Introduction Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 References

Urine Drug Testing Interactive Case Vignettes

Urine drug testing is a method which involves the analysis of a urine specimen to detect the presence or, in some cases, the absence of a drug and/or the metabolite(s) at or above a predetermined threshold.

UDT plays a key role in safely managing a chronic pain patient. It is a simple and valuable tool for pain management clinicians in the initial and ongoing assessment of chronic pain patients.

These interactive UDT case vignettes have been designed to help increase understanding of the utilization and interpretation of UDT to help to build mutual trust and honesty in the doctor-patient relationship.  Each case is interactive, requesting your interpretation and next steps for each case scenario. You are also able to check your answers with those of your peers.

An effective and patient-centered UDT strategy combined with accurate interpretation of the test results can be used as part of a comprehensive risk management strategy to reduce stigma and improve patient care.

Please select from the following cases by clicking on the corresponding picture:

Case 1 Case 1
A new patient with moderate-to-severe low back pain as a result of a MVA
  Case 2 Case 2
A female patient who scores high on a risk assessment evaluation on a CR opioid
Case 3 Case 3
A patient currently on an opioid, complaining of activity-related pain, requesting a new specific opioid
  Case 4 Case 4
A patient with escalating doses of opioid medication
Case 5 Case 5
An opioid-dependent patient with chronic pain requiring analgesia
  Case 6 Case 6
A new patient with a moderate-high risk of substance abuse on controlled substances for treating chronic pain, depression, and anxiety


These case vignettes were developed by:
Howard A. Heit, MD, FACP, FASAM
Assistant Clinical Professor of Medicine
Georgetown University School of Medicine
Washington, DC
& Doug Gourlay, MD, FRCPC, FASAM
Director, Pain and Chemical Dependency
Wasser Pain Management Centre
Mount Sinai Hospital
Toronto, Ontario, Canada