Laboratory Test Guide

Drug Testing for Chronic Prescription of Controlled Substances

The Washington State legislature directed the Medical Quality Assurance Commission to adopt new rules for management of chronic non-cancer pain. We have formulated a simplified process for urine drug testing which incorporates an ordering strategy based on risk. Providers should assess risk (e.g., Opioid Risk Tool, ORT), review clinical patient care data, and order tests as described below (list Expected Drugs on the order form, which will facilitate interpretation). Additional information regarding these rules can be found via UW TelePain and the Dept. of Anesthesiology & Pain Medicine website.

There are many drug testing options through the UW Department of Laboratory Medicine.

Please see our detailed recommendations and quick reference guides on drug testing for chronic pain patients (updated 09/01/2017).
Please see our detailed recommendations and quick reference guides on drug testing for chronic amphetamine and chronic benzodiazepine patients (updated 09/01/2017).

Chronic Controlled Substances Table of Tests

Risk	Defined as	Order	Includes	Frequency
Low	M.E.D.<90 mg/day ORT 0-3 Patients compliant with outpatient buprenorphine therapy	Chr Pain Drug Rsk1 w/Cnslt, URN [UCPD1C] (includes THC) Chr Pain Drg Rsk1 w/o THC w/Con,URN [UCPD4C] (without THC)	Screen for all common drugs* Confirmation testing for opiates / methamphetamine / benzodiazepines as needed**	1x/year Regularly for buprenorphine monitoring
Medium to High	M.E.D.≥90 mg/day ORT≥4 Recent aberrant behavior	Chr Pain Drug Rsk2 w/Cnslt,URN [UCPD2C] If recent compliance, consider Low Risk Panel	Screen for all common drugs* Confirmation testing for opiates is always included Confirmation testing for methamphetamine / benzodiazepines as needed*	2x/year
High, with concern for lorazepam or clonazepam	Same as Medium to High Risk Panel Additional concern for clonazepam or lorazepam	Chr Pain Drug Rsk3 w/Cnslt,URN [UCPD3C]	Screen for all common drugs* Confirmation testing for opiates and benzodiazepines are always included Methamphetamine confirmation as needed*	2-4x/year

*A panel of immunoassays for Amphetamine/Methamphetamine, Barbiturates, Benzodiazepines, Cocaine, Opiates, Oxycodone, Buprenorphine, and Methadone; THC/Cannabinoids included in all orders except Chr Pain Drg Rsk1 w/o THC w/Con,URN [UCPD4C].

**As needed: expected drugs and screening results are discrepant; Please ALWAYS enter Expected Drugs.

Associated Tests

Code	Name	Specimen
UBNZC	Benzodiazepine Confirmation, URN	Urine
UCPD4C	Chr Pain Drg Rsk1 w/o THC w/Con,URN	Urine
UCPD1C	Chr Pain Drug Rsk1 w/Cnslt, URN	Urine
UCPD2C	Chr Pain Drug Rsk2 w/Cnslt,URN	Urine
UCPD3C	Chr Pain Drug Rsk3 w/Cnslt,URN	Urine
UAMPC	Drug Confirmation, Amphetamines, Urine	Urine