Gathered from the headlines to help you decide what questions you need to ask your doctor.

Dr. Jaffe’s Juicy Jewels

Gathered from the headlines to help you decide what

questions you need to ask your doctor.

Urine Drug Screening and THC Use

A little truth about Urine Drug Screening. In the 1980’s the CDC and the US

Government came to those of us who were pioneering the field of pain medicine,

yes, I am that old, and wanted the “Fifth Vital Sign”, the Pain Scale was born. They

also believed that there was no limit to the amount of opiate one could prescribe.

There were a few nay-sayers. I happen to have given a lecture in 1997, and again in

2003 (invited to reprise the lecture because of its prophetic nature), on the need to

understand pain management, pharmacology and addiction medicine to be able to

practice Pain Medicine safely. I was practicing in Florida and between 1997 and

2003 we had our Pill Mill Crisis. So in 2000 I took the time to study and prepare,

and became Board Certified in Addiction Medicine as well. Fast forward to 2018

and the CDC and the FDA, and the Arizona Legislature and Board of Medicine all

agree that opiates are not ideal for chronic pain and to try to limit to 55 Morphine

Milligrams Equivalent, and maximum of 90MME absolute. Also suggested is to not

use opiates around the clock. I can already see the antenna flying up. What do I do

at night you ask, and what has this to do with Urine Drug Screening?January 4, 2026

2

There was a wonderful study done in the early 2000’s with PET scanner showing

around the clock usage of opiate depletes the brain of dopamine completely. Since

the pain relieving property of opiates is mediated (enacted) through what are called

the lateral (or emotional) pathways of the brain, to change your perception of pain

(how you feel about it), depleting the dopamine reduces its’ effectiveness. Using an

opiate only 2-3 times a day improves its effectiveness. I know: “But what do I do at

night?” So this is why I was a Marijuana physician in Florida. We prescribed THC for

nighttime usage, and opiate for daytime usage. The THC works through a different

receptor, the cannibanoid receptor, and allows regeneration of dopamine. After

about 2-3 months (yes it does take some time to return to normal, actually a full year

to return to nearly normal), the patient will notice marked improvement in relief

from their medication. Some doctors will keep patients on an opiate contract that

forbids THC just so they can end up with an accidentally positive urine and increase

mandatory urine drug screening from the recommended two to four times a year to

more frequently. Urine Drug Screening is a cash cow for many pain doctors. Some

doctors who are hospital employed can make as high as a $50,000 quarterly bonus by

increasing the number of urine drug screens. Some private practices will charge

outrageous amounts for a drug screen that can be an immunoassay cup ($25) but

instead do a full mass spectrometer ($500-$900, or more). As an ethical and

compassionate practice, we are stringent on amounts we prescribe, but we do take

the time to explain the why and the alternatives to opiates. If you are unhappy with

the care you are being provided by your pain physician, Jaffe Ethical Addiction and

Pain Care is happy to set an appointment, even just to answer questions, whether you

want to change physicians or not.

Psychology and Pain Management, “BRE”

Association with Overprescribing and Mismanagement

Some private or other practices force monthly psychologic testing on patients who

are taking opiates, maybe only if you are above a certain dosage. The prices charged

may be appropriate (about $200-$300), and others may try to charge in the $3,000+

range, knowing that the patient has had time to become addicted or dependent to

the medication and will agree to the testing to keep their medication. The charge

goes to the insurance company and unless the patient sees their explanation of

benefits they may never know what the charges were or what was paid.January 4, 2026

3

The testing is conducted by a paraprofessional usually, not a psychiatrist or

psychologist, and conclusions are made based on some standardized interpretation by

an AI computer or a high school or college graduate hired to score responses. The

problem with this kind of testing is that while it is good for screening, its’ effectiveness

is only as good as the interpreter and the follow up. When the real purpose of testing

such as this is to increase the bottom line, the professionals receiving the results end up

paying less and less attention to the testing and more attention to ordering them so as

to achieve certain income to company levels. The desire to create an increased income

can color one’s willingness to prescribe at a level that mandates such testing, especially

if it creates bonus money. This ends up putting patients on round the clock opiates,

which ends up depleting dopamine, which causes depression. The patient with chronic

pain almost always developed “Chronic Pain Syndrome”. But they also were almost

always on opiates around the clock. This caused depletion of dopamine, which caused

depression, one of the signs of Chronic Pain Syndrome. As we have backed down on

opiates, patients have been able to be more involved in their lives, their depression has

improved.

I cannot tell you how many patients tell me that they are on six a day Oxycodone,

which wears off at about three hours, and the symptoms they describe are exactly the

same as withdrawal. Those willing to change over to a different type of medication, or

even get off medication and pursue interventional care, ultimately agree that they are

much better and they just have been dependent on the medication. It can be

frightening, but we will explain the why and the how of the process. Dr. Jaffe has been

practicing for over 40 years. He is skilled in all interventional techniques. Many of his

patients get one or two injections and are so much improved they come in for a follow

up and are told to call only if the pain worsens or returns.

Conclusions For This Month’s Newsletter

If your doctor has accused you of a dirty urine and put you on every two week visits and

urine drug screens, come talk to us. We may not disagree, but we may have a solution.

If you are at a practice that doesn’t have a physician who can take the time to explain

your condition to you, come see us.

We are at 2051 Evergreen Lane, Unit C, Show Low, 85901- Call 928-892-5776 for appt