As of 2023, 24 states have binding legislation that requires providers that treat pain patients to perform at least one urine drug test prior to initiating long-term opioid therapy. This health care Fast Fact reviews claims data from 2013–2021 that found these laws were successful at increasing rates of urine drug testing among chronic patients undergoing opioid therapy and that these policies were most effective for enrollees most affected by chronic pain and in need of long-term opioid therapy.
Figure 3 Key Findings From the Study: Percentage Effect of Urine Drug Test (UDT) Laws on Testing Rates, by Enrollee Characteristics • Urine drug testing rates among chronic pain patients undergoing opioid therapy rose in all states from Oil & Gas Extraction, Mining 29% 2013–2021. However, when comparing testing rates before and after a state adopted a urine drug testing November 9, 2023, #486 Construction 25% law, the average yearly increase in testing rates was 8 percentage points, which is higher than the upward Manufacturing, Nondurable Goods 24% secular trend in testing rates among enrollees in states that have not adopted adopt these policies. From Wholesale 24% 2013–2021, testing rates increased an average of 3.3 percentage points per year in states that did not pass Ages 57–64 19% these policies, suggesting that mandatory urine drug testing laws increase testing rates by 4.7 percentage Drug Testing Rates Among Chronic Pain Patients Undergoing Ages 47–56 19% points (11 percent). PPO/POS Plan 19% Opioid Therapy Increase in Response to State Mandates Retail Trade 19% • The effects are largest f Wom or een nrollees most affected by chronic pain a 17% nd in need of long-term opioid Men 16% In 2016, the Centers for Disease Control (CDC) issued a “guidance for prescribing opioids for chronic pain.” As therapy. The treatment effect for those ages 47–56 is 19 percent, and the treatment effect for those ages HRA Plan 15% part of this guidance, the CDC stated, “when prescribing opioids for chronic pain, clinicians should use urine drug 57–64 is 24 percent, while the treatment effect for younger enrollees ranges from 11–15 percent, with Ages 37–46 15% testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed effects increasing based on age. Treatment effects are also the largest for employees in the wholesale, Transportation, Communications, Utilities 14% medications as well as other controlled prescription drugs and illicit drugs.” These tests are an important durable goods manufacturing, construction, and oil and gas extraction industries, where the effects range Manufacturing, Durable Goods 14% diagnostic tool for doctors to detect opioid or other illicit substance abuse and refer patients to treatment. This from 24 percent to 29 percent. Just like older workers, employees in these industries have the highest Services 14% guidance is simply a recommendation for providers and is not binding. However, as of 2023, 24 states do have rates of diagnosed and prescribed opioid use. Ages 27–36 12% binding legislation that requires providers that treat pain patients to perform at least one urine drug test prior to Comprehensive Plan 12% initiating long-term opioid ther Ages ap 14 y– , w 26 hich is generally defined as an opioid prescription of three months or more. 11% *Average Percentage Effect is 11% HSA-Eligible Health Plan 10% Louisiana was the earliest state to adopt such a policy, doing so in 2008, and Texas was the latest, passing a Agriculture, Forestry, Fishing 8% policy in 2022. A nearly uniform requirement of all these state policies is that urine drug testing must be initiated HMO/EPO Plan 7% for pain patients who are prescribed at least a three-month supply of opioids. Finance, Insurance, Real Estate 2% 0% 5% 10% 15% 20% 25% 30% 35% Figure 1 shows the distribution of these state policies. A recent EBRI report based on claims data from 2013–2021 Figure 2 found that these laws were successful at increasing rates of urine drug testing among chronic patients undergoing Source: Employee Benefit Research Institute estimates based on administrative enrollment and claims data. Treatment effects calculated as a Share of Enrollees With Chronic Pain Who Were Prescribed 3 or difference-in-differences model, where treatment is having a UDT policy. The model also controls for state and year fixed effects. opioid therapy and that these policies were most effective for enrollees most affected by chronic pain and in need More Months of Opioids and Are Getting a Urine Drug Test (UDT) of long-term opioid therapy. Figure 1 Geographical Distribution of State Urine Drug Testing (UDT) Laws These findings are the first documented evidence of state-level policies’ efficacy in increasing testing of chronic States With UDT laws (before) States With UDT laws (after) States Without UDT laws pain patients. These results are promising and indicate that urine drug testing can be an important and powerful 80% 73% 72% tool for allowing employees with pain diagnoses to receive appropriate care while remaining safe. Not only could 69% 68% 70% testing have clear benefits to workers, but also to employers through reduced health care spending and reduced 63% 65% 64% 63% 61% 60% 62% 61% employee turnover. For these reasons, additional resear59% ch is needed to document these downst 59% ream benefits. 57% 59% 60% 53% 54% 54% 49% 50% 49% 50% About EBRI: The Employee Benefit Research Institute is a private, nonpartisan, and nonprofit research institute 43% 39% 39% based in Washington, D.C., that focuses on health, savings, retirement, and economic security issues. EBRI does 40% 32% not lobby and does not take policy positions. The work of EBRI is made possible by funding from its members 31% 30% and sponsors, which include a broad range of public and private organizations. For more information, visit 20% www.ebri.org. 10% 0% 2013 2014 2015 2016 2017 2018 2019 2020 2021 ### Source: Employee Benefit Research Institute estimates based on administrative enrollment and claims data. Source: Information compiled using WestLaw and state registers. Data indicate presence or lack of policy by 2023. 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