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Constipation, emesis, and confusion were associated with increased p-LOS in patients receiving opioids after orthopedic surgery. In addition, there was a significant linear relationship between the number of adverse effects/patient and increased p-LOS, and the strength of the association increased as the number of adverse effects increased. Although the opioid dosages and adverse-effect rates were typical, these findings reinforce the need to balance pain management with risk of events.

While the participating panel members recognize that there currently is a limited evidence base to support the expert panel's recommendations, primary care providers and pain specialists are largely acting today based on anecdote, intuition, and individual experience. The recommendations are meant to begin to provide a framework for standardizing practices for UDM in the treatment of chronic pain, and to serve as a catalyst to advance research that quantifies the effects of UDM on opioid therapy management and patient outcomes.

Chronic opioid treatment is a highly effective method to treat chronic pain; however, the prevalence of abuse of opioids can make treating patients with these agents difficult for clinicians. The objective of this study was to describe rates of inappropriate utilization, abuse, and diversion in a population of patients who were prescribed chronic opioids, as measured by urine drug testing in the clinical setting. A retrospective analysis was conducted of results from all urine drug tests conducted by Ameritox, Ltd. between January 2006 and January 2009, for patients whose physicians ordered the test in order to screen for noncompliance. Data from 938,586 patient test samples showed that 75% of patients were unlikely to be taking their medications in a manner consistent with their prescribed pain regimen. Thirty-eight percent of patients were found to have no detectable level of their prescribed medication, 29% had a nonprescribed medication present, 27% had a drug level higher than expected, 15% had a drug level lower than expected, and 11% had illicit drugs detected in their urine. Note that all categories add to a total greater than 100% as each category is not mutually exclusive, and a single patient could fall into multiple categories. The high observed rate of noncompliance demonstrates a significant clinical concern and confirms the importance of periodic urine drug screening for the population prescribed long-term opioid therapy.

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