Can they tell what kind of pain medicine you are taking with urine drug test?

All medications (pain meds and all others) break down in the intestines, liver, and kidneys into specific metabolites.

When urine is tested, the tests look for the metabolites of drugs, not the drug itself.

As well, some combinations of medications, or combinations of medications and street / illegal drugs, or combinations of medications, street drugs, and alcohol can produce characteristic metabolites that labs regularly check for in a urine specimen.