Treatment changes following aberrant urine drug test results for patients prescribed chronic opioid therapy

Morasco, Benjamin J.; Krebs, Erin E.; Cavanagh, Renee; Hyde, Stephanie; Crain, Aysha; Dobscha, Steven K.

doi:10.5055/jom.2015.0251

Cited by 6 publications

(9 citation statements)

References 20 publications

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“…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%). Lastly, Morasco et al (24) found 28.8% of their patients were positive for marijuana and 2.5% were positive for cocaine ( Table 3). The range of positive results for illicit substances could be due to different patient populations (suburban vs. urban) included in the studies as well as differences in medical marijuana laws in various states (24).…”

Section: S141mentioning

confidence: 92%

“…Lastly, Morasco et al (24) found 28.8% of their patients were positive for marijuana and 2.5% were positive for cocaine ( Table 3). The range of positive results for illicit substances could be due to different patient populations (suburban vs. urban) included in the studies as well as differences in medical marijuana laws in various states (24). Even though medical marijuana is approved in 23 states, it is still against laws of the federal government to consume it for recreational or non-recreational (i.e., "medical") purposes, and this causes some ambiguity for pain physicians when attempting to treat patients who may be using marijuana for medicinal purposes.…”

Section: S141mentioning

confidence: 92%

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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: S141mentioning

confidence: 92%

Section: S141mentioning

confidence: 92%

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

et al. 2017

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“…4,5 Evidence of high-risk behaviors, such as UDTs that are positive for illicit or non-prescribed controlled substances, may lead to discontinuation of long-term opioid therapy (LTOT). 6 Among a national sample of patients who were discontinued from LTOT, 37% were discontinued because of an aberrant UDT. 7 While current recommendations suggest tapering or discontinuing opioid therapy and considering substance use treatment when indicated, 8 data about the care patients receive following LTOT discontinuation are limited.…”

Section: Introductionmentioning

confidence: 99%

“…Cannabis is among the most common substances to be detected on a UDT among chronic pain patients prescribed LTOT. 6,7 More than half of the US and the District of Columbia (DC) have passed legislation to allow medical cannabis use, and eight of these states and DC also allow recreational cannabis use. 8 These trends suggest a growing public acceptance of cannabis, despite limited evidence for effective pain management for most chronic pain conditions.…”

Section: Introductionmentioning

confidence: 99%

Substance Use Disorder Treatment Following Clinician-Initiated Discontinuation of Long-Term Opioid Therapy Resulting from an Aberrant Urine Drug Test

et al. 2017

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BACKGROUND:It is unclear whether substance use disorder (SUD) treatment is offered to, or utilized by, patients who are discontinued from long-term opioid therapy (LTOT) following aberrant urine drug tests (UDTs). OBJECTIVE: To describe the proportion of patients who were referred to, and engaged in, SUD treatment following LTOT discontinuation and to examine differences in SUD treatment referral and engagement based on the substances that led to discontinuation. DESIGN: From a sample of 600 patients selected from a national cohort of Veterans Health Administration patients who were discontinued from LTOT, we used manual chart review to identify 169 patients who were discontinued because of a UDT that was positive for alcohol, cannabis, or other illicit or non-prescribed controlled substances. MAIN MEASURES: We extracted sociodemographic, clinical, and health care utilization data from patients' electronic medical records. KEY RESULTS: Forty-three percent of patients (n = 73) received an SUD treatment referral following LTOT discontinuation and 20% (n = 34) engaged in a new episode of SUD treatment in the year following discontinuation. Logistic regression models controlling for sociodemographic and clinical variables demonstrated that patients who tested positive for cannabis were less likely than patients who tested positive for non-cannabis substances to receive referrals for SUD treatment (aOR = 0.44, 95% CI = 0.23-0.84, p = 0.01) or engage in SUD treatment (aOR = 0.42, 95% CI = 0.19-0.94, p = 0.04). Conversely, those who tested positive for cocaine were more likely to receive an SUD treatment referral (aOR = 3.32, 95% CI = 1.57-7.06, p = 0.002) and engage in SUD treatment (aOR = 2.44, 95% CI = 1.00-5.96, p = 0.05) compared to those who did not have a cocaine-positive UDT. CONCLUSIONS: There may be substance-specific differences in clinician referrals to, and patient engagement in, SUD treatment. This suggests a need for more standardized implementation of clinical guidelines that recommend SUD care, when appropriate, following LTOT discontinuation.KEY WORDS: long-term opioid therapy; chronic pain; substance use treatment; physician referral.

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“… 10 Even with urine drug test monitoring, providers often fail to respond to abnormal results. 11 These areas of enquiry are all important, but do not address the management of problematic behaviours when they arise. Further, we argue that gaps in knowledge about how to respond to these behaviours are a barrier to optimal implementation of opioid guidelines.…”

Section: Introductionmentioning

confidence: 99%

Management of problematic behaviours among individuals on long-term opioid therapy: protocol for a Delphi study

et al. 2016

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IntroductionGiven the sharp rise in opioid prescribing and heightened recognition of opioid addiction and overdose, opioid safety has become a priority. Clinical guidelines on long-term opioid therapy (LTOT) for chronic pain consistently recommend routine monitoring and screening for problematic behaviours. Yet, there is no consensus definition regarding what constitutes a problematic behaviour, and recommendations for appropriate management to inform front-line providers, researchers and policymakers are lacking. This creates a barrier to effective guideline implementation. Thus, our objective is to present the protocol for a Delphi study designed to: (1) elicit expert opinion to identify the most important problematic behaviours seen in clinical practice and (2) develop consensus on how these behaviours should be managed in the context of routine clinical care.Methods/analysisWe will include clinical experts, defined as individuals who provide direct patient care to adults with chronic pain who are on LTOT in an ambulatory setting, and for whom opioid prescribing for chronic non-malignant pain is an area of expertise. The Delphi study will be conducted online in 4 consecutive rounds. Participants will be asked to list problematic behaviours and identify which behaviours are most common and challenging. They will then describe how they would manage the most frequently occurring common and challenging behaviours, rating the importance of each management strategy. Qualitative analysis will be used to categorise behaviours and management strategies, and consensus will be based on a definition established a priori.Ethics/disseminationThis study has been approved by the Institutional Review Board (IRB) of the University of Alabama at Birmingham (UAB). This study will generate Delphi-based expert consensus on the management of problematic behaviours that arise in individuals on LTOT, which we will publish and disseminate to appropriate professional societies. Ultimately, our findings will provide guidance to front-line providers, researchers and policymakers.

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Treatment changes following aberrant urine drug test results for patients prescribed chronic opioid therapy

Abstract: Current methods for optimizing treatment after obtaining aberrant UDT results should be enhanced. To improve the utility of UDT to reduce prescription opioid misuse, additional interventions and support for clinicians need to be developed and tested.

Cited by 6 publications

References 20 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

Substance Use Disorder Treatment Following Clinician-Initiated Discontinuation of Long-Term Opioid Therapy Resulting from an Aberrant Urine Drug Test

Management of problematic behaviours among individuals on long-term opioid therapy: protocol for a Delphi study

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