UDM Solutions

As the president of a clinical laboratory, I cannot answer this question for you. There are no published guidelines for urine drug testing frequency from any society, academy or association that I am aware of. As a physician, I can tell you about my experiences, the experiences of my colleagues and published research and recommendations.

I practiced pain medicine in a pain & addiction clinic, so most of my chronic pain patients suffered from the disease of addiction. So as not to appear as being biased (which we were often accused of), we tested every patient at every visit. Our three-strikes-and-you’re-out policy seemed to work well to keep motivated patients in the program, and refer others to a higher level of care. This policy of frequent testing allowed us to address relapse issues early, helped to build trust, and confirmed adherence. All of this improved the care that we delivered to our patients. What I learned through this process is to always give my patients the benefit of the doubt, as long as there’s a UDT collected to corroborate the history.

A colleague of mine uses a popular protocol for testing that stratifies patients based upon risk of misuse or addiction. Patients are placed into low, medium or high risk categories and tested accordingly (i.e., low risk - annually, medium risk - quarterly, high risk - every visit or 1-2 months). This strategy allows for early identification of patients who may be at risk of misuse or addiction and limits potentially unnecessary testing for low risk patients who are making progress in treatment.

Recommendations from research articles and pain medicine publications vary widely in specifics. Of those that recommend testing, some suggest testing every patient at every visit¹, while others suggest testing as a response to aberrant behavior.² There is research that indicates urine drug testing in combination with other clinical observations provide more insight into pharmacotherapy than either used separately.³

Until progress is made in guidelines for monitoring pharmacotherapy, it is up to each clinician to determine an appropriate testing protocol for their practice and their patients. I'd like to hear from you about how you determine testing frequency to monitor pharmacotherapy for your patients and what your experience has been (positive and negative). You can comment on this post or send me an email.

1. Katz NP, Managing Chronic Pain with Opioids in Primary Care. PainEDU.org Inflexxion Health Series, 2007.
2. Hammett-Stabler CA, Webster LR, A Clinical Guide to Urine Drug Testing: Augmenting Pain Management and Enhancing Patient Care. UMDMJ–Center for Continuing and Outreach Education, 2008.
3. Katz NP, et al., Behavioral Monitoring and Urine Toxicology Testing in Patients Receiving Long-Term Opioid Therapy. Anesth Analg 2003;97:1097-102.