Recommendations for Urine Drug Monitoring as a Component of Opioid Therapy in the Treatment of Chronic Pain

Peppin JF, Passik SD, Couto JE, Fine PG, Christo PJ, Argoff C, Aronoff GM, Bennett D, Cheatle MD, Slevin KA, Goldfarb NI. Pain Med. 2012;13(7):886-896.

Urine drug monitoring (UDM) is a major tool available to monitor for abuse, misuse, and diversion of opioids and to help physicians safely manage chronic opioid therapy. To help establish consensus recommendations regarding UDM, a multidisciplinary national panel of pain medicine experts met three times between March 2010 and April 2011, with support from Thomas Jefferson University, to provide answers to five key questions.

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These recommendations help answer:


Whom to Test

No patient is at zero risk for opioid abuse; patients on long-term opioid therapy should be tested as part of a comprehensive treatment plan.


How to Test

Communicate the intent of UDM to the patient, establish trust, and use a comprehensive urine drug test that includes illicit drugs, opioids, benzodiazepines, barbiturates, and other drugs of potential abuse.


When to Test

Prior to initiating chronic opioid therapy, use an initial urine drug test to evaluate substances in the patient’s system as a component of risk assessment. This helps develop a protocol for periodic monitoring based on risk assessment and stratification: low-risk patients should be tested twice a year; medium to high risk, four times yearly.


How to Interpret Results

When interpreting results of concern, consider multiple factors including: patient history and risk factors; type, frequency, and magnitude of the findings; patient advance disclosure and/or acknowledgment of findings; practitioner’s assessment and ability to address the findings with the patient; and the finding of illicit drugs.


How to Handle Discrepancies in Test Results

Remembering each patient is unique, a basic approach can include verifying major abnormal results with the lab, documenting findings, and discussing those findings with the patient in a non-judgmental, non-accusatory manner.

Full Recommendations

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Recommendations for Urine Drug Monitoring as a Component of Opioid Therapy in the Treatment of Chronic Pain

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