Pain Management

Pain management drug testing helps clinicians and patients use controlled medicines safely and as prescribed. A proactive plan verifies adherence, checks for undisclosed substances, and flags dangerous combinations (for example, opioids with benzodiazepines). It starts with the right specimen (urine is most common; oral fluid, blood, or hair when indicated), a rapid screen for broad classes, and definitive confirmation by mass spectrometry (LC-MS/MS or GC-MS) whenever results are non-negative or policy requires it.

Testing supports clinic agreements, risk-mitigation visits, and documentation for quality care. Results do not prove impairment, dose, or timing. Always interpret with your medication list, exam findings, and program policy.

Signs, Situations & Related Needs

  • Adherence checks: verify that prescribed opioids/adjuncts are present with expected metabolites

  • Unexpected negatives/positives: possible non-adherence, diversion, or undisclosed substances

  • Risk mitigation: high MED (morphine-equivalent) dosing, concurrent benzodiazepines, history of substance use disorder

  • Care transitions: new patient intake, peri-operative planning, return-to-work/safety-sensitive roles

  • Urgent care: suspected overdose, severe sedation, chest pain, suicidal thoughts—seek immediate medical help
    All testing should be reviewed by your clinician or Medical Review Officer (MRO).

Why These Tests Matter

What testing can do

  • Confirm presence/absence of prescribed drugs and identify specific metabolites

  • Detect non-prescribed or illicit substances that increase risk

  • Provide objective trends over time to guide visit frequency, counseling, or taper plans

What testing cannot do

  • Prove impairment, exact dose, or time since use

  • Replace clinical judgment, PDMP checks, chain-of-custody, or program policies

  • Explain intent without context

What These Tests Measure (at a glance)

  • Opioids & semisynthetics

    • Morphine, codeine; 6-MAM (heroin metabolite) — confirms heroin exposure

    • Hydrocodone → hydromorphone; Oxycodone → oxymorphone — expected metabolite patterns

    • Fentanyl → norfentanyl — definitive fentanyl exposure

    • Methadone → EDDP; Buprenorphine → norbuprenorphine — adherence in MAT/pain

    • Tramadol → O-desmethyltramadol; Tapentadol → N-desmethyl/O-sulfate — synthetic analgesics
      Caveat: patterns matter; use confirmation for specificity.

  • Benzodiazepines

    • Alprazolam → α-hydroxyalprazolam; Clonazepam → 7-aminoclonazepam; Diazepam → nordiazepam/oxazepam/temazepam; Lorazepam/oxazepam/temazepam (often glucuronidated; best detected by LC-MS/MS).
      Caveat: some screens miss glucuronidated benzos; confirm by LC-MS/MS.

  • Adjuncts / co-prescribed (as ordered)

    • Gabapentin, Pregabalin, Carisoprodol → meprobamate, TCAs — adherence and interaction context

  • Illicit/other classes (when indicated)

    • Cocaine (benzoylecgonine), Amphetamines (± D/L isomer), THC-COOH, PCP, barbiturates, synthetic opioids/novel psychoactives

  • Specimen validity (urine): creatinine, specific gravity, pH, oxidants — detects dilution/adulteration

  • Alcohol context (when relevant): EtG/EtS for recent exposure; PEth for sustained use (not impairment tests)

Detection windows (typical; vary by dose/frequency/cutoff)

  • Urine: ~1–3 days for many drugs; THC longer with frequent use

  • Oral fluid: hours to ~1–2 days (very recent)

  • Blood: hours to ~1 day (current presence)

  • Hair: weeks–months (patterns, not impairment)

How the Testing Process Works

  1. Define the goal & matrix: adherence vs. abstinence vs. recent or long-term pattern; choose urine, oral fluid, blood, or hair.

  2. Screen first: rapid immunoassay for target classes per clinic policy.

  3. Confirm definitively: any non-negative (or policy-directed classes) by LC-MS/MS or GC-MS with metabolites and cutoffs.

  4. Add validity (urine): creatinine, specific gravity, pH, oxidants to assess dilution/adulteration.

  5. Review & trend: compare with prescriptions, timing, PDMP, and clinical findings; schedule repeat testing as needed.

Interpreting Results (General Guidance)

  • Confirmed positive with expected metabolites: supports adherence (e.g., oxycodone with oxymorphone).

  • Confirmed positive for non-prescribed/illicit drugs: safety risk; clinician review required.

  • Negative or below cutoff for a prescribed drug: consider timing, metabolism, formulation, or possible non-adherence/diversion.

