Urine drug test interpretation: What do physicians know?


  • Gary M. Reisfield, MD
  • Roger Bertholf PhD
  • Robert L. Barkin, MBA, PharmD
  • Fern Webb, PhD
  • George Wilson, MD




urine drug test, chronic opioid therapy, interpretation, physician knowledge


Objective: To determine the level of urine drug test (UDT) interpretive knowledge of physicians who use these instruments to monitor adherence in their patients on chronic opioid therapy.
Methods: A seven-question instrument consisting of six five-option, single-best-answer multiple choice ques¬tions and one yes/no question was completed by 114 physicians (77 who employ UDT and 37 who do not) attending one of three regional opioid education confer¬ences. We calculated frequencies and performed %2 analyses to examine bivariate associations between UDT utilization and interpretive knowledge.
Results: The instrument was completed by 80percent of eligible respondents. None of the physicians who employ UDT answered all seven questions correctly, and only 30 percent answered more than half correctly. Physicians who employ UDTperformed no better on any of the ques¬tions than physicians who do not employ UDT.
Conclusions: Physicians who employ UDT to monitor patients receiving chronic opioid therapy are not profi¬cient in test interpretation. This study highlights the need for improved physician education; it is imperative for physicians to work closely with certified laboratoryprofes- sionals when ordering and interpreting these tests.

Author Biographies

Gary M. Reisfield, MD

Assistant Professor and Director, Division of Palliative Medicine, Department of Community Health & Family Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.

Roger Bertholf PhD

Department of Pathology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.

Robert L. Barkin, MBA, PharmD

Rush University Medical Center, Rush Pain Center, Deerfield, Illinois.

Fern Webb, PhD

Department of Community Health & Family Medicine, University of Florida College of Medicine- Jacksonville, Jacksonville, Florida.

George Wilson, MD

Department of Community Health & Family Medicine, University of Florida College of Medicine- Jacksonville, Jacksonville, Florida.


Dasgupta N, Kramer ED, Zalman MA: Association between non-medical and prescriptive usage of opioids. Drug Alcohol Depend. 2006; 82(2): 135-142.

Gilson AM, Ryan KM, Joranson DE, et al.: A reassessment of trends in the medical use and abuse of opioid analgesics and implications for diversion control: 1997-2002. JPain Symptom Manage. 2004; 28(2): 176-188.

Chelminksi PR, Ives TJ, Felix KM, et al.: A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity. BMC Health Serv Res. 2005; 5(1): 3.

Rounsaville BJ, Petry NM, Carroll KM: Single versus multiple drug focus in substance abuse clinical trials research. Drug Alcohol Depend. 2003; 70(2): 117-125.

Miller NS, Greenfield A: Patient characteristics and risk factors for development of dependence on hydrocodone and oxy¬codone. Am J Ther. 2004; 11(1): 26-32.

Levy S, Harris SK, Sherritt L, et al.: Drug testing of adolescents in ambulatory medicine: Physician practices and knowledge. Arch Pediatr Adolesc Med. 2006; 160(2): 146-150.

Heit HA, Gourlay DL: Urine drug testing in pain medicine. J Pain Symptom Manage. 2004; 27(3): 260-267.

Lee HK, Lewis LD, Tsongalis GJ, et al.: Negative urine opioid screening caused by rifampin-mediated induction of oxy¬codone hepatic metabolism. Clin Chim Acta. 2006; 367(1-2): 196-200.

Goldstein A, Brown BW: Urine testing in methadone mainte¬nance treatment: Applications and limitations. J Subst Abuse Treat. 2003; 25(2): 61-63.

Durback LF, Scharman EJ, Brown BS: Emergency physi¬cians’ perceptions of drug screens at their own hospitals. Vet Hum Toxicol. 1998; 40(4): 234-237.

Downing SM: The effects of violating standard item writing principles on tests and students: The consequences of using flawed test items on achievement examinations in medical education. Adv Health Sci Educ Theory Pract. 2005; 10(2): 133¬143.

Upshur CC, Luckmann RS, Savageau JA: Primary care provider concerns about management of chronic pain in com¬munity clinic populations. J Gen Intern Med. 2006; 21(6): 652¬655.

Ponte CD, Johnson-Tribino J: Attitudes and knowledge about pain: An assessment of West Virginia family physicians. Fam Med. 2005; 37(7): 477-480.

Gourlay D, Heit HA, Caplan YH: Urine Drug Testing in Primary Care: Dispelling the Myths and Designing Strategies. San Francisco: California Academy of Family Physicians, PharmaCom Group, 2002.

Swotinsky R, Smith D: The Medical Review Officer’s Manual, 3rd ed. Beverly Farms, MA: OEM Press, 2006.




How to Cite

Reisfield, MD, G. M., R. Bertholf PhD, R. L. Barkin, MBA, PharmD, F. Webb, PhD, and G. Wilson, MD. “Urine Drug Test Interpretation: What Do Physicians Know?”. Journal of Opioid Management, vol. 3, no. 2, Mar. 2007, pp. 80-86, doi:10.5055/jom.2007.0044.




Similar Articles

You may also start an advanced similarity search for this article.