Prescription Drug Monitoring


Urine toxicology screening and confirmation testing is an important standard of care in the field of Pain Management, Internal Medicine, Family Practice, Obstetrics, Neurology, Rheumatology, Pediatric care, or any clinic where prescribed controlled substances are present. It is also an important tool to measure prescribed medications, potential medication conflicts and harmful drug interactions.


Why test for the pharmacology present in a patient’s system?


  • Increases the safety of prescribing controlled medications by identifying the potential for overdose or serious drug interactions
  • Verifies compliance of the current prescribed controlled medications
  • Helps assess the efficacy of the treatment plan and medication effectiveness
  • Identifies prescribed controlled substances and illicit drugs prior to establishing a treatment plan
  • Increases safety prior to surgery
  • Helps assess patient use of opioids for chronic pain management
  • Identifies patients who are abusing alcohol or illicit drugs which may have a fatal interaction
  • Identifies a relapse to substance abuse and establishes patterns for developing drug abuse
  • Monitors abstinence in a patient with a known substance abuse disorder (SUD).
  • Identifies at-risk neonates and patients who are pregnant
  • Identifies adolescents who are struggling with ADHD or other disorders and are not taking their medications as prescribed



This testing follows medically necessary guidelines for CMS and follows SAMSHA guidelines for testing rather than basing protocol on suspicion.  By following these guidelines for a Prescription Drug Monitoring Protocol, your practice can ensure accurate laboratory testing to monitor patients and provide objective support for clinical observations.



Classify Patients in Low, Moderate or High Risk by following the following Guidelines:


          Low Risk = New Patients, Patients who are pregnant or looking to get pregnant, or no reported medications.

          Moderate Risk = Patients that require a specific controlled substance for treatment or demonstrate moderate risk

          High Risk =         Patients that are prescribed multiple medications, those identified as substance abuse patients or have multiple diagnoses codes and have demonstrated high risk.


Select Patient Group and Risk Profile:


Multiple Medication Monitoring

Patient is taking multiple prescribed controlled substances with more than one diagnosis code.


Chronic Opioid Therapy (COT) 

Patients on short or long term care utilizing opioid medications for the treatment of pain or other conditions.



New patient, patient not reported as taking other medications, pregnant patient, or patient requesting controlled substances or displaying suspicious behavior. This also includes patients that pose a risk to the practice.


After selecting Patient Group and Risk Profile, Quantify all medications, proceed to

Section 1 or 2 to select a test profile based on risk assessment.


  • Medication Monitoring Profile
  • Chronic Opioid Profile
  • Illicit Profile

     For Patients on Chronic Opioid Therapy:


               Low Risk =         Random testing 1-2 times every 12 months. If results show illicit usage or medications contradictory to what is risk factor can be re-assessed.


               Moderate =          Random testing 1-2 times every six months or Quarterly testing. See additional information under COD patients.


               High Risk =          Random testing performed 1-3 times every 3 months for prescribed medications. See more detail under frequency guidelines for COT patients.


          Definitive Testing Guidelines for patients on Multiple Medications or diagnosed with Substance Use Disorder:


              Low Risk=        For patients with > 90 consecutive days of abstinence, definitive testing is expected 1-3 times per month.


               Moderate=        For patients with 31-90 consecutive days of abstinence, definitive testing is expected 1-3 times per month.


              High Risk=        For patients with 0-30 consecutive days of abstinence, definitive testing is expected at a frequency not to exceed 1 test per week.


          Presumptive Testing Guidelines for patients with Substance Use Disorder or on multiple



               For patients with 0-90 consecutive days of abstinence, presumptive testing is expected at a frequency of 1-3 times per week.

               For patients with > 90 consecutive days of abstinence, presumptive testing is expected at a frequency of 1-3 tests per month.


Patient chart notes should support classification of testing. Additional information can be found on the government website:  ­­­­­­­­­­­­­­­


Hormone Testing:

  • Check off male or female for hormone profile based on gender and any additional testing that may be required. Where appropriate and entire hormone profile can be utilized on patients.
  • Add ICD-10 code for appropriate hormone testing


Hormone testing can assist in identifying any hormone levels which may be missed in diagnosis of depression, anxiety, lack of motivation, change in sleep patterns or activity level. It can help chronic opioid patients, patients in recovery from substance abuse and patients that change or alter medication dosages.


Molecular UTI Testing:

  • Check off UTI Profile if additional urinalysis is needed for female patients over the age of 50, problems with urination or bladder, recurring UTI’s, or long-term opioid use which increases risk for hematuria in the urine or polymicrobial infections in the urinary tract and kidneys.


After determining Risk and Testing Profile, complete the requisition form to include:


  • Fill out patient name, DOB, gender
  • Check off prescribing prescriber and get physicians signature
  • List at least one ICD10 code
  • Add in collection date and temperature if so desired or ordering Hormone testing
  • Check off prescribed controlled substances or attach medication list
  • Attach a Demographic sheet to include patient name, DOB, address, insurance info
  • Ensure patients initials are on the bar code label and one label is adhered to cup
  • Get patient’s signature if no controlled substance agreement is in place
  • Put paperwork in pocket in bio-hazard bag and urine cup with label inside bag
  • Put all Urine cups with appropriate paperwork in gray liner and put in pre-labeled box
  • Put at front desk
  • Call 1-800-633-1850, ext. 3 for a pick up. Do not call UPS or FedEX direct

Give a two hour window for pick up.  Urine does not need refrigeration.