Urine drug testing: current recommendations and best practices.
BACKGROUND
The precise role of urine drug testing (UDT) in the practice of pain medicine is currently being defined. Confusion exists as to best practices, and even to what constitutes standard of care. A member survey by our state pain society revealed variability in practice and a lack of consensus.


OBJECTIVE
The authors sought to further clarify the importance of routine UDT as an important part of an overall treatment plan that includes chronic opioid prescribing. Further, we wish to clarify best practices based on consensus and data where available.


METHODS
A 20-item membership survey was sent to Texas Pain Society members. A group of chronic pain experts from the Texas Pain Society undertook an effort to review the best practices in the literature. The rationale for current UDT practices is clarified, with risk management strategies outlined, and recommendations for UDT outlined in detail. A detailed insight into the limitations of point-of-care (enzyme-linked immunosorbent assay, test cups, test strips) versus the more sensitive and specific laboratory methods is provided.


CONCLUSIONS
Our membership survey was of a limited sample size in one geographic area in the United States and may not represent national patterns. Finally, there is limited data as to the efficacy of UDT practices in improving compliance and curtailing overall medication misuse.


CONCLUSIONS
UDT must be done routinely as part of an overall best practice program in order to prescribe chronic opioid therapy. This program may include risk stratification; baseline and periodic UDT; behavioral monitoring; and prescription monitoring programs as the best available tools to monitor chronic opioid compliance.
Texas Pain Rehabilitation Institute, Houston, TX, USA.
Graves T
GT
Owen
Allen W
AW
Burton
Cristy M
CM
Schade
Steve
S
Passik
D000701:Analgesics, Opioid / Q000627:therapeutic use / Q000652:urine*; D059350:Chronic Pain / Q000188:drug therapy; D006801:Humans; D009293:Opioid-Related Disorders / Q000652:urine*; D017410:Practice Guidelines as Topic / Q000592:standards*; D015813:Substance Abuse Detection / Q000379:methods*; D016482:Urinalysis
D000701:Analgesics, Opioid