  • Special markers: 6-MAM (heroin), norfentanyl (fentanyl), EDDP (methadone), norbuprenorphine(buprenorphine) strengthen interpretation.

  • Matrix matters: oral fluid/blood reflect recent use; urine reflects clearance; hair shows long-term use.
    Always interpret within clinical and policy context.

Choosing Panels vs. Individual Tests

  • Routine pain-clinic monitoring: targeted opioid ± benzodiazepine panel with metabolite confirmation and urine validity

  • MAT (buprenorphine/methadone): include parent metabolite (norbuprenorphine or EDDP) to verify metabolism

  • Unexpected screen results: broaden to definitive LC-MS/MS; consider amphetamines D/L isomer testing

  • Long-term pattern review: hair panels; pair with periodic urine or oral fluid for near-term checks

  • Tampering concerns: add specimen validity to urine tests

FAQs

Why confirm after a non-negative screen?
Screens can cross-react. Mass spectrometry confirms the specific drug and metabolite and reduces false positives.

Does a positive mean the patient was impaired?
No. It shows presence above a cutoff—not impairment or exact timing.

Which specimen should I use?
Match the window to your goal: blood (now), oral fluid (recent), urine (recent/clearance), hair (weeks–months).

How do metabolite patterns help?
They verify biologic processing (e.g., norfentanyl with fentanyl) and help distinguish adherence from non-prescribed use.

What if a prescribed drug is negative?
Check dosing interval, formulation, metabolism, and timing; consider definitive confirmation and clinical discussion.

Can urine be diluted or adulterated?
Yes—use specimen validity (creatinine, specific gravity, pH, oxidants) and follow collection policy.

Internal Links & Cross-References

  • Drug & Alcohol Tests Hub

  • Employment & Compliance Testing

  • Drug & Alcohol Tests Hub

  • Drug Screening

  • Drug Confirmation Test

  • Drug Monitoring

  • Drug Toxicology Monitoring

  • Alcohol

  • Key Lab Tests: Opioid/Benzodiazepine Targeted Panel • LC-MS/MS Drug Confirmation • Fentanyl/Norfentanyl Confirmation • Buprenorphine/Norbuprenorphine • Methadone/EDDP • Specimen Validity • Hair Drug Panel

References

  1. Centers for Disease Control and Prevention. Opioid prescribing and risk-mitigation: urine drug testing considerations.

  2. American Society of Interventional Pain Physicians. Guidelines for responsible opioid prescribing and monitoring.

  3. American Society of Addiction Medicine (ASAM). Appropriate use of drug testing in clinical addiction medicine.

  4. Substance Abuse and Mental Health Services Administration (SAMHSA). Drug testing cutoffs and laboratory guidance.

  5. American Association for Clinical Chemistry (AACC). Definitive drug testing best practices (LC/GC-MS).

  6. College of American Pathologists (CAP). Toxicology standards and chain-of-custody considerations.

  7. ARUP Consult/clinical toxicology compendia. Detection windows, metabolite interpretation, and specimen validity.

Available Tests & Panels

Your pain management testing menu is pre-populated in the Ulta Lab Tests system. Choose a targeted opioid ± benzodiazepine panel, add LC/GC-MS confirmation for any non-negative results, and include specimen validity for urine. Use filters to select the specimen matrix and drug classes that fit your program, and review all results with your clinician or MRO.

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The Base Panel Urine Drug Screen screens a multi-drug panel in urine using immunoassay methods to detect commonly monitored substances above threshold levels. The panel includes drugs such as amphetamines, benzodiazepines, cocaine, opioids, and more. This broad screening test is widely used in clinical, workplace, and monitoring settings for initial detection across multiple drug classes.

Urine
Urine Collection
Also Known As: Drug Monitoring Base Panel Screen Urine

The Panel 1 Urine Drug Screen detects multiple commonly abused drugs in urine using immunoassay screening at defined cutoff levels. This test provides an initial overview of recent substance exposure, making it useful in clinical, workplace, or monitoring settings. Screening results indicate potential presence of one or more drugs, serving as a broad first step in evaluating substance use.

Urine
Urine Collection
Also Known As: Drug Monitoring Panel 1 Screen Urine

The Panel 3 Urine Drug Screen detects multiple commonly abused drugs in urine using immunoassay technology at defined cutoff levels. Designed as an expanded screening tool, it provides an initial overview of substance exposure across a broader range of drugs than basic panels. Results indicate potential presence of one or more substances, supporting clinical, workplace, and monitoring needs.

