Background: Drug abuse is a critical concern worldwide. Urine drug screening is a common practice applied for the detection of common drugs of abuse for both clinical and legal issues. Objective: This study was performed to screen for opioid abuse in urine samples collected from adult subjects (aged > 18 years) at the toxicology laboratory and toxicology unit, Emergency Hospital, Mansoura University, and to compare enzyme-multiplied immunoassay (EMIT) with thin layer chromatography (TLC) techniques for confirmation of opiate in samples. Patients and Methods: A total of 500 urine samples were randomly collected and screened with immunochromatographic (rapid) test strips for opiates. The positive urine samples obtained by the rapid test were further analyzed by EMIT and TLC techniques. Results: A total of 80 samples (16%) were positive for opiate by the rapid test. By analyzing these positive samples using EMIT, only 68 samples were positive (68/80; 85%). Only 66 samples (66/80; 82.5%) revealed positive results (opiate spot) meaning that TLC was able to confirm 2 false-positive results by EMIT. This might be due to drug interactions. Conclusion: Opioid abuse seems to be a problem among the Egyptian adult population. Despite the high sensitivity of EMIT (100%), TLC is more specific when compared with it. Indeed, EMIT can be a relatively accurate alternative for TLC, but, whenever positive results need to be re-checked, it is recommended to use the cheap and widely available TLC technique or ideally use the High-performance liquid chromatography (HPLC), particularly for legal purposes.