Blood testing is quickly becoming a useful laboratory tool for opioid prescribers who wish to
document and assess patient tolerance, more objectively monitor patient safety, and evaluate
patient compliance using information that is not available with traditional urine drug testing (UDT).
Blood testing does not need to be performed as frequently as UDT but provides extremely valuable
information which can be used to more accurately evaluate patient compliance and assist with
interpreting blood toxicology results commonly used in impairment or overdose cases.
This narrative review presents the current evidence supporting the use of blood testing within the
chronic pain management setting. In addition, this review aims to introduce and discuss the role of
routine blood testing within the chronic pain management setting.
Blood testing for the purpose of documenting opioid tolerance is a relatively novel tool for pain
physicians and as such this review is not intended to be a comprehensive or exhaustive review
of the scientific or medical literature. Prescribers must also be aware that this type of laboratory
testing need only be administered to chronic pain patients receiving daily opioid therapy. Patients
taking infrequent, low dose, or as needed medications are not anticipated to benefit from this
type of test.
Based on the complexity of both achieving acceptable outcomes with opioid treatment and the
legal and societal issues at hand, we feel that the addition of blood concentration levels will
become the standard of care in the near future.
Key words: Chronic pain, blood testing, opioids, opioid tolerance, patient compliance, opioid
overdose
Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey