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

Abstract

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

Interventions to optimize prescribed medicines and reduce their misuse in chronic non-malignant pain: a systematic review

“…Nine studies used prospective cohort design [ 15 , 17 , 20 , 23 , 24 , 28 , 30 ]. Seven were retrospective cohort studies [ 18 , 19 , 21 , 22 , 25 – 27 ] one was a cross-sectional design [ 31 ] and one was pre-post interventional design without a control arm [ 16 ]. Six studies were conducted in primary care settings [ 17 – 19 , 25 , 27 , 29 ], four in pain centres [ 23 , 24 , 28 , 31 ], seven in outpatient’s pain clinics [ 14 , 15 , 22 , 26 , 29 , 31 ], two recruited patients from primary care and pain clinics [ 16 , 20 ] and one recruited patient from primary care and an internet site (Table 3 ) [ 13 ].…”

“…Non-adherence was defined as presence of underuse and/or overuse of prescribed medication. Knezevic et al (USA) [ 22 ] To assess the compliance of chronic opioid consuming patients in an outpatient setting and evaluate if utilizing repeated urine drug testing could improve compliance. Retrospective analysis of prospectively collected data using urine samples and patient medical charts.…”

“…Four of the included studies aimed to reduce the use or reliance on opioids [ 13 , 19 , 25 , 30 ], nine aimed to identify and reduce misuse, abuse of drugs or aberrant drug behaviour [ 11 , 14 , 17 , 20 , 21 , 23 , 24 , 28 , 29 ]. Two studies aimed to improve adherence ( n = 2) [ 12 , 16 ] and four focused on patients’ compliance with prescribed opioids [ 11 , 18 , 22 , 31 ]. Considering pain type and locations, eight studies included both nociceptive and neuropathic pain patients [ 12 , 13 , 17 , 18 , 21 , 22 , 25 , 31 ].…”

“…Two studies aimed to improve adherence ( n = 2) [ 12 , 16 ] and four focused on patients’ compliance with prescribed opioids [ 11 , 18 , 22 , 31 ]. Considering pain type and locations, eight studies included both nociceptive and neuropathic pain patients [ 12 , 13 , 17 , 18 , 21 , 22 , 25 , 31 ]. Eight studies focused on populations suffering from nociceptive pain, including low back pain, arthritis and other musculoskeletal disorders [ 11 , 15 , 20 , 23 , 24 , 27 , 28 , 30 ].…”

“…The scope of medication taking behaviour was defined differently among the included studies. These included misuse [ 11 , 17 , 28 ], abuse [ 23 ], aberrant drug-taking behaviour [ 14 , 19 , 21 ], non-adherence( n = 3) [ 12 , 15 , 16 ], compliance (n = 3) [ 18 , 22 , 31 ] and illicit drug use ( n = 1) [ 24 ]. Seven studies did not define any medication taking behaviour [ 13 , 20 , 25 – 27 , 29 , 30 ].…”