Random urine drug testing among patients receiving opioid therapy for cancer pain

Cancer ◽  
2020 ◽  
Author(s):  
Joseph A. Arthur ◽  
Michael Tang ◽  
Zhanni Lu ◽  
David Hui ◽  
Kristy Nguyen ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Drug Testing ◽  
Opioid Therapy ◽  
Urine Drug Testing ◽  
Urine Drug

scholarly journals Repeated Quantitative Urine Toxicology Analysis May Improve Chronic Pain Patient Compliance with Opioid Therapy

2017 ◽  
Vol 2 (20;2) ◽  
pp. s135-s145 ◽  
Author(s):  
Nebojsa Nick Knezevic
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Retrospective Analysis ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Opioid Therapy ◽  
Urine Toxicology ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Improve Compliance

Background: Even though serious efforts have been undertaken by different medical societies to reduce opioid use for treating chronic benign pain, many Americans continue to seek pain relief through opioid consumption. Assuring compliance of these patients may be a difficult aspect of proper management even with regular behavioral monitoring. Objective: The purpose of this study was to accurately assess the compliance of chronic opioidconsuming patients in an outpatient setting and evaluate if utilizing repeated urine drug testing (UDT) could improve compliance. Study Design: Retrospective analysis of prospectively collected data. Setting: Outpatient pain management clinic. Methods: After Institutional Review Board (IRB) approval, a retrospective analysis of data for 500 patients was conducted. We included patients who were aged 18 years and older who were treated with opioid analgesic medication for chronic pain. Patients were asked to provide supervised urine toxicology specimens during their regular clinic visits, and were asked to do so without prior notification. The specimens were sent to an external laboratory for quantitative testing using liquid chromatography-tandem mass spectrometry. Results: Three hundred and eighty-six (77.2%) patients were compliant with prescribed medications and did not use any illicit drugs or undeclared medications. Forty-one (8.2%) patients tested positive for opioid medication(s) that were not prescribed in our clinic; 8 (1.6%) of the patients were positive for medication that was not prescribed by any physician and was not present in the Illinois Prescription Monitoring Program; 5 (1%) patients tested negative for prescribed opioids; and 60 (12%) patients were positive for illicit drugs (8.6% marijuana, 3.2% cocaine, 0.2% heroin). Repeated UDTs following education and disclosure, showed 49 of the 77 patients (63.6%) had improved compliance. Limitations: This was a single-site study and we normalized concentrations of opioids in urine with creatinine levels while specific gravity normalization was not used. Conclusions: Our results showed that repeated UDT can improve compliance of patients on opioid medications and can improve overall pain management. We believe UDT testing should be used as an important adjunctive tool to help guide clinical decision-making regarding opioid therapy, potentially increasing future quality of care. Key words: Urine toxicology analysis, chronic pain, opioids, compliance, pain management, urine drug testing, urine drug screening

scholarly journals Random vs Targeted Urine Drug Testing Among Patients Undergoing Long-term Opioid Treatment for Cancer Pain

JAMA Oncology ◽  
2020 ◽  
Vol 6 (4) ◽  
pp. 580 ◽  
Author(s):  
Joseph Arthur ◽  
Zhanni Lu ◽  
Kristy Nguyen ◽  
David Hui ◽  
Bernard Prado ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Drug Testing ◽  
Opioid Treatment ◽  
Urine Drug Testing ◽  
Urine Drug

The Role of Urine Drug Testing for Patients on Opioid Therapy

Pain Practice ◽  
2010 ◽  
Vol 10 (6) ◽  
pp. 497-507 ◽  
Author(s):  
Joseph Pergolizzi ◽  
Macro Pappagallo ◽  
Joseph Stauffer ◽  
Christopher Gharibo ◽  
Neil Fortner ◽  
...  
Keyword(s):  
Drug Testing ◽  
Opioid Therapy ◽  
Urine Drug Testing ◽  
Urine Drug

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

Family physicians’ proficiency in urine drug test interpretation

2007 ◽  
Vol 3 (6) ◽  
pp. 333 ◽  
Author(s):  
Gary M. Reisfield, MD ◽  
Fern J. Webb, PhD ◽  
Roger L. Bertholf, PhD ◽  
Paul A. Sloan, MD ◽  
George R. Wilson, MD
Keyword(s):  
Family Medicine ◽  
Drug Testing ◽  
Opioid Therapy ◽  
Physician Education ◽  
Test Interpretation ◽  
Multiple Choice Questions ◽  
Drug Test ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Urine Drug Test

Objective: To determine the proficiency in urine drug test interpretation among family medicine physicians who order these tests to monitor adherence in their patients on chronic opioid therapy.Methods: A seven-question instrument, consisting of six, five-option, single-best-answer multiple choice questions and one yes/no question was administered to 80 family medicine physicians attending a University of Kentucky Family Medicine Review Course. We calculated frequencies and performed χ2 analyses to examine bivariate associations between urine drug test utilization and interpretive knowledge.Results: The instrument was completed by 60/80 (75 percent) of eligible physicians (44 order urine drug testing; 16 do not). None of the physicians who order urine drug testing answered more than five of the seven questions correctly, and only 20 percent answered more than half correctly. Physicians who order urine drug testing performed better than physicians who do not order urine drug testing on only four of the seven questions, although there were no statistically significant differences between the groups on any question.Conclusions: Family medicine physicians who order urine drug testing to monitor their patients on chronic opioid therapy are not proficient in their interpretation. This study highlights the need for improved physician education in this area. It is imperative for physicians to work closely with certified laboratory professionals when ordering and interpreting urine drug tests.

Choosing the right laboratory: A review of clinical and forensic toxicology services for urine drug testing in pain management

2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Gary M. Reisfield, MD ◽  
Bruce A. Goldberger, PhD ◽  
Roger L. Bertholf, PhD
Keyword(s):  
Pain Management ◽  
Drug Testing ◽  
Forensic Toxicology ◽  
Opioid Therapy ◽  
Standards Of Practice ◽  
Clinical Laboratories ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
The Right ◽  
Drug Free

Urine drug testing (UDT) services are provided by a variety of clinical, forensic, and reference/specialty laboratories. These UDT services differ based on the principal activity of the laboratory. Clinical laboratories provide testing primarily focused on medical care (eg, emergency care, inpatients, and outpatient clinics), whereas forensic laboratories perform toxicology tests related to postmortem and criminal investigations, and drug-free workplace programs. Some laboratories now provide UDT specifically designed for monitoring patients on chronic opioid therapy. Accreditation programs for clinical laboratories have existed for nearly half a century, and a federal certification program for drug-testing laboratories was established in the 1980s. Standards of practice for forensic toxicology services other than workplace drug testing have been established in recent years. However, no accreditation program currently exists for UDT in pain management, and this review considers several aspects of laboratory accreditation and certification relevant to toxicology services, with the intention to provide guidance to clinicians in their selection of the appropriate laboratory for UDT surveillance of their patients on opioid therapy.

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