Several important guidelines recommend that long-term opioid patients have periodic urine drug monitoring (UDM). However, they do not address specific questions such as which patients to test, for which substances, how often to test and how to act on the results.
To ensure safe and effective treatment, it is essential to screen patients on a regular basis. To identify patients who are eligible for treatment, drug testing can be used to assess their effectiveness in pain relief, assess potential misuse, addiction, or diversion, and to ensure that they follow a prescribed treatment plan. Urine is typically the specimen of choice since it’s easier to collect, drugs/metabolites are typically detected at higher concentrations and for a longer period of time compared with blood/serum/plasma. Urine drug testing has a traditional clinical purpose; to confirm a doctor’s diagnosis and to identify a toxin if there is no differential diagnosis.
There is no standardization in the scope of testing within the industry but each patient should receive testing that is tailored to their needs. When making testing decisions, you should consider prescribed controlled medications and substances that are endemic in a specific region. Patients with substance misuse/abuse issues will need more thorough testing and according to the American Society of Addiction Medicine, the frequency of testing should match patient risk.
Drug testing is required when:
- Prescribing a Schedule II or III controlled substance for 90 consecutive days or greater in a given year for the treatment of chronic pain
- The condition is not terminal
- The patient is not in a hospice, hospital or nursing home
Frequency of drug testing:
- Morphine equivalent dose 30 mg/day or less aEUR” at least once a year
- Morphine equivalent dose greater than 30 mg/day aEUR” at least every three months on a random basis
- If the physician determines there is a substantial hardship for the patient, the frequency of testing may be reduced to once a year regardless of dose
Recognizing Relapse In Addiction Recovery
Routine drug and alcohol testing is a common method of identifying relapse quickly. Early intervention is possible to get patients back on track by allowing for early detection. These programs offer effective treatment plans that can be used for both inpatient and outpatient care. Routine testing and accountability are crucial in helping to prevent relapses and ensure abstinence and sobriety for patients in a program.
Former addicts can stay clean and drug-free in some “Board & Care”, or “Sober Life” programs. They are subject to routine drug testing. Patients who fail to pass a drug test because of a relapse will lose their right to live at the facility. Regular testing is one way addicts can stay committed to their treatment and stick to it long-term.
What Does Urine Testing Reveal About A Pain Patient?
The only problem with urine drug testing is the inability to provide information about how much drug was taken. This is not an issue for prescription drugs and illicit drugs. It’s more about determining if they are in the patient’s system. Providers are also concerned about their patients’ use of prescribed pain medication. They may only be using one pill each day to pass the urine drug test, and then sell the rest. Since there is no direct relationship between the amount of drug detected in urine and the actual amount ingested, the patient will appear to be compliant as long as it is visible in their urine. We need to look at the steady-state blood levels if we want to determine how much drug was taken.
If your primary concern is illegal drug use or nonprescription drug use, urine testing will be used. It gives you an extended window of detection that allows you to find those items that are not there. Blood testing is best if your main concern is to find out how much prescription medication the patient is taking to make sure they are not over medicating.
Reviewing Results and Creating Plan Of Action
Once the screen has been collected and results are present providers must review the test and then create an action plan for the patient. This is the last step in responsible urine drug testing. Interpreting urine drug testing results may pose challenges. Knowledge of the limitations of testing—cutoff or threshold concentrations, drug targets and cross reactivities is important. Knowledge of metabolic patterns, and the influence of pharmacokinetics is necessary for appropriate interpretation of results. Unexpected results require investigation to include the patient, the specimen, and the testing.
Payors will be questioned about the necessity of the ordered tests if results are not reviewed. Providers who are unable to provide full documentation about the medical necessity of ordering or performing any test can be refunded or refunded by payers.
Conclusion
A physician can use urine drug testing to help them assess and manage patients who are or will be being treated with controlled substances. It may prove very useful to have a working relationship with a trusted testing laboratory in order to interpret urine test results accurately. When using urine drug testing in clinical practice, the physician must have a trusting and honest relationship with each patient. Both the patient and the practitioner will benefit from a well-planned testing strategy and an accurate interpretation of the results. It is important that urine drug testing be done in a consensual manner. This is to improve patient care and allow physicians to advocate for patients. The results should be used for patient care and communication within the context of the doctor-patient relationship.
If you or a loved one are suffering from addiction or substance abuse, please contact us today. We are here to help you along the way, and throughout your road to recovery.
