Frequency, predictors, and outcomes of urine drug testing among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic

Cancer ◽  
2016 ◽  
Vol 122 (23) ◽  
pp. 3732-3739 ◽  
Author(s):  
Joseph A. Arthur ◽  
Tonya Edwards ◽  
Zhanni Lu ◽  
Suresh Reddy ◽  
David Hui ◽  
...  
Keyword(s):  
Supportive Care ◽  
Advanced Cancer ◽  
Drug Testing ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Care Clinic ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Outpatient Supportive Care

Frequency, predictors, and outcomes of urine drug test among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 94-94
Author(s):  
Joseph Anthony Arthur ◽  
Tonya Edwards ◽  
David Hui ◽  
Jessica Marie Waletich-Flemming ◽  
Suresh K. Reddy ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Opioid Therapy ◽  
Cancer Stage ◽  
Chronic Opioid Therapy ◽  
Advanced Cancer Patients ◽  
Care Clinic ◽  
Urine Drug ◽  
Outpatient Supportive Care

94 Background: Data on the utilization and outcomes of urine drug tests (UDT) among advanced cancer patients is limited. The main objective of this study was to determine the factors associated with UDT ordering and results in advanced cancer outpatients. Methods: A retrospective chart review of 1058 patients seen from March 2014 to November 2015 at an outpatient supportive care clinic was conducted. Sixty-one patients on chronic opioid therapy who underwent UDT were identified. A control group of 120 patients who did not undergo UDT was selected for comparison of information on demographic and clinical characteristics. Results: 61/1058 patients (6%) underwent UDT. 33/61 patients (54%) had abnormal results. Multivariate analysis found that the odds ratio for UDT ordering was 3.9 in CAGE positive patients (p = 0.002), 4.41 in patients less than 45years (p < 0.001), 5.58 in patients with moderate to severe pain (ESAS pain score ≥ 4) (p < 0.001), 0.27 in patients with advanced cancer stage, (p = 0.008), and 0.25 in patients with moderate to severe fatigue (p = 0.001). Among 52 abnormal UDT results in 33 patients, the most common opioid findings were: prescribed opioids absent in urine (14/52, 27%) and un-prescribed opioids in urine (13/52, 25%). Conclusions: UDT was used infrequently among advanced cancer patients receiving outpatient chronic opioid therapy. Younger age, CAGE positivity, early cancer stage or NED status, higher pain intensity, and lower fatigue were significant predictors of UDT ordering. More than 50% of UDTs were abnormal. More research is necessary to better characterize aberrant opioid use in advanced cancer patients.

scholarly journals Urine Drug Testing In Chronic Pain

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. 123-143 ◽  
Author(s):  
Paul J. Christo
Keyword(s):  
Chronic Pain ◽  
Prescription Drugs ◽  
Drug Testing ◽  
Opioid Therapy ◽  
Drug Misuse ◽  
Compliance Monitoring ◽  
Chronic Opioid Therapy ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Adherence Monitoring

Therapeutic use, overuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain continue to be an issue for physicians and patients. The challenge is to eliminate or significantly curtail abuse of controlled prescription drugs while still assuring the proper treatment of those patients. Some physicians are apprehensive regarding the use of chronic opioid therapy in chronic non-cancer pain due to a perceived lack of proven evidence, the misuse of opioids, tolerance, dependence, and hyperalgesia. However, others have criticized the underuse of opioids, resulting in the undertreatment of pain. It has been the convention that federal, state, and local governments; professional associations; as well as pharmaceutical companies, physicians, accrediting bodies, medical licensure boards, and the public all share responsibility for preventing abuse of controlled prescription drugs. To overcome the critical challenge of eliminating or significantly curtailing abuse of controlled prescription drugs and at the same time assuring the appropriate treatment for those patients who can be helped by these medications, it is crucial to practice adherence or compliance monitoring of opioid therapy. Compliance monitoring has been shown to be crucial in delivering proper opioid therapy and preserving this therapy for the future. Urine drug testing (UDT) is considered one of the mainstays of adherence monitoring in conjunction with prescription monitoring programs and other screening tools, however, UDT is associated with multiple limitations secondary to potential pitfalls related to drug metabolism, reliability of the tests, and the knowledge of the pain physician. UDT is a widely available and familiar method for monitoring opioid use in chronic pain patients. UDT can provide tools for tracking patient compliance and expose possible drug misuse and abuse. UDT is one of the major tools of adherence monitoring in the assessment of the patient’s predisposition to, and patterns of, drug misuse/abuse – a vital first step towards establishing and maintaining the safe and effective use of opioid analgesics in the treatment of chronic pain. This comprehensive review provides the role of UDT in monitoring chronic opioid therapy along with reliability and accuracy, appropriate use, overuse, misuse, and abuse. Key words: Controlled substances, opioids, benzodiazepines, illicit drugs, abuse, diversion, prescription monitoring programs, adherence monitoring, compliance monitoring, urine drug testing, immunoassay, chromatography, false-positives, false-negatives

