Urine drug screening: a valuable office procedure

Am Fam Physician. 2010 Mar 1;81(5):635-40.


Urine drug screening can enhance workplace safety, monitor medication compliance, and detect drug abuse. Ordering and interpreting these tests requires an understanding of testing modalities, detection times for specific drugs, and common explanations for false-positive and false-negative results. Employment screening, federal regulations, unusual patient behavior, and risk patterns may prompt urine drug screening. Compliance testing may be necessary for patients taking controlled substances. Standard immunoassay testing is fast, inexpensive, and the preferred initial test for urine drug screening. This method reliably detects morphine, codeine, and heroin; however, it often does not detect other opioids such as hydrocodone, oxycodone, methadone, fentanyl, buprenorphine, and tramadol. Unexpected positive test results should be confirmed with gas chromatography/mass spectrometry or high-performance liquid chromatography. A positive test result reflects use of the drug within the previous one to three days, although marijuana can be detected in the system for a longer period of time. Careful attention to urine collection methods can identify some attempts by patients to produce false-negative test results.

MeSH terms

  • Ambulatory Care
  • Chromatography, High Pressure Liquid
  • False Negative Reactions
  • False Positive Reactions
  • Health Behavior
  • Humans
  • Immunoassay
  • Occupational Health
  • Opioid-Related Disorders / diagnosis*
  • Primary Health Care
  • Specimen Handling
  • Substance Abuse Detection / methods*
  • Substance Abuse Detection / standards
  • Urinalysis