The Effect of Optimizing Urine Drug Screening Panels at Two Academic Medical Centers

Drugs included in the urine drug screening (UDS) panel may not reflect current drug use patterns and therefore their clinical utility, particularly for drugs with low positivity rates, may be minimal. Laboratories should frequently review the components of their UDS panel.

Based on clinical need and local epidemiology, the updated UDS panel included immunoassay screens for amphetamines, benzodiazepines, cocaine metabolite, fentanyl, opiates, and oxycodone. At Site 1 (June 2022), barbiturates and cannabinoids (THC) were removed, while fentanyl and oxycodone were added. At Site 2 (October 2024), THC and methadone were removed. Both sites implemented an improved assay for benzodiazepines. We determined volumes and positivity rates and assessed clinical effects pre- and post-implementation of an updated UDS panel and assessed whether clinicians ordered drug screens that were omitted from the panel.

At Site 1, post-implementation, only 0.2% and 6.3% of UDS panels included a separate order for barbiturates or THC (e.g., UDS panel + THC screen), respectively. In contrast, fentanyl and oxycodone testing increased by 8- and 3-fold, respectively. At Site 2, post-implementation, only 2.8% and 7.1% of UDS panels included a separate order for methadone or THC, respectively. The positivity rate for benzodiazepines increased by 16% at both sites following implementation of an improved assay.

Changes to the UDS panel aligned laboratory testing with patterns of drug use and clinical utility and standardized care within our healthcare system. Unnecessary testing was reduced; drugs removed from the panel were infrequently ordered.