LETTER TO THE EDITOR

Drug Testing and the American Academy of Pain Medicine

Kudos to the American Academy of Pain Medicine (AAPM) for being the first major professional pain association to no longer recommend urine drug testing (UDT) for people in pain management. According to Martha Lara, AAPM’s Director of Marketing & Communications, “…AAPM has no specific position on the use of UDT.”¹ This is a major policy shift for the organization as it has recommended drug testing for years.²

Since UDT in pain management is not supported by either the science or law, it is not surprising that the AAPM has come to this decision. Three reviews found lack of efficacy for drug testing^3–5 including a 2015 review by Chou et al. which determined that there were no studies on risk management tools, including UDT, which, “…evaluated the effectiveness of risk mitigation strategies for improving outcomes related to overdose, addiction, abuse, or misuse.”⁵ It was Chou and colleagues’ previous work which recommended drug testing for the AAPM even though there was a dearth of evidence.² Furthermore, drug testing raises constitutional issues regarding unreasonable searches and seizures of bodily fluids.⁶ In 2014, the ACLU of Indiana challenged an Indiana State law requiring drug testing of people in pain management and won.⁷ This suggests drug testing may be unconstitutional.

Considering that the annual cost of drug testing to insurers is in the billions of dollars,⁸ there is no proof of efficacy, and it is likely unconstitutional; it is uncertain as to why other professional pain associations continue to support drug testing in pain management.