Urine Toxicology Screening Among Chronic Pain Patients on Opioid Therapy: Frequency and Predictability of Abnormal Findings

Abstract

These results confirm past findings that random urine toxicology screens among patients prescribed opioids for pain reveal a high incidence of abnormal findings. Common patient descriptors, and number, type, and dose of prescribed opioids were found to be poor predictors of abnormal results.

Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

“…44 Our hypothesis that males would have more illicit drug results was not confirmed; findings in previous studies were mixed. 16,18 Consistent with prior studies, 18,20 we found no significant association between opioid regimen characteristics and illicit drugs.…”

“…Most prior studies focused only on predictors of illicit drug detection and included THC with other illicit drugs. [16][17][18][19] Our findings confirm the importance of younger age, SUD history, and smoking as risks for aberrancies, and reveal that risk factors vary across aberrancy types. In this setting, male gender predicted only THC detection; furthermore, history of mental health and alcohol use disorders (at least in the past two years) generally did not predict aberrancies.…”

“…Low frequency of UDT illicit drug detection has also been reported for older patients in pain clinics. 17,18 Patients with prior SUD diagnoses had almost three times greater odds of an illicit drug finding. Among Veterans Affairs healthcare network COT patients, the percentage of UDTs positive for illicit substances (including THC) was about three times higher for those with prior-year SUD diagnoses.…”

“…Non-prescribed opioids (detected in 5 % of UDTs) were more common among patients under the age of 45, consistent with previous findings of greater illicit drug use and opioid abuse among younger adults. 18,[22][23][24][25][26][27][28][29] Excessive days' supply of prescribed opioids was also a risk factor, suggesting the importance of prescriber attention to total days' supply of prescribed opioids. The odds of having a non-prescribed opioid detected were over twice as great for African-Americans as for whites; further research is needed to explore possible reasons.…”

“…In pain clinic and other settings, some studies found illicit drugs (including tetrahydrocannabinol [THC]) to be more common among UDTs of males 16 and younger patients. 17,18 Among veterans, UDT detection of illicit substances (including THC) was more common for those with SUD diagnoses. 19 Studies in diverse settings 18,20 found no significant association between opioid regimen characteristics and UDT detection of illicit drugs.…”