OBJECTIVES: The purpose of this study is to better quantify how urine drug monitoring (UDM) is used in clinical practice. While several published studies have reported utilization of UDM in clinical practice, little is known about how often patients are monitored, which patients are monitored, which substances are important to detect, and under what circumstances clinicians modify the frequency of monitoring. METHODS: An online survey was developed based on qualitative phone interviews with eight clinicians who use UDM as a routine component of clinical practice. One thousand fourteen randomly selected clinicians known to order urine toxicology screenings were invited by mail to respond to the online survey assessing their clinical needs and preferences with regards to UDM. Ninety-three responses were received before the online survey was closed. RESULTS: Of the 93 respondents, 43% (n=40) self-identified as pain management specialists and another 42% (n=39) as family/internal medicine practitioners. Seventy-six percent of respondents (n=72) require all new patients to have UDM performed when they enter their clinic. The majority administer UDM to chronic opioid therapy patients four times a year. Overall, the respondents showed broad support to test patients consistently for the most common illicit drugs, the majority of opioids, and a handful of prescription medications associated with abuse. Ninety-one percent of respondents stated that all of their patients are tested for the same substances, regardless of abuse history. The most common reasons cited by clinicians for a change in the frequency of monitoring are patient history of substance abuse and aberrant behaviors.  CONCLUSIONS: Despite a lack of agreement between guidelines informing the use of UDM, there appears to be a general consensus among practitioners that utilize UDM on: which patients to monitor, how often to monitor, and which substances are most important to detect.