Appropriate Use

Appropriate Use of UDT / UDS to Improve Patient Care

Urine drug testing (UDT) is an important component of the treatment plan for patients who are prescribed opioids for chronic pain. While there is not enough information so far to support a specific testing protocol for patient-centered clinical urine drug testing, experts in the fields of pain and addiction and pharmacology have developed recommendations for the use of UDT as an initial assessment and for ongoing monitoring in this population:

Why:

To provide physicians with objective information about drug misuse and diversion prior to prescribing scheduled medications. To monitor a patient’s treatment adherence and possible drug use problems during pain treatment

Screening: To identify the need for further assessment
Better Care: To help provide better care and proper diagnosis to the patient.
Monitoring: To monitor patient progress, when used in combination with other assessments and modalities.

Who:

High Risk Patients: It is strongly recommended that patients at high risk for substance use problems (as determined/assessed through the process of risk stratification) undergo urine testing on a periodic basis.

All Patients: A weaker recommendation suggests that physicians collect information on patients who are not high risk throughout treatment by performing UDT or other means such as prescription drug monitoring programs, family interviews, or pill counts. Some practitioners recommend adopting a policy of testing all patients to avoid stigmatizing or singling out certain patients, as well as to avoid missing problems in patients who might not have been otherwise tested based on their history of drug use.

When:

First Visit: For all patients new to treatment, confirmatory testing is recommended. This initial baseline result can help predict future compliance and illicit drug use problems

Other Indications: A UDT is also recommended in the following instances:

Change in medication type or dosage

Decline in patient’s level of functioning

Timing: Collect samples at the beginning of the visit – before a prescription is written.

Frequency: The decision on how often to collect samples is up to the practitioner and can vary depending on the individual patient. For example, take into account patient characteristics such as Patient behavior past positive tests, Indications of abuse or addiction

Schedule: It is best to collect samples on an unannounced, “as requested” basis. Two to three collections per year can be enough for pain patients who do not show signs of aberrant behavior

Window of detection: Most drugs have a window of detection in urine of 1 to 3 days after ingestion.

Relying on behavior to monitor your patient may not be sufficient; one study found that over 25% of patients on chronic opioid therapy who didn’t display behaviors that suggested aberrant behavior tested positive on urine drug screens.