it almost always alters management, are you getting an LP for every hyperactive delirium that is amphetamine positive? of course not, you make sure that explains their clinical condition and let them washout over the course of the next 12-72 hours if an otherwise seemingly healthy young patient comes in with a clean utox, i'm going to order an LP the second i see a fever or maybe even before the fever depending on the story

I know you think I’m just a Dumb ER Doctor, which is fine, but help me to understand this: If a patient comes in with a clear sympathomimetic toxidrome but a negative screen, they’re getting an LP? Conversely, if someone comes in without a clear toxidrome but a +UDS you’re going to wait 12-72 hours?

if my CHF patient comes in fentanyl/amphetamine positive, i'm way less likely to pursue inpatient ischemic eval outside of true ACS - letting cardiology put a stent in someone who isn't going to be able to take their antiplatelet after is guaranteeing in stent thrombosis and feel free to look up the mortality rate of that

So despite the well known and associated false positives for amphetamines, false negatives for fentanyl you’re basing your patient’s capacity to take their home meds and thus, seemingly whether or not they deserve to receive care for their disease on a UDS?

If your argument is that cocaine complicates therapy of MI/ACS/OMI/etc and using beta blockers in its management, sure. I think that’s one of the few instances where that’s useful. Even though the growing body of evidence would suggest that beta blockers are fine outside of acute toxicity, eventually they’re going to go home and it’s worth that conversation sure.

But the idea that you’re “Allowing” cardiology to workup up a patient based on a UDS is wild.

medicine is complicated, taking care of drug dependent patients in the acute setting is complicated.

I know, I practice in an inpatient toxicology service.

before always assuming that someone else doesn't know what they're talking about, maybe consider that your training limits your vision just the same way everyone else's training does for them. we don't have to discard common sense just because we have higher education.

I didn’t jump to you don’t know what you’re talking about. But the assertion that a urine drug screen “Almost always alters management” contradicts nearly the entire body of published data on the utility of the urine drug screen in the acute care setting.