The Philosophy of Urine Drug Testing

 

Urine drug testing / Urine drug screening (UDT / UDS) is a useful tool in pain management and all other physician practices prescribing prescription pain medicine that provides valuable objective information to assist in diagnostic and therapeutic decision making. Results of a UDT / UDS provide confirmation of the agreed-upon treatment plan (patient compliance). They can diagnose relapse or drug misuse as early as possible, and they also can be used to advocate for the patient with possible third-party interests.

To assess compliance, the healthcare professional may look for the presence of prescribed medications in the urine as evidence of their use. Finding no presence of the prescribed drug or finding unprescribed or illicit drugs in the urine merits further discussion with the patient. At the same time, it is important to recognize that laboratory error and test insensitivity can result in misleading data. Bingeing by the patient can result in unexpected negative urine reports if the patient runs out of medication prior to urine sample collection. Therefore, these results by themselves cannot be relied upon to prove drug diversion and may be consistent with addiction, pseudo addiction, or the use of an opioid for non-pain purposes—so called chemical coping.

The purpose of UDT / UDS should be explained to the patient at the initial evaluation. UDT / UDS can also enhance the relationship between healthcare professionals and patients by providing documentation of adherence to mutually agreed-upon treatment plans.

In the pain management setting, the presence of an illicit or unprescribed drug does not necessarily negate the legitimacy of the patient’s pain complaints, but it may suggest a concurrent disorder such as drug abuse, diversion or addiction. The patient must be willing to accept assessment and treatment of all disorders to receive adequate outcomes in either. Thus, the diagnosis of a concurrent addictive disorder, when it exists, does nothing to negate a legitimate pain disorder; rather, it complicates it.

Healthcare professionals sometime find the subject of drug testing a difficult one to explore with their patients, especially those who have been in the practice for many years. Often, a healthcare professional’s perception is that requesting a urine sample for drug testing may be seen as mistrusting the patient and, consequently, potentially damaging to the healthcare professional-patient
relationship. In fact, when approached in a respectful, patient-centered fashion, most patients are more than willing to do their part in managing risk in order to receive the medication management care that they need.