As a healthcare provider, it can be tough determining when to urine drug test patients. With the opioid epidemic in full swing and state medical boards shutting down clinics who fail to adequately monitor patients on controlled medication, the burden of drug testing loyal patients can put you between a rock and a hard place. Here are some recommended practices for medication monitoring based on prescribed regimen.
Patients on Opioids & Opiates
Recommended: Every 1-3 Months
Patients prescribed triplicate medication are recommended to be tested monthly to quarterly. Patients who are high-risk with a history of dependency should be tested every follow-up to ensure adherence to prescribed regimen and pinpoint attempted diversion.
Brand names: OxyContin, Exalgo ER, Percocet, Lorcet, Norco, Vicodin, Subsys, Duragesic, Abstral, Utram, Duramorph, MS Contin, Dolophine, Methadose, Butrans, Subutex, Suboxone, Ritalin, Concerta, Adderall, Vyvanse
Generic names: Oxycodone, Oxymorphone, Hydrocodone, Fentanyl, Tramadol, Morphine, Methadone, Buprenorphine, Methylphenidate, Amphetamine
Patients on Controlled Medication
Recommended: Every 3 Months
This includes benzodiazepines and sleep medications. These drugs are often slept on - no pun intended - as they aren't formally classified as opioids, nor do they fall within Schedule I - III categorization. They do, however, contribute a great deal to the current overdose crisis as Xanax and Ambien appear frequently in drug cocktails and, when it's too late, in an autopsy.
Brand names: Xanax, Klonopin, Ativan, Valium, Ambien, Sonata, Lunesta
Generic names: Alprazolam, Clonazepam, Lorazepam, Diazepam, Zolpidem, Zaleplon, Eszopiclone
Patients on Antidepressants/Muscle Relaxants (SSRI & SSNI medications)
Recommended: Every 3-6 Months
This is mainly for patient safety and to ensure the prescribed dosage is adhered to, rather than accidentally overdosing because one pill feels less effective over time. Confirmatory testing urine would pinpoint the exact quantity of the drug and determine if the recommended amount is being taken as prescribed.
Brand names: Zoloft, Cymbalta, Paxil, Prozac, Celexa, Flexeril, Soma
Generic names: Sertraline, Duloxetine, Paroxetine, Fluoxetine, Citalopram, Cyclobenzaprine, Carisoprodol
All New Patients
Recommended: On the first visit, before prescription
This is truly to establish a baseline. Painkiller or not, wouldn't you want to know of any existing medication in a patient's system before prescribing anything that could potentially cross-react and harm?
The Bottom Line
As healthcare providers, you have patients who have seen you through the years and place a great deal of trust in your care. It may come as a surprise to your patient of 15 years when they're recommended to take a urine drug test. But it may come as a bigger surprise when you discover this patient is taking Xanax prescribed by you, but also Adderall from their neighbor to stay focused through the day, and Soma because it helps them go to sleep at night. Perhaps you as a provider may not want to know such information but truth be told, the out of sight, out of mind mentality continues to be a huge factor in the drug overdose epidemic we have today.
Across the nation, federal and state governing bodies are revoking licenses and even administering jail time to healthcare providers who are prescribing controlled medication while not performing medication monitoring on their patients. Fortunately we have developed a Clinic Testing Guidelines One-Pager which can be downloaded here, to put up within your practice and keep you in full compliance.