Random versus targeted urine drug testing among cancer patients receiving opioid therapy at a supportive care clinic.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 221-221
Author(s):  
Joseph Anthony Arthur ◽  
Zhanni Lu ◽  
David Hui ◽  
Kristy Nguyen ◽  
Bernard Lobato Prado ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Random Group ◽  
Care Clinic ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Abnormal Results

221 Background: Although urine drug testing (UDT) is an effective risk monitoring tool for patients on chronic opioid therapy, there is currently no evidence to guide physicians in identifying who should have UDT, or when and how often it should be ordered. The main objective of our study was to describe the characteristics of patients who underwent random UDT and a similar cohort who underwent targeted UDT. Methods: Demographic and clinical information of 212 patients who underwent random UDT was retrospectively reviewed and compared with 88 patients who underwent targeted UDT. Targeted UDT was ordered based on the physician’s estimation of patient risk for nonmedical opioid use. All patients were eligible for random UDT regardless of their risk potential for nonmedical opioid use. Results: 212/231 (92%) eligible patients underwent random UDT. Of these 59 (28%) had abnormal results. Among 64 abnormalities detected, 14 (20%) were prescribed opioids that were absent from the urine, 19 (30%) were unprescribed opioids that were present, and 32 (50%) were illicit drugs (91% marijuana). 38/88(43%) of targeted patients had abnormal results. Among 49 abnormalities detected, 13 (27%) were prescribed opioids that were absent from the urine, 15 (31%) were unprescribed opioids that were absent, and 21 (43%) were illicit drugs (71% marijuana). UDT abnormalities were significantly higher in the targeted group than the random group (43.2% vs. 27.8%, p=0.01). There were no significant differences in demographic and clinical characteristics between random and targeted patients with abnormal UDT findings. UDT abnormality was independently associated with age (OR= 0.97 per year, 95% CI: 0.95-0.99, p=0.012), female gender (OR=0.47, 95% CI: 0.28-0.81, p=0.006), anxiety (OR=1.11per point, 95% CI: 1.01-1.22, p=0.039), and appetite (OR= 1.14 per point, 95% CI: 1.04-1.26, p=0.006). Conclusions: More than 1 in 4 cancer patients who underwent random UDT had abnormal results. UDT abnormality in randomly selected patients were no different from targeted patients. Further studies are needed to guide clinical practice regarding standardization of UDT ordering among patients with cancer.

(445) Chronic opioid therapy urine drug testing in primary care: rates and predictors of aberrant results

2014 ◽  
Vol 15 (4) ◽  
pp. S87
Author(s):  
J. Turner ◽  
K. Saunders ◽  
S. Shortreed ◽  
L. LeResche ◽  
M. Von Korff
Keyword(s):  
Primary Care ◽  
Drug Testing ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Urine Drug Testing ◽  
Urine Drug

Assessing for urine drug testing in non-cancer patients on chronic opioid therapy

2018 ◽  
Vol 14 (6) ◽  
pp. e18
Author(s):  
A.M. Gabisi ◽  
E.J. Bergeron ◽  
J.Y. Milton-Brown ◽  
A. Henry ◽  
C. Pradia-Williams
Keyword(s):  
Cancer Patients ◽  
Drug Testing ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Urine Drug Testing ◽  
Urine Drug

scholarly journals Increased frequency of urine drug testing in chronic opioid therapy: rationale for strategies for enhancing patient adherence and safety

2019 ◽  
Vol Volume 12 ◽  
pp. 2239-2246 ◽  
Author(s):  
David J DiBenedetto ◽  
Kelly M Wawrzyniak ◽  
Michael E Schatman ◽  
Hannah Shapiro ◽  
Ronald J Kulich
Keyword(s):  
Drug Testing ◽  
Patient Adherence ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Urine Drug Testing ◽  
Urine Drug
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