Though it is known that point-of-care (POC) urine drug screening (UDS) has its limitations, clinicians request POC UDS due to its convenience and cost effectiveness. Common clinical recommendations are to use urine drug screens as the first line of testing followed up by a definitive laboratory test. However, the cost of sending every urine drug test to the lab is not always realistic or feasible for some clinical settings or patient populations. There needs to be a balance between cost and the best solution to meet the needs of the patient population. Instead of describing optimal drug screening from a scientific perspective, this article presents a real-world case study evaluating the causes that prevented successful implementation of a POC UDS process at a facility initially and then describes the recent, successful implementation of a new POC UDS at the same facility.