Best Practices in Urine Drug Monitoring

Established medical guidelines recommend urine drug/toxicology screenings to help ensure the safety of patients prescribed opioids long term and to identify any aberrant use. However, a study conducted by the California Workers’ Compensation Institute shared new research that reveals the growing practice of urine drug screening is overused and abused, driving claims expenses for services that do not benefit injured workers. This session at the 24th Annual National Workers’ Compensation & Disability Conference highlighted best practices on how urine drug monitoring (UDM) data should be used.

Speakers included:

• Alex Swedlow, President, California Workers’ Compensation Institute
• Mark Pew, Senior Vice President, PRIUM

1. Understand and act on inconsistent results. This should be the start of a dialogue. If you do not engage with the individual, you can not tell the difference between what may be drug abuse or explainable results. Some potential reasons that a drug was not detected in a drug test include:

• Not taking it, diversion or hoarding
• Lab error
• Self-escalating
• Binge use
• Rapid metabolism
• Drug/drug interaction
• False positive

2. Utilize supplemental tools to ensure compliance. UDM is a best practice, but only one tool of many. Other tools include:

• Narcotic contracts
• Pill count
• Accessing the state’s PDMP
• Office visits that are more than just a refill exercise

3. Proactively handle discrepancies:

• Verify results with the lab
• Document findings and schedule a follow-up visit
• Meet with the patient and discuss findings in an open-ended manner
• Review the treatment agreement
• Counsel the patient as appropriate
• Consider retesting or additional testing

4. Actions count after someone tests positive for a non-prescribed medication. 46% of the time that a patient tests positive of non-prescribed drugs, doctors discharge them from the practice. That is never what is best for the patient.

5. Ask if the drugs are even the best medical treatment for the patient with this condition at this time. Between 1999-2013, more than 175,000 have died from prescription overdoses because we are not asking this question.