continue to improve, so too will the accuracy and reliability of these tests. If you were to take one thing from this talk, remember that urine drug screens are a great tool in workers' compensation claims and are the cornerstone of modern health care and safety practices. Urine drug screens provide essential information to a treating provider that aid in the medical treatment decisions for an injured worker and can also promote and enhance workplace safety. However, they are just one tool that can confirm compliance with the prescribed treatment plan or identify potential abuse. However, false positives may be detected with the consumption of certain foods or undisclosed medications. Additional testing may be necessary to confirm the results of a previous test. Thank you for listening.

Speaker 1: 7:44

Thank you for tuning in to MEC Connect Expert Insights. Here at MEC, we focus on what matters most worker recovery and better claims outcomes. Focus on what matters most worker recovery and better claims outcomes. Our skilled people, proven processes and innovative technology achieve measurable results and create lasting value. We hope you found Jeff's insights on urine drug screening valuable. Stay tuned for more from MEC Connect and more expert insights. Thank you for listening.