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Why Test: The Scope of the Problem

In this video about Drug Testing in Pain Management, Bill H. McCarberg, MD, FABPM explains the scope of the problem:  “We were taught that under-treatment of pain was epidemic and opioids were safe and effective in helping manage this problem.  We now face an epidemic of prescription drug abuse.”

Facts about prescription drug misuse and abuse:

  • More than 36,000 people died of drug overdoses in 2008, and the majority of those deaths were caused by prescription drugs.1
  • Nearly 3 out of 4 drug overdoses are caused by opioids.1
  • Approximately 7 million people used psychotherapeutic drugs non-medically in 2010, and more than 5 million of them abused pain relievers.2
  • Prescription medications are one of the most common types of drugs abused by adolescents.2

Why Urine Drug Testing (UDT)?
Physicians find UDT benefits a patient-centered treatment plan and improves adherence to opioid medication prescriptions.

However, the reasons why you should incorporate urine drug testing into your busy practice—particularly in cases where abuse is not suspected—may be less clear.

Physician Hesitation to Use UDT Is Understandable
Some hesitation about regular UDT is understandable.  You have a large volume of patients to see—each within an already-limited amount of time.  You have developed long-standing relationships with each patient, whom you trust will safeguard their opioid prescription and judiciously take it as prescribed.  Furthermore, perhaps you lack financial and/or staff resources to administer one more test.

Reasons to Consider UDT
There are many reasons why you should consider urine drug testing—both in cases when aberrant behavior is noticeable, and at times when it is not.  That is not to say that all patients who take prescription opioid drugs will misuse or abuse the medication.

However, in a study by Nathaniel Katz, MD, he (and colleagues) noted that behavioral observation alone missed 49% of patients with problems.3  A “problem” was defined as a positive urine drug test or a behavioral issue.  Combining UDT and behavioral observation detected more patients with a problem.

Developing a drug testing protocol for your practice is possible, and it is imperative to address epidemic prescription drug misuse and abuse in the United States.


  1.  Policy Impact: Prescription Pain Killer Overdoses.  National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention (CDC).  November 2011.  Accessed January 29, 2013.
  2. Topics in Brief: Prescription Drug Abuse. National Institute on Drug Abuse (NIDA).  Revised December 2011. Accessed January 29, 2013.
  3. Katz NP, Sherburne S, Beach M, et al. Behavioral monitoring and urine toxicology testing in patients receiving long-term opioid therapy. Anesth Analg 2003;97:1097-102.
First published on: January 30, 2013