Urine
Urine Collection
Also Known As: Drug Monitoring Panel 3 Screen Urine

The Panel 4 Urine Drug Screen detects multiple commonly abused drugs in urine using immunoassay analysis at preset cutoff levels. As a broader screening option, Panel 4 covers an expanded set of substances compared to baseline panels, helping clinicians, workplace programs, and monitoring services assess recent drug exposure. Results reveal possible presence of one or more drugs for further evaluation.

Urine
Urine Collection
Also Known As: Drug Monitoring Panel 4 Screen Urine

The Panel 5 Urine Drug Screen detects multiple commonly abused drugs in urine using immunoassay screening at established cutoff levels. As a standard 5-panel test, it covers core substances like amphetamines, opioids, cocaine, cannabis, and PCP to provide a foundational assessment of substance exposure in clinical, workplace, or monitoring contexts. Positive findings may indicate the presence of one or more drugs.

Urine
Urine Collection
Also Known As: Drug Monitoring Panel 5 Screen Urine

Random
Phlebotomist

The Alcohol Urine Drug Test quantitatively measures ethyl glucuronide (EtG) and ethyl sulfate (EtS) levels in urine to assess recent alcohol intake. This precise quantitative analysis enables clinicians and monitoring programs to track consumption patterns over time, distinguish between trace exposure and significant use, and support reliable alcohol monitoring in clinical, treatment, or legal settings.

Urine
Urine Collection
Also Known As: Drug Monitoring Alcohol Metabolite Quantitative Urine Test

The Panel 1 Urine Drug Screen with Confirmation detects multiple commonly abused drugs in urine and verifies positive findings with advanced confirmatory testing. This two-step process improves accuracy by reducing the chance of false positives, making it valuable for clinical, workplace, or monitoring settings. The combination of broad screening and confirmation ensures reliable assessment of recent substance exposure.

Urine
Urine Collection
Also Known As: Drug Monitoring Panel 1 Screen with Confirmation Urine

The Panel 6 Urine Drug Screen with Confirmation detects multiple commonly abused drugs in urine via immunoassay screening and then validates positive findings with confirmatory testing. This two-step method enhances result reliability by reducing false positives, providing a trustworthy overview of substance exposure suited for clinical, monitoring, or workplace settings.

Urine
Urine Collection
Also Known As: Drug Monitoring Panel 6 Screen with Confirmation Urine

The Alcohol Urine Drug Screen with Confirmation detects and confirms the presence of ethyl glucuronide (EtG), a direct metabolite of alcohol, in urine samples. This test is designed to identify recent alcohol use and verify initial screening results with confirmatory analysis, providing reliable and accurate information for monitoring purposes in clinical, legal, and treatment settings.

Urine
Urine Collection
Also Known As: Drug Monitoring Alcohol Metabolite Screen with Confirmation Urine

The Amphetamines Urine Drug Test quantitatively measures the concentration of amphetamine and methamphetamine in urine using advanced laboratory methods. This quantitative analysis provides precise levels to support clinical monitoring, treatment programs, or medical evaluation. It offers more information than a basic screen by showing how much of these compounds are present.

Urine
Urine Collection
Also Known As: Drug Monitoring Amphetamines Quantitative Urine Test

The Amphetamines Urine Drug Screen detects the presence of amphetamine and related compounds in urine above defined cutoff levels. This screening test provides an initial assessment of recent amphetamine use and is commonly applied in workplace, treatment, and clinical monitoring contexts. Results indicate detection at or above threshold limits but are not confirmed by additional testing.

Urine
Urine Collection
Also Known As: Drug Monitoring Amphetamines Screen Urine

The Amphetamines Urine Drug Screen with Confirmation combines initial screening and confirmatory testing to detect and verify the presence of amphetamines in urine. This method delivers both sensitivity and specificity, ensuring positive results are validated. Ideal for clinical, legal, or monitoring settings, it supports reliable reporting of amphetamine use.

Urine
Urine Collection
Also Known As: Drug Monitoring Amphetamines Screen with Confirmation Urine

The Amphetamines Urine Drug Screen with Confirmation and D/L Isomers first screens for amphetamine compounds, then applies confirmatory testing that distinguishes D- and L-methamphetamine isomers. This test combines detection, verification, and isomer differentiation to offer more precise insight in clinical, legal, or monitoring settings.

Urine
Urine Collection
Also Known As: Drug Monitoring Amphetamines Screen with Confirmation and D/L Urine

The Amphetamines Urine Drug Test with D/L Isomers quantitatively measures levels of amphetamine and methamphetamine in urine while distinguishing D- and L-isomer forms. This enhanced test provides detailed insight into stereoisomer composition, supporting clinical or forensic monitoring with greater specificity and clarity in amphetamine use assessment.

