Medical treatment guidelines, such as the American College of Occupational and Environmental Medicine and the Work Loss Data Institute's Official Disability Guidelines, recommend urine drug testing (UDT) for monitoring injured workers who are prescribed opioids. Yet studies show that few physicians actually order the tests.

There are a variety of concerns about UDT, including its potential over-use, under-use, effectiveness and cost. The guidelines are fairly nonspecific in terms of the frequency and type of testing that are most appropriate for injured workers. The fact is, all UDTs are not created equally and should not be used interchangeably.

Immunoassay tests, for example, are preferred when simply trying to detect the presence or absence of illegal drugs in a person's system. More sophisticated tests, such as liquid chromatography, may be more suitable for clinical applications. These are far more accurate than immunoassay tests, can identify parent medication and metabolites, and identify specific medications rather than just drug classes.