Drug testing in pain management

Drug testing in pain management is essential to ensure compliance of a patient with prescribed opiates. In addition, it is important to ensure that these patients are not using any illicit drugs. Several guidelines for opioid prescribing recommend urine drug testing as an effective tool to monitor adherence; however, there are limited studies evaluating utility or cost-benefit for urine drug testing in pain management. It has been reported that illicit drug use in the pain experiencing patient population decreases with continued drug testing. Although FDA-approved immunoassays can be used for broad screening, confirmation of prescribed opiate or opioid is important. Although gas chromatography combined with mass spectrometry can be used for opioid confirmation, more recently liquid chromatography combined with tandem mass spectrometry (LC-MS/MS) is getting popularity because of its sensitivity, specificity as well as no requirement of derivatization prior to analysis.