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July 27, 2011

Reducing Opioid Abuse and Diversion

JAMA. 2011;306(4):381-383. doi:10.1001/jama.2011.1042

To the Editor: Drs Volkow and McLellan1 recognize that it is by well-crafted, multifaceted public health approaches involving prescribers and the public that prescription opioid–related morbidity and mortality can be curtailed while preserving access to medically indicated opioid therapy. They point to important aspects of assessment and ongoing monitoring in risk management, including the use of urine drug testing. We are concerned that while overall costs of care and potential benefits of routine urine drug testing are being established,2 the coverage determination language of the Centers for Medicare & Medicaid Services and their contracted fiscal intermediaries does not support these contemporary principles of practice. For example, Medicare requires a suspicion of illicit drug use before covering routine preventive toxicology screens.3 This stands in contradiction to the position of Volkow and McLellan.1