What is the frequency of required controlled substance agreements and urine drug screens for patients prescribed benzodiazepines (benzos) and stimulants?

From the Guidelines

Controlled substance contracts for benzodiazepines and stimulants are typically required once at the initiation of therapy, with annual renewal thereafter, while urine drug testing frequency varies based on risk assessment, generally occurring at baseline, then every 3-6 months for average-risk patients, and more frequently for higher-risk individuals, as supported by the most recent and highest quality study 1.

Key Considerations

• The frequency of urine drug testing is determined by the prescribing physician based on the patient's history, risk factors for misuse, and state regulations.
• Some practices require more frequent monitoring during the first few months of treatment before establishing a regular testing schedule.
• The testing and contract requirements may be more stringent for patients with a history of substance use disorders, those on higher doses, or when concerning behaviors are observed.
• Insurance coverage for frequent testing may be limited, potentially resulting in out-of-pocket costs for patients.

Risk Assessment and Management

• Validated risk-assessment instruments and screening questionnaires, such as the Screener and Opioid Assessment for Patients in Pain, the Opioid Risk Tool, and the Brief Risk Interview and Questionnaire, can help identify patients prone to misuse or those currently misusing prescribed opioids 1.
• Factors associated with a risk of prescription opioid abuse or misuse include age, male sex, multiple opioid prescriptions, early prescription opioid refills, escalating morphine dosages, psychiatric outpatient visits, hospital visits, diagnoses of nonopioid substance abuse, depression, PTSD, and hepatitis.

Evidence-Based Recommendations

• Prospective studies have shown that adherence monitoring with a controlled substance agreement, periodic monitoring, periodic drug testing, pill counts, and education when necessary can reduce controlled substance abuse and increase compliance 1.
• A systematic review investigating the effectiveness of opioid treatment agreements and urine drug testing in reducing opioid misuse among patients with chronic noncancer pain found a decrease in opioid misuse with the use of treatment agreements as part of the opioid management strategy.

From the Research

Controlled Substance Contracts and Urine Tests for Benzos and Stimulants

• The frequency of controlled substance contracts for benzos and stimulants is not explicitly stated in the provided studies 2, 3, 4, 5.
• However, it is mentioned that benzodiazepines have a high potential for addiction and dependence, which may require careful monitoring and management 3.
• Urine tests are commonly used to screen for drugs of abuse, including benzodiazepines and stimulants, but may produce false-positive results due to certain medications or substances 2.
• The study from 2010 2 highlights the importance of confirming urine test results with additional analytical methods to avoid adverse consequences for patients.
• There is no specific information on the frequency of urine tests required for patients taking benzos and stimulants, but it is likely that healthcare providers will use their discretion to determine the necessity of such tests based on individual patient needs and circumstances.

Benzodiazepine Use and Dependence

• Benzodiazepines are widely prescribed and have a high potential for addiction and dependence 3.
• The treatment of benzodiazepine withdrawal typically involves tapering the medication, and alternative methods are being explored 3.
• The pharmacokinetic properties of different benzodiazepines, such as alprazolam, adinazolam, and clonazepam, may influence their potential for dependence and withdrawal 5.

Urine Testing and False-Positive Results

• Urine tests for drugs of abuse, including benzodiazepines and stimulants, may produce false-positive results due to certain medications or substances 2.
• Commonly prescribed medications, such as antihistamines, antidepressants, and antibiotics, may trigger false-positive urine test results 2.
• Verification of urine test results with additional analytical methods, such as gas chromatography-mass spectrometry, is necessary to avoid adverse consequences for patients 2.