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.

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.

Search Terms

chronic controlled substances, chronic pain, long term amphetamine, long term benzodiazepine, pain testing

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

Last updated 2022-12-02T17:28:20.601856+00:00