Urine
Urine Collection
Also Known As: Drug Monitoring Amphetamines with D/L Quantitative Urine Test

The Barbiturates Urine Drug Test quantitatively measures concentrations of key barbiturate drugs (e.g. phenobarbital, pentobarbital) in urine using mass spectrometry. This definitive analysis supports therapeutic monitoring, compliance tracking, and safety evaluation by providing precise levels rather than just presence/absence of barbiturates.

Urine
Urine Collection
Also Known As: Drug Monitoring Barbiturates Quantitative Urine Test

The Barbiturates Urine Drug Screen detects the presence of barbiturate compounds in urine above established cutoff levels, using immunoassay methodology. This screening test is used in clinical, treatment, and monitoring settings to identify barbiturate use. A positive result indicates detection but does not include confirmatory testing, so results should be interpreted in context.

Urine
Urine Collection
Also Known As: Drug Monitoring Barbiturates Screen Urine

The Barbiturates Urine Drug Screen with Confirmation performs an initial immunoassay screening for barbiturates and then confirms positives using mass spectrometry. It verifies the presence of barbiturate drugs like phenobarbital, pentobarbital, secobarbital, and more. Designed for clinical, legal, or treatment monitoring, it delivers both detection and validation for greater confidence in results.

Urine
Urine Collection
Also Known As: Drug Monitoring Barbiturates Screen with Confirmation Urine

The Base Panel Urine Drug Screen with Confirmation combines an initial multi-drug immunoassay screen with confirmatory testing to validate positive findings. It detects common substances across multiple drug classes in urine, then uses advanced analysis to confirm the presence of specific analytes. This dual approach boosts accuracy and confidence in results for clinical or monitoring settings.

Urine
Urine Collection
Also Known As: Drug Monitoring Base Panel Screen with Confirmation Urine

The Benzodiazepines Urine Drug Test quantitatively measures concentrations of benzodiazepine compounds in urine using advanced analytical methods. Designed for clinical monitoring and treatment programs, this test provides exact levels rather than a simple positive/negative. Results offer better insight into use patterns, dosing, and compliance over time.

Urine
Urine Collection
Also Known As: Drug Monitoring Benzodiazepines Quantitative Urine Test

The Benzodiazepines Urine Drug Screen detects the presence of benzodiazepine compounds in urine above established cutoff levels using immunoassay techniques. This screening test identifies recent use of medications like diazepam, alprazolam, or lorazepam in clinical, treatment, or monitoring settings. Positive results indicate detection at threshold levels but are not confirmed by additional testing.

Urine
Urine Collection
Also Known As: Drug Monitoring Benzodiazepines Screen Urine

The Benzodiazepines Urine Drug Screen with Confirmation performs an initial screening for benzodiazepine compounds in urine, followed by confirmatory testing to validate positive results. This process ensures reliable identification of drugs like diazepam, lorazepam, or alprazolam in clinical or monitoring settings, adding confidence and specificity to benzodiazepine detection.

Urine
Urine Collection
Also Known As: Drug Monitoring Benzodiazepines Screen with Confirmation Urine

The Buprenorphine and Naloxone Urine Drug Test quantitatively measures concentrations of buprenorphine, naloxone, and their metabolites in urine using precise analytical techniques. This test offers detailed insight into medication-assisted therapy adherence, distinguishing between metabolite levels over time and helping clinicians monitor dosage, compliance, and drug disposition in a reliable manner.

Urine
Urine Collection
Also Known As: Drug Monitoring Buprenorphine and Naloxone Quantitative Urine Test

The Buprenorphine Urine Drug Screen detects the presence of buprenorphine and its metabolites in urine above established cutoff levels using immunoassay screening methods. This test is commonly used in treatment, clinical monitoring, and compliance settings to identify recent buprenorphine use. Positive results reflect detection, but do not include confirmatory testing.

Urine
Urine Collection
Also Known As: Drug Monitoring Buprenorphine Screen Urine

The Buprenorphine and Naloxone Urine Drug Screen with Confirmation begins with a screening test for buprenorphine and its metabolites (including naloxone) in urine, then validates positive findings using confirmatory methods. This combined approach balances sensitivity and specificity, helping clinicians, treatment programs, or monitoring services to reliably verify medication-assisted therapy adherence.

Urine
Urine Collection
Also Known As: Drug Monitoring Buprenorphine Screen with Confirmation includes Naloxone Urine