Who and When to Test
Urine drug screening is recommended by the Federation of State Medical Boards' policy statement, State agencies, and leading pain organizations as an integral part of quality patient care when opioid medication is prescribed to treat chronic pain. Although a mandatory guideline setting forth who and when to test is not yet available—physicians rely on their clinical judgment and skills honed by years of experience caring for diverse patient populations.
|Howard A. Heit, MD, FACP, FASAM
Assistant Clinical Professor
Georgetown University School of Medicine
In general, a patient’s past and current behaviors, and history of substance abuse (both their own and family history) are significant. Patients who warrant UDT may include those who:
- Will be started on opioids
- Already taking opioids
- Making a major change in rational pharmacotherapy
- Resist a full evaluation
- Request a specific drug (even if the request is valid)
- Display aberrant behavior
- Exhibit mental health problems
- Smoke cigarettes
Risk Assessment Models
Several risk assessment models are available to help physicians assess a patient’s risk of prescription drug non-compliance. Understanding the types of information these models attempt to capture, and the benefits and limitations of each tool, can help you efficiently implement them into practice. The Opioid Risk Tool (ORT)4 is an example.
Opioid Risk Tool (ORT) Example4
When to Test
Determining how often to assess risk and utilize UDT is based on the physician’s clinical judgment. What is important is to implement these tenants of care into practice.
|Humam H. Akbik, MD, FIPP
Chief, Pain Medicine Division
Mercy Health, Fairfield, OH