The use of urine drug monitoring in chronic opioid therapy: An analysis of current clinician behavior

Abstract

The purpose of this study was to better quantify how urine drug monitoring (UDM) is used in clinical practice. Little is known about which patients are monitored, how often patients are monitored, which substances are important to detect, and under what circumstances clinicians modify the frequency of monitoring. An online survey was developed based on qualitative phone interviews with eight clinicians who use UDM as a routine component of clinical practice. One thousand fourteen randomly selected clinicians known to order urine toxicology screenings were invited by mail in June 2011 to respond to the online survey assessing their clinical needs and preferences regarding UDM. Of the 93 respondents, 76 percent (n = 72) require all new patients to have UDM performed when they enter their clinic. The majority administer UDM to patients four times a year. The most common reasons cited by clinicians for a change in the frequency of monitoring are patient history of substance abuse and aberrant behaviors. Overall, the respondents showed broad support to test patients consistently for the most common illicit drugs, the majority of opioids, and a handful of prescription medications associated with abuse. Despite a lack of agreement between guidelines informing the use of UDM, there appears to be a general consensus among practitioners that use UDM on: which patients to monitor, how often to monitor, and which substances are most important to detect.