Can clinicians accurately predict which patients are misusing their medications?

A rational approach to opioid use disorder in primary care

“…For example, in a study of patients clinicians thought were not at risk for misuse of medications, 60% had urine drug tests showing either the presence of illicit drugs or no evidence of the prescribed drug. 9 The prevalence of problematic opioid use in patients on chronic opioid therapy for pain has been variably reported in the literature, but one systematic review found that misuse rates ranged from 21% to 29% (95% confi dence interval 13%-38%) and addiction rates averaged 8% to 12% (3%-17%). 10 These numbers are alarming, and prescribers need to know how to screen for and diagnose opioid addiction when they see it.…”

Breaking the pain contract: A better controlled-substance agreement for patients on chronic opioid therapy

“…But in fact, physicians are notoriously poor at predicting which patients will misuse prescription opioids or suffer adverse effects. 25 Therefore, it is important to be transparent and consistent with monitoring practices for all patients on chronic opioid therapy. 26 Framing the controlled-substance agreement in terms of safety and using it universally can minimize miscommunication and unintentional stigmatization.…”

“…53 Historically, primary care physicians have used controlled-substance agreements inconsistently and primarily for patients believed to be at high risk of misuse. 54 However, because physicians cannot accurately predict who will misuse or divert medications, 25 controlledsubstance agreements should be used universally, ie, for all patients prescribed controlled substances.…”

Prospective, Longitudinal Study to Evaluate the Clinical Utility of a Predictive Algorithm to Detect Opioid Use Disorder in Chronic Pain Patients

“…Although easy to use, these subjective questionnaires pose variable reliability [17]. Regardless of how accurate patients answer the questions, physicians still have only a 50% chance of predicting the development of OUD [18]. For more objective information, physicians can run random urine drug tests (UDT) to monitor medication metabolites in urine, or query the database of the Prescription Drug Monitoring Program (PDMP) for drug prescription records [19].…”