The history of drug testing in America has largely been adversarial and began in earnest in the mid 1980s with the “drug free America” initiative. The purpose of this testing model was never meant to be clinical and yet the influence of forensic testing in clinical care has been undeniable. The process of drug testing does not need to be adversarial. The way results are used, however, will determine whether the testing is “patient centered,” designed to identify and manage risk toward a better clinical outcome, OR a process to help distinguish between “good patients and bad patients.” In this presentation, the basic elements of drug testing will be examined, especially in the context of clinical care. Clinical options beyond termination of care will be explored. In this context, attendees will be able to implement a defensible, rational, and ultimately compassionate approach to the use of urine drug testing in risk mitigation in the treatment of chronic pain.