In the treatment of pain management, physicians employ a variety of drugs, ranging from low-impact to highly potent, and to maximize patient health, urine toxicology analyses can significantly improve the delivery of pain treatment.
Drugs such as opioids that are used for pain management are peculiar in that they provide effective pain relief and have a high risk of addiction. The use of illicit drugs in the general population has been on the rise; however, self-reporting and close monitoring of patient behavior are insufficient means to detect drug abuse and confirm compliance.
Screening surveys may be helpful to a clinician in determining the risk of aberrant drug behaviors and guiding the frequency of monitoring. Screening can include surveys including but not limited to:. Urine drug testing UDT should be used as a therapeutic tool and screens can be useful for monitoring adherence to therapy and for detecting the presence of other illicit or non-prescribed controlled substances that may point to a need for increased surveillance, consultation, and possible discontinuation of current opioid treatment.
Laboratory tests are also necessary to verify the presence of the prescribed opioid medication at levels that are consistent with dose and frequency in order to detect potential aberrant behavior such as diversion. Providers that are involved in urine drug testing should determine the questions the tests are intended to answer prior to specimen collection. A review of the test results and a prompt, meaningful response to findings are necessary to fully integrate urine drug testing into managing chronic pain.
The clinician's choice of a urine drug screen needs to be consistent with the patient's pain therapy. There are not any one-size-fits-all screens covering the entire range of opioids. The urine drug screen also needs to be consistent with drug use patterns in the community. Legal and illegal drug use patterns vary between communities.
Abstract Therapeutic use, overuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain continue to be an issue for physicians and patients. Publication types Review. Substances Analgesics, Opioid. October 26, Print. For assistance with questions about the testing process or locations, call 1.
QUEST 1. For assistance with clinical drug monitoring results, call 1. RXTOX 1. Helping you stay current in drug monitoring. Jenkins, Ph. Scientific Director, Toxicology Opioids and other medications non-opioid analgesics, benzodiazepines, antidepressants, anticonvulsants, muscle relaxants are prescribed to treat chronic pain of non-cancer origin.
Therefore, the objectives of periodic urine drug tests are: To detect prescribed drug compliance: Identify use of prescribed medications Identify use of undisclosed drugs To discourage drug misuse: Decrease potential of abuse Decrease potential for diversion Testing methods Urine drug testing typically utilizes a presumptive initial screening test, usually immunoassay IA , which may be laboratory based or a point-of-care device.
The decision-making process of whether to order confirmation testing should include: Are the presumptive results inconsistent with clinical expectations or the pharmacy record?
Does the presumptive test detect the drug s of interest? Is definitive identification of a drug required applicable mainly to IA drug class tests?
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