Describing Prescription Opioid Adherence among Individuals with Chronic Pain using Urine Drug Testing

Matteliano, Deborah; Chang, Yu‐Ping

doi:10.1016/j.pmn.2014.04.001

Cited by 16 publications

(19 citation statements)

References 21 publications

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“…A similar finding was present in Michna et al's study (10.2%) (18). Matteliano and Chang's study (19) showed a higher percentage of similar noncompliance where 23% of their patients had absence of one or more of their prescribed opioids and 12.5% had presence of non-prescribed medication. Also Couto et al's study (20) found that 38% of the patients did not have the prescribed medication present and 29% had non prescribed medication present (Table 3).…”

Section: S141supporting

confidence: 83%

“…discussion Results of our study showed that 77.2% of our patients were compliant with prescribed opioid medications. Our results showed higher rates of compliance than other published studies (18)(19)(20). Michna et al showed that 45% of their patients had abnormal UDT results (18), Matteliano and Chang found 54% of their patients appeared non-compliant to their prescribed opioid regimen (19), and an even more staggering figure was found in a retrospective study conducted by Couto et al, which showed that 75% of patients from the Ameritox database were non-compliant with prescribed medication (20) (Table 3).…”

Section: S141contrasting

confidence: 71%

“…Our results showed higher rates of compliance than other published studies (18)(19)(20). Michna et al showed that 45% of their patients had abnormal UDT results (18), Matteliano and Chang found 54% of their patients appeared non-compliant to their prescribed opioid regimen (19), and an even more staggering figure was found in a retrospective study conducted by Couto et al, which showed that 75% of patients from the Ameritox database were non-compliant with prescribed medication (20) (Table 3). A reason for higher rates of compliance in our study may be due to a stricter discharge policy for non-compliant patients in conjunction with our dedicated patient educational process undertaken for every potential candidate for this type of therapy.…”

Section: S141contrasting

confidence: 71%

“…Ameritox's data analysis found that 11% of the patients tested in their database were positive for illicit drugs (20). According to Matteliano and Chang's data (19), they had a higher rate of positive results for illicit drugs (marijuana 24.2%, and cocaine 11.7%). As for a study conducted by Katz et al (14), 26 (21.3%) of the 122 patients tested were positive for illicit drugs (marijuana 16.4% and cocaine 4.9%).…”

Section: S141mentioning

confidence: 99%

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

et al. 2017

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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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Section: S141supporting

confidence: 83%

Section: S141contrasting

confidence: 71%

Section: S141contrasting

confidence: 71%

Section: S141mentioning

confidence: 99%

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

et al. 2017

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“…21 Second, we assumed that patients were taking drugs after they filled prescriptions, but non-adherence for opioids in particular is a major concern. 22,23 In addition, total and average daily opioid dose were computed using days' supply data that may not be reliable. Third, we examined patients' medications and overdose events in 6-month intervals in order to establish a tractable but reasonably long time frame to examine receipt of drugs and this outcome.…”

Section: Discussionmentioning

confidence: 99%

Drug Overdose in a Retrospective Cohort with Non-Cancer Pain Treated with Opioids, Antidepressants, and/or Sedative-Hypnotics: Interactions with Mental Health Disorders

Turner

Liang

2015

J GEN INTERN MED

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Do Urine Drug Tests Reveal Substance Misuse Among Patients Prescribed Opioids for Chronic Pain?

et al. 2021

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BACKGROUND: Urine drug testing (UDT) is a recommended risk mitigation strategy for patients prescribed opioids for chronic pain, but evidence that UDT supports identification of substance misuse is limited. OBJECTIVE: Identify the prevalence of UDT results that may identify substance misuse, including diversion, among patients prescribed opioids for chronic pain. DESIGN: Retrospective cohort study. SUBJECTS: Patients (n=638) receiving opioids for chronic pain who had one or more UDTs, examining up to eight substances per sample, during a one 1-year period. MAIN MEASURES: Experts adjudicated the clinical concern that UDT results suggest substance misuse or diversion as not concerning, uncertain, or concerning. KEY RESULTS: Of 638 patients, 48% were female and 49% were over age 55 years. Patients had a median of three UDTs during the intervention year. We identified 37% of patients (235/638) with ≥1 concerning UDT and a further 35% (222/638) having ≥1 uncertain UDT. We found concerning UDTs due to non-detection of a prescribed substance in 24% (156/638) of patients and detection of a non-prescribed substance in 23% (147/638). Compared to patients over 65 years, those aged 18-34 years were more likely to have concerning UDT results with an adjusted odds ratio (AOR) of 4.8 (95% confidence interval [CI] 1.9-12.5). Patients with mental health diagnoses (AOR 1.6 [95% CI 1.1-2.3]) and substance use diagnoses (AOR 2.3 [95% CI 1.5-3.7]) were more likely to have a concerning UDT result. CONCLUSIONS: Expert adjudication of UDT results identified clinical concern for substance misuse in 37% of patients receiving opioids for chronic pain. Further research is needed to determine if UDTs impact clinical practice or patient-related outcomes.

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Describing Prescription Opioid Adherence among Individuals with Chronic Pain using Urine Drug Testing

Cited by 16 publications

References 21 publications

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

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

Drug Overdose in a Retrospective Cohort with Non-Cancer Pain Treated with Opioids, Antidepressants, and/or Sedative-Hypnotics: Interactions with Mental Health Disorders

Do Urine Drug Tests Reveal Substance Misuse Among Patients Prescribed Opioids for Chronic Pain?

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