Urine Drug Testing for Pain Management

There is an epidemic of prescription drug abuse in the United States, which has created an increased burden on clinical toxicology laboratories and those who oversee drug testing. According to the 2009 report of the Drug Abuse Warning Network (DAWN), there were approximately 4.5 million drug-related visits to the emergency department, and the report revealed that more than 50% of the visits involved the nonmedical use of pharmaceuticals. In this report, the nonmedical use of pharmaceuticals included (1) taking more than the prescribed dose of a prescription pharmaceutical, (2) taking more than the recommended dose of an over-thecounter pharmaceutical or supplement, (3) taking a pharmaceutical prescribed for another individual, (4) deliberate poisoning with a pharmaceutical by another person, and (5) documented misuse or abuse of a prescription drug, an over-the-counter pharmaceutical, or a dietary supplement. Further scrutiny of the DAWN data revealed that almost 39% of the nonmedical use of pharmaceuticals involved opioids and 29% involved benzodiazepines (Fig. 1).