The Urine Drug Screen can be an important tool in evaluating patients for appropriateness of chronic pharmacotherapy, as well as in identifying sources of delirium and altered mental status. However, interpretation of results can be a daunting task. The following questions will need to be answered in order to properly understand the UDS.

Essential Questions and References

How should the urine drug screen be utilized in pharmacy practice?

  1. Moeller K. Struggles with urine drug screens. Presented at the CPNP annual meeting (2018). [Weblink]

How should the urine drug screen be used in chronic pain management?

  1. Cone EJ, Caplan YH. Urine toxicology testing in chronic pain management. Postgrad Medicine. 2nd ed. 2009;121(4):91-102. DOI: 10.3810/pgm.2009.07.2035. PubMed PMID: 19641275.
  2. 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]

How sensitive is the urine drug screen? How long will the substance be detected in the urine after last use?

  1. 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]

What are some common agents that may cause false positives on the UDS?

  1. 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.
  2. 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.

Should I order confirmatory testing? What good will it do?

  1. Premier Biotech. Laboratory screening and confirmation – defined. 2017.  [Weblink]
  2. 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.

Could the use of one opioid cause a positive result for another? How are the various opioids metabolized?

  1. Milone MC. Laboratory testing for prescription opioids. J. Med. Toxicol. 2nd ed. 2012;8(4):408-16. DOI: 10.1007/s13181-012-0274-7. PubMed PMID: 23180358; PubMed Central PMCID: PMC3550258.

Can we test for novel drugs of abuse?

  1. 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]
  2. 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]