Urine And Blood Tests
by Forest Tennant, MD, DrPH
 A New Era
One of the most exciting and quality-producing movements in pain care has been the
introduction of blood and urine testing to the clinic setting. Commercial laboratories
which specialize in pain care have brought us methods to identify abusers of illegal drugs
and to monitor compliance with medication instruction and help identify those who misuse
or divert pain medications. Testing provides a high degree of medical malpractice
liability protection and gives the public assurance that only legitimate pain patients are
being prescribed potentially abusable drugs.
While the new era of blood and urine testing is most propitious and needed, the
technical and scientific information has come so fast and furious it is somewhat confusing
as to how urine and blood testing should be done. Given below are some guidance and
recommendations as to when and why the different tests should be used. A cautionary
admonition is highlighted since—unlike past experience with blood and urine testing
which was primarily based on pre-employment, confirmed drug abusers, or opioid-naive
humans—chronic pain patients may take high dosages of opioids and other pain
medications. It is becoming increasingly clear that chronic administration of opioids to
tolerant pain patients induces metabolism that is not yet fully understood. Consequently,
recommendations and guidance provided here will undoubtedly refine and advance in the
future.
Please refer to the June 2007 issue for the complete text. In the event you need to order a back issue, please click here.
— June 2007
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