Physician's Guide To
Urine Drug Testing

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.

"If you do not test [UDT], you are less likely to identify misuse or addiction, and miss what is called the golden moment—the opportunity to address a very treatable medical problem."
  Howard A. Heit, MD, FACP, FASAM
Assistant Clinical Professor
Georgetown University School of Medicine
Arlington, VA

Patient Behaviors

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.

"Each visit, once a year, every quarter, at random, when medication changes…when is based on the physician’s clinical judgment."
  Humam H. Akbik, MD, FIPP
Chief, Pain Medicine Division
Mercy Health, Fairfield, OH

Who and When to Test: Determining When

Last updated on: August 20, 2013