PA Medical News about chronic pain; urine toxicology testing

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Urine Toxicology Testing in Chronic Pain Management
Postgraduate Medicine, 07/29/09

Cone EJ et al. – This article describes the technical aspects of urine toxicology testing and provides recommendations for monitoring patients to maximize the safety of opioid therapy. Urine tests can detect prescribed and illicit substances that are present above a specific threshold, but they provide limited data about the source, dose, or route of administration of substances detected. Effective monitoring requires careful test selection, an understanding of pharmacologic and metabolic factors influencing test results, and awareness of methods by which patients who are substance abusers may tamper with test specimens to escape detection. All patients prescribed opioids, not just those considered at risk for abuse, should undergo urine toxicology testing. Given its inherent complexities, effective urine testing requires close collaboration between the primary care physician and a reliable laboratory to develop an appropriate test protocol for each patient and to interpret test results.