Joanna L. Starrels, MD, MS; Daniel P. Alford, MD, MPH; Barbara J. Turner, MD, MSEd, Executive Deputy Editor
Potential Conflicts of Interest: None disclosed.
Starrels J., Alford D., Turner B.; Urine Drug Testing Is Still an Invaluable Resource for Primary Care. Ann Intern Med. 2010;153:420-421. doi: 10.7326/0003-4819-153-6-201009210-00019
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Published: Ann Intern Med. 2010;153(6):420-421.
We agree with Dr. Reisfield and colleagues that UDT is a valuable tool for monitoring patients receiving long-term opioid therapy for chronic pain, but our endorsement of its use in primary care is tempered by its limitations. Urine drug testing can detect use of illicit or nonprescribed drugs that is not disclosed by patients, which is essential to managing the risks associated with prescribed opioids. When ordered and interpreted correctly, UDT can also detect nonuse of prescribed opioids. However, although UDT detects these 2 types of aberrant behavior, current evidence does not support the claim that it can detect the clinical diagnoses of opioid use disorders (that is, abuse and dependence) or the crime of diversion (that is, selling or giving away). Indeed, Katz and colleagues' article (1), referenced by Dr. Reisfield and colleagues, found that UDT is effective in detecting “behaviors suggestive of inappropriate medication use.” To detect the more serious outcomes of abuse, dependence, or diversion, serial UDT results need to be interpreted over time along with data from other sources, including patient interviews; physical examination; pill counts; and monitoring of patient behaviors, such as requests for early refills.
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