Urine drug monitoring (UDM) is recommended for patients taking opioids for chronic pain although data regarding its efficacy in preventing overdose, opioid use disorder, and diversion are limited. To address this, new consensus recommendations for UDM were published in Pain Medicine.

A panel of clinicians and experts in pain medicine, substance use disorders, and primary care reviewed existing literature and guidelines, and clinical experiences to form consensus recommendations for UDM in patients with chronic pain who are prescribed opioids. 

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Definitive testing (eg, chromatography-based) was recommended as the most clinically appropriate form of UDM due to its accuracy; institutional or payer policies, however, may first require presumptive testing such as an immunoassay. The panel stated that the choice of substances to analyze for UDM are patient-specific and related to illicit drug availability. The opioid risk stratification depends on patient’s history of psychiatric conditions or substance use disorder, prescription drug monitoring program data, results from valid risk assessment tools, and previous UDM. 

In general, UDM should be performed at baseline for most patients prescribed opioids for chronic pain. For low-risk patient, testing should be conducted at least yearly, for those at moderate risk, ≥2 times a year, and for those at high risk, ≥3 times a year. Additional UDM can be done as needed based on the discretion of the clinician. 

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