Pain and Addiction Management – Drug Testing

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Many substances that are prescribed for pain management and other legitimate indications are found to be taken incorrectly (either inadvertently or purposefully), shared, sold, or otherwise misdirected. In addition, many substances are available for illicit use, including prescription substances (eg, opioids, Adderall, Xanax) and/or nonprescription drugs (eg, heroin, methamphetamines).

To ensure safe and effective therapy, current practice guidelines recommend monitoring patients for adherence to prescribed medication(s) and abstinence from nonprescribed drugs through periodic drug tests. 1 However, drug testing strategies and testing methods are not standardized, adding challenges to the selection of the right test, collection of the appropriate specimen, and interpretation of test results.


Urine and blood specimen (serum/plasma) tests are available for most drugs commonly prescribed for pain management, as well as many illicit substances. Urine is typically preferred for pain management testing; serum or plasma is an acceptable alternative.

Saliva testing is available for select drugs; however, there is no evidence that drug testing in alternate specimens (eg, hair, saliva) is more effective than urine testing in pain management patients.

Timing of Collection

Specimens should be collected for drug testing at the initiation of opioid therapy and periodically during therapy to confirm the presence of prescribed medications and exclude the presence of illicit and nonprescribed drugs.