Psychiatric Pharmacy Essentials: Utilization of Urine Drug Screens in Clinical Practice

The urine drug screen (UDS) can be an important tool in evaluating patients for appropriateness of chronic pharmacotherapy, identifying sources of delirium and altered mental status, and monitoring for substance use. However, interpretation of results can be sometimes be viewed as challenging or complicated.

  • How should the urine drug screen be utilized in pharmacy practice?1-2
  • How should drug testing be utilized in primary care?3
  • How should the urine drug screen be used in chronic pain management?4-5
  • How sensitive is the urine drug screen?6
  • How long will the substance be detected in the urine after last use?4,6
  • What common agents may cause false positives or negatives on the UDS?7-9
  • What is the cross-reactivity between opioids?10
  • How do I interpret quantitative buprenorphine levels?11
  • When should I order confirmatory testing?12-13
  • Can we test for novel drugs of abuse?14‑16

Reviewer 1: Carly Rainey, PharmD, BCPP, BCPS
Reviewer 2: Austin Smith, PharmD, BCPP
2024-2025 AAPP Resident and New Practitioner Committee

References

  1. Moeller K. Struggles with urine drug screens. Presented at the CPNP annual meeting (2018). [Weblink]
  2. American Society of Addiction Medicine. Appropriate Use of Drug Testing in Clinical Addiction Medicine Consensus Document. [Weblink]
  3. Substance Abuse and Mental Health Services Administration. Clinical drug testing in primary care – Technical Assistance Publication Series 32. 2012. [Weblink]
  4. Christo PJ, Manchikanti L, Ruan X, et al. Urine drug testing in chronic pain. Pain Physician. 2011;14(2):123-43. [PubMed]
  5. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016.  MMWR Recomm Rep. 2016;65(1):1-49. [PubMed]
  6. Moeller KE, Kissack JC, Atayee RS, Lee KC. Clinical interpretation of urine drug tests: What clinicians need to know about urine drug screens. Mayo Clinic Proceedings. 2017;92(5):774-96. [PubMed]
  7. Saitman A, Park H-D, Fitzgerald RL. False-positive interferences of common urine drug screen immunoassays: a review. J Anal Toxicol. 2014;38(7):387-96. DOI: 10.1093/jat/bku075. PubMed PMID: 24986836.
  8. Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA. Commonly prescribed medications and potential false-positive urine drug screens. Am J Health Syst Pharm. 2010;67(16):1344-50. DOI: 10.2146/ajhp090477. PubMed PMID: 20689123.
  9. Jaffee WB, Trucco E, Levy S, Weiss RD. Is this urine really negative? A systematic review of tampering methods in urine drug screening and testing. J Subst Abuse Treat. 2007;33(1):33-42. [PubMed]
  10. Milone MC. Laboratory testing for prescription opioids. J Med Toxicol. 2012;8:408-416. [PubMed]
  11. Donroe JH, Holt SR, O’Connor PG, Sukumar N, Tetrault JM. Interpreting quantitative urine buprenorphine and norbuprenorphine levels in office-based practice. Drug Alcohol Depend. 2017;180:46-51. [PubMed]
  12. Premier Biotech. Laboratory screening and confirmation – defined. 2017.  [Weblink]
  13. Jarvis M, Williams J, Hurford M, Lindsay D, Lincoln P, Giles L, et al. Appropriate Use of Drug Testing in Clinical Addiction Medicine. J Addict Medicine. 2017;11(3):163-173. DOI: 10.1097/ADM.0000000000000323. PubMed PMID: 28557958.
  14. Dasgupta A. Challenges in laboratory detection of unusual substance abuse: Issues with magic mushroom, peyote cactus, khat, and solvent abuse. Adv Clin Chem. 2017; 78: 163-186. [PubMed]
  15. Nieddu M, Burrai L, Baralla E, et al. ELISA detection of 30 new amphetamine designer drugs in whole blood, urine and oral fluid using Neogen® "Amphetamine" and "methamphetamine/MDMA" kits. J Anal Toxicol. 2016;40(7): 492-7. [Pubmed]
  16. Swortwood MJ, Hearn WL, DeCaprio AP. Cross-reactivity of designer drugs, including cathinone derivatives, in commercial enzyme-linked immunosorbent assays. Drug Test Anal. 2014;6(7-8):716-27. [PubMed]