**6. When to use UDT**

Urine drug testing must be tailored to fit the pain patient's clinical history. For the intake visit, the patient is advised as to the necessity for UDT and is typically requested to provide a urine specimen. If the patient fails to do this, he or she may be immediately dismissed from the practice. In some practices, the urine specimen is tested by a POC device at the time of the appointment and the results are compared to the patient reported history. If necessary, discrepancies are discussed. As a matter of course, a portion of the POC urine sample is sent to the reference laboratory to confirm the POC test results, test for additional medications, and, at the discretion of the physician, to test for the prescribed medications, non-prescribed medications and illicit drugs at lower cutoff levels than those provided by the POC test. For many established pain patients, quarterly or semi-annual UDT is considered appropriate. It is best if this is done on a random basis. The strongest recommendation for doing UDT is adding additional medications to the regimen or changing medications. Urine drug testing may also be administered if a patient changes their behavior or exhibits addiction tendencies such as complaining of running out of medications early (Chou et al., 2009; Trescot et al., 2006). Testing may be conducted as frequently as every office visit for some patients who exhibit unusual behavior, have a history of abuse, or if illicit or nonprescription drugs were found to be present on a previous test. Gourlay, D. & Heit, H. (2010a).
