Why Would I Need To Take A Drug Test For Pain Management?

It’s never a favorable feeling when you feel disconnected from your healthcare management. Unfortunately, there still exists a gap between the treatment/procedures a given patient receives and the patient education and engagement of those treatments. One example that we would bring more insight to is why your pain management doctor may ask for you to provide a urine-drug test. It has been estimated that 20% patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings. From 2007–2012, the rate of opioid prescribing has steadily increased among specialists more likely to manage acute and chronic pain. If you are currently taking an opioid or certain non-opioid pain medications, your doctor may at some point request you provide a urine drug test. So let’s quickly detail what the urine-drug test is and then provide some reasons why it is important to your pain management treatment.

What Is A Urine-Drug Test?

You would be correct in assuming this procedure tests drug levels in the body through a urine sample. But let’s get a little more technical as to the mechanics of a urine-drug test. Once a urine sample is collected, it is sent to a certified laboratory where the sample is analyzed using laboratory methods known as immunoassay and chromatographic methods (e.g., liquid chromatography with mass spectrometry detection) to yield high detection sensitivity and drug specificity. The test will also determine the concentration of a given medication; the higher the dose of a medication, the higher the concentration will appear on the test. The results are then shipped back to your physician where they will overview the results with you as well as determine what the next step should be in your pain management treatment.

Why Is A Urine-Drug Test Being Done?

There are three main reasons why a urine-drug test is completed for a clinical setting. In general, the test will provide objective evidence and documentation that you are properly taking your medication, and not taking any substance that you are not prescribed. It’s a tool that physicians use to keep you safe, other patients safe, and themselves safe.

  1. Allows your physician to determine the right dose for your medication. When a medication is ingested and absorbed into the blood system, it will travel to the liver where specific metabolic enzymes will convert the medication into its metabolites. These metabolites are what are tested in a urine-drug test. Our DNA dictates as to how [active] our liver enzymes are at metabolizing a drug. Some people are slow metabolizers, meaning it takes longer to form a metabolite; some people are fast metabolizers, meaning a metabolite is formed much more rapid when compared to a normal metabolizer. Let’s use dilauded as an example. Two people are both given a 1mg dose of dilauded. One patient is a slow metabolizer where a lower concentration of dilauded’s metabolites will appear in a urine-drug test when compared to a patient who is normal. Because of a lower concentration of the metabolites, this patient is not receiving the full analgesic-effect of this dose. Thus the physician may determine to either increase the dose or alternate to a different medication.
  2. Determines If You Are Correctly Taking A Drug & Being Honest About It. Misuse of drugs can be accidental or intentional – unfortunately, it can also be fatal. A urine-drug test will report whether you are taking a medication at the prescribed dose and at the proper time. Your physician may decide to remove this medication from your drug therapy or change the dose depending on why the drug was not originally being taken properly.
  3. Determines If You Are Taking Any Illicit or Other Non-Prescribed Drugs. One chronic pain study found that many patients fail to report their drug use, especially illicit drugs. Abusing an illicit or non-prescribed drug can also be fatal, depending on the drugs involved. If potentially fatal drugs are being taken, your physician will do what they can to minimize the risk, and there is no way of telling by looking at a person what the risk for that person is. Because the potential consequences of medication abuse are so serious, i.e. death, your doctor may be required to test a patient who is prescribed an opioid.

We would like to point out that due to the advancements of technology, your doctor may choose to do a saliva, buccal cheek swab, or hair follicle test rather than a urine- test. Although these are different methods, the test still provides the same results so do not be too concerned with the method of testing your doctor may chose to do. Drug testing for opioid or other pain drugs is an important tool that healthcare providers can use to assess drug therapy treatment compliance and opioid misuse; however, no diagnostic test is perfect. It is sometimes possible to “game” the system, and avoid being detected for a while, although who are you really helping with that strategy? If you have trouble managing your medications or your pain, or you are using illegal or non-prescribed drugs, talk to your provider and get help! You don’t have to go it alone.

Tags: urine-drug test, medication, opioids, pain management, healthcare, technology

References:

  1. Centers for Disease Control and Prevention. Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012. MMWR 2014; 63(26):563-568.
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