title: Urine drug testing in long-term opioid therapy: ethical considerations.
abstract: As long-term opioid analgesic therapy has gained increasing clinical and societal acceptance over the past 2 decades, morbidity and mortality related to the misuse of these drugs have increased in lockstep. Hence, monitoring for opioid-related problems, largely through urine drug testing, has become a central component of risk mitigation in long-term opioid therapy. Despite the increasing use of urine drug testing, little has been written about the ethical aspects of its application. In this paper, we analyze multiple aspects of drug testing-rationale for testing, specimen collection, ordering and interpretation, and response to inappropriate test results-through the principlist lens, using the ethical principles of beneficence, nonmaleficence, justice, and autonomy.
authors.affiliation: *Pain Management Services, Department of Psychiatry, Divisions of Addiction Medicine and Forensic Psychiatry, University of Florida College of Medicine, Gainesville, FL †The Hastings Center, Garrison, NY.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Reisfield
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Maschke
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use / Q000652:urine*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000209:etiology / Q000652:urine*; D010146:Pain / Q000188:drug therapy* / Q000652:urine
chemical_list: D000701:Analgesics, Opioid