Having a urine drug testing policy in place when prescribing opioids can help clinicians make preliminary treatment decisions and may deter individuals with opioid-seeking behaviors, according to a recent article published in Anesthesia & Analgesia.

Gagan Mahajan, MD, of the department of anesthesiology & pain medicine, University of California Davis in Sacramento, notes that clinicians should use immunoassay screens and urine drug tests to determine compliance with chronic opioid therapy.

The overprescription of opioids for chronic non-malignant pain in recent years has resulted in a public health crisis. In fact, opioids account for the greatest percentage of poisoning deaths in the United States. Nonetheless, opioids represent an important therapeutic option for many patients with serious chronic pain, and monitoring patients who use these agents can help mitigate some of the negatives associated with opioid prescription.

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Although the evidence for urine drug testing in patients on chronic opioid therapy is weak, guidelines from medical societies and state and federal regulatory agencies often recommend that such testing be included as a monitoring tool in patients receiving opioids. Immunoassay screening has a high detectability threshold and only provides qualitative information about a select number of drug classes, resulting in high false-positive and false-negative rates. It is, however, cheap, and can be performed either in-office or as a laboratory-based test. In contrast, a confirmatory urine drug test has a lower threshold of detectability and provides both qualitative and quantitative information. Its greater degree of specificity results in relatively low false-negative and false-positive rates.

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Clinicians must be cautious, however, when interpreting the meaning of positive and negative test results. When the meaning is unclear, they should contact the laboratory to avoid drawing incorrect conclusions that could result in harm to a patient.


Mahajan G. Role of urine drug testing in the current opioid epidemic. Anesth Analg. 2017;125(6):2094-2104.