In the ordinary regulation setting the standards for prescribing controlled substances, 201 KAR 9:260, the Board requires that during the course of long-term prescribing or dispensing of controlled substances for the treatment of pain and related symptoms associated with a primary medical complaint, the physician shall utilize urine drug screens in a random manner at appropriate times to determine whether the patient is taking prescribed medications or taking illegal substances or medications not prescribed by the physician.
The Board has developed the following intervals for urine drug screens in order to provide some guidance to physicians on this subject:
- At least once a year if the patient is considered “low risk” based on upon the screening done by the physician and other factors.
- At least twice a year if the patient is considered “moderate risk” based upon the screening done by the physician and other factors.
- At least three to four times a year if considered “high risk” based on the screening done by the physician and other factors.
- At each office visit if the patient has exhibited aberrant behavior such as multiple lost prescriptions, multiple requests for early refills, opioids from multiple providers showing up on KASPER, unauthorized dose escalation, and apparent intoxication.
It is important is important that the Board does not mandate or require urine drug screens prior to acute prescribing.