1. 2010;13;167-186Importance of Urine Drug Testing in the Treatment of Chronic Noncancer Pain: Implications of Recent Medicare Policy Changes in Kentucky
   Narrative Review
   John W. Gilbert, MD, G R. Wheeler, MD, Gregory E. Mick, DO, B B. Storey, MD, S L. Herder, MD, G B. Richardson, MD, E Watts, MD, K Gyarteng-Dakwa, MD, B S. Marino, MD, C M. Kenney, MD, M Siddiqi, MD, and P G. Broughton, ARNP.

BACKGROUND: Urine drug testing has become a widely used tool in American society for deterring illicit drug use. In the practice of medicine, urine drug testing is commonly used to help diagnose substance misuse, abuse, or addiction.

OBJECTIVE: This narrative review provides an informed perspective on the importance of urine drug testing in the medical treatment of chronic noncancer pain. The history and current uses of urine drug tests in the United States are reviewed, the prevalence and nature of prescription drug misuse is described as is related to chronic noncancer pain, and implications and considerations for practitioners are presented related to the noncancer pain diagnosis and treatment.

DISCUSSION: Practitioners are confronted with the ethical and legal dilemma of being called to adequately treat chronic pain in a culture with a high prevalence of prescription drug abuse. Yet the symptoms of drug abuse are nonspecific and therefore of limited value to the practitioner in determining patient compliance to drug treatment regimens. In contrast, urine drug testing has a reliable history, both in and out of medicine, as an independent sign of drug misuse. This sign can be used to aid in the diagnosis and treatment of drug misuse and underlying addictions to improve patient outcomes.

CONCLUSION: Regular urine drug testing should be a part of acute and chronic pain management whether or not the patient has any signs or symptoms of drug misuse.