Purpose of Review <p>This study reviews urine drug screening (UDS) outcomes in patients undergoing chronic opioid therapy for non-cancer related pain. The objective was to assess the prevalence of aberrant results, including the presence of non-prescribed substances, absence of prescribed opioids, and other discrepancies, using random electronic medical record (EMR) review over a one-year period.</p> Recent Findings <p>Fifty-six patient records from January 1, 2024, to December 31, 2024, were randomly selected and reviewed. Urine drug screens were compared against prescribed opioid regimens. Eight patients (14.3%) tested positive for tetrahydrocannabinol (THC) compounds, while one patient (1.8%) tested positive for cocaine. Notably, nine patients (16.1%) had negative screens for opioids that were currently prescribed, raising concerns about diversion or nonadherence. Additionally, three patients (5.4%) tested positive for an opioid different from the one prescribed. Overall, discrepancies between prescribed medications and urine drug screen findings were common, suggesting challenges in adherence monitoring and the need for structured screening protocols.</p> Conclusion <p>Unexpected urine drug screening results are prevalent among patients on chronic opioid therapy for non-cancer pain. The high rates of absent prescribed opioids, presence of non-prescribed substances, and detection of illicit drugs highlight the importance of routine screening, careful documentation, and patient-provider communication to optimize safe opioid prescribing practices.</p>