Recommendations for urine drug monitoring as a component of opioid therapy in the treatment of chronic pain.
OBJECTIVE
Several prominent guidelines recommend that patients on long-term opioid therapy have periodic urine drug monitoring (UDM) for appropriate use; however, none address the specific questions of which patients to test, which substances to test for, how often to test, and how to act on the results.


METHODS
In the absence of adequate scientific evidence in the literature, a panel of experts in the field of pain and addiction medicine was convened to develop consensus UDM recommendations. The panel met three times between March 2010 and April 2011, and reviewed several drafts of the recommendations document between meetings.


RESULTS
The group was able to achieve consensus on a set of UDM recommendations addressing test selection, test frequency, interpretation of results, and how to handle discrepancies based on specific results.


CONCLUSIONS
While the participating panel members recognize that there currently is a limited evidence base to support the expert panel's recommendations, primary care providers and pain specialists are largely acting today based on anecdote, intuition, and individual experience. The recommendations are meant to begin to provide a framework for standardizing practices for UDM in the treatment of chronic pain, and to serve as a catalyst to advance research that quantifies the effects of UDM on opioid therapy management and patient outcomes.
The Pain Treatment Center of the Bluegrass, Lexington, KY, USA.
John F
JF
Peppin
Steven D
SD
Passik
Joseph E
JE
Couto
Perry G
PG
Fine
Paul J
PJ
Christo
Charles
C
Argoff
Gerald M
GM
Aronoff
Daniel
D
Bennett
Martin D
MD
Cheatle
Kieran A
KA
Slevin
Neil I
NI
Goldfarb
D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D009293:Opioid-Related Disorders / Q000209:etiology / Q000517:prevention & control* / Q000652:urine*; D010146:Pain / Q000150:complications / Q000188:drug therapy / Q000652:urine*; D017410:Practice Guidelines as Topic; D015813:Substance Abuse Detection / Q000592:standards*; D014481:United States; D016482:Urinalysis / Q000592:standards*
D000701:Analgesics, Opioid