Rational urine drug monitoring in patients receiving opioids for chronic pain: Consensus recommendations

Charles E. Argoff, Daniel P. Alford, Jeffrey Fudin, Jeremy A. Adler, Matthew J. Bair, Richard C. Dart, Roy Gandolfi, Bill H. McCarberg, Steven P. Stanos, Jeffrey A. Gudin, Rosemary C. Polomano, Lynn R. Webster

Research output: Contribution to journalReview article

12 Scopus citations


Objective. To develop consensus recommendations on urine drug monitoring (UDM) in patients with chronic pain who are prescribed opioids. Methods. An interdisciplinary group of clinicians with expertise in pain, substance use disorders, and primary care conducted virtual meetings to review relevant literature and existing guidelines and share their clinical experience in UDM before reaching consensus recommendations. Results. Definitive (e.g., chromatography-based) testing is recommended as most clinically appropriate for UDM because of its accuracy; however, institutional or payer policies may require initial use of presumptive testing (i.e., immunoassay). The rational choice of substances to analyze for UDM involves considerations that are specific to each patient and related to illicit drug availability. Appropriate opioid risk stratification is based on patient history (especially psychiatric conditions or history of opioid or substance use disorder), prescription drug monitoring program data, results from validated risk assessment tools, and previous UDM. Urine drug monitoring is suggested to be performed at baseline for most patients prescribed opioids for chronic pain and at least annually for those at low risk, two or more times per year for those at moderate risk, and three or more times per year for those at high risk. Additional UDM should be performed as needed on the basis of clinical judgment. Conclusions. Although evidence on the efficacy of UDM in preventing opioid use disorder, overdose, and diversion is limited, UDM is recommended by the panel as part of ongoing comprehensive risk monitoring in patients prescribed opioids for chronic pain.

Original languageEnglish (US)
Article numberpnx285
Pages (from-to)97-117
Number of pages21
JournalPain Medicine (United States)
Issue number1
StatePublished - Jan 1 2018



  • Chronic Pain
  • Opioids
  • Pain Management
  • Screening Tools
  • Substance Use Disorders
  • Urine Drug Monitoring

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Argoff, C. E., Alford, D. P., Fudin, J., Adler, J. A., Bair, M. J., Dart, R. C., Gandolfi, R., McCarberg, B. H., Stanos, S. P., Gudin, J. A., Polomano, R. C., & Webster, L. R. (2018). Rational urine drug monitoring in patients receiving opioids for chronic pain: Consensus recommendations. Pain Medicine (United States), 19(1), 97-117. [pnx285]. https://doi.org/10.1093/pm/pnx285