As a physician prescribing “pain killers” and sometimes anxiolytics for chronic painful conditions and spasms, you know that obtaining random urine drug screens (UDS) is essential for assuring compliance of the patient to agreed upon treatment plan.
Knowing the metabolism of common benzodiazepines helps you understand why patients can test positive on a urine drug screen (UDS) for a benzodiazepine that is not being prescribed (when sent for gas chromatography/mass spectrometry analysis).
For example, your patient being prescribed Valium (diazepam) by their Psychiatrist can test positive for Restoril (temazepam).
Note: As the commenter Steve (a prominent pain physician) notes below, benzos should NOT be prescribed by pain physicians (except for the rare pre-procedure or pre-MRI dosing). BZD should be for short-term anxiety needs only, and be prescribed by a Psychiatrist. Also, Soma (carisoprodol) is marketed as a skeletal muscle relaxant, but actually functions more as an anxiolytic and therefore should not be used for treating pain either.
Here is an excellent link explaining the problems with benzodiazepines: http://www.suboxonetalkzone.com/the-problem-with-benzodiazepines/
Below is an image of a chart I made to show the basic metabolism of benzodiazepines (click to enlarge).
Download a PDF of the chart HERE.
Pain physicians should not entertain ongoing Rx for any BZD. They should also not Rx Soma. Use of 1-2 pills before an MRI or procedure is reasonable, daily usage is not.
http://www.suboxonetalkzone.com/the-problem-with-benzodiazepines/
I completely agree Steve. I do not prescribe benzodiazepines, nor do I continue them when patients present to me on them. They should be the purview of Psychiatrists only; except for the pre-procedure or MRI dosing. The link you provided is excellent and I will add that to the original post above. Thank you.