Toxicology is typically a urine sample but oral sampling is also available. Saliva samples are able to determine ‘under the influence’ testing. Urine samples can be slower to be detected and can be adulterated.

Toxicology is typically performed on new patients and is recommended when there is a change in medication type or dosage or a decline in patient function. Pain patients may be tested several times a year or more dependent on history of abuse or their behavior.

Testing can be performed as a screen or a confirmation. Screens will determine presence of certain drugs above a minimum concentration. This testing is less sensitive and specific but can be performed onsite. Confirmation uses spectrometry to identify specific drugs providing a quantitative and accurate assessment. Confirmation results provide legally defendable results and are recommended for pain patients. If specificity is needed, confirmation is the best option.