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
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