Maintaining Patient Trust in Urine Drug Testing

The panelists describe their methods for managing risk among patients who are prescribed opioid medication without sacrificing trust.

“I see this in my community all the time that a patient will come back with one positive drug test, and the clinicians call me and they want to transfer the patient to me right away because I’m the expert,” Jeffrey A. Gudin, MD, says. “I try to counsel my colleagues that, ‘Hey, listen, this is a lab test. It’s subject to error. There are false negatives as well as false positives, and we should never make a clinician decision or base our clinical rationale on one simple test finding just like in any other area of medicine.’ ”

Though moderator Peter Salgo, MD, points out the perception of mistrust towards patients who are given urine drug tests, Joseph Pergolizzi, MD, says he tells his patients that “we regularly test your INR when you’re on a blood thinner, (and) you’re (also) on a chronic disease management program when you buy into chronic pain medicine, and so I tell them that that’s part of it,” while Gudin notes that many physicians have adopted a universal testing policy to communicate that “we’re not selecting you out because we think you’re doing anything wrong.”

Using an example of a patient who legally uses marijuana in Colorado but is given a urine drug test at a practice in Florida where the substance is illegal, Pergolizzi says the test is “not an end-all, be-all” even when it is implemented across the board for every new patient. To help patients understand the risks and benefits of urine drug testing throughout treatment, Pergolizzi recommends signing opioid contracts.

“It’s miserable to be a chronic pain patient, and so you really have to be the ombudsman on their side of things,” Pergolizzi says. “These types of opioid contracts or informed consents … should include some type of quarterly or annual educational process where you can direct them to various websites or direct them to look at their medication guides. And that’s how things like REMS, urine drug testing, and multimodal, multidisciplinary patterns all come together.”