Behavioral Monitoring and Urine Toxicology Testing in Patients Receiving Long-Term Opioid Therapy

Abstract

Monitoring both urine toxicology and aberrant behavior in chronic-pain patients treated with opioids identified more problem patients than by monitoring either alone. The authors recommend routine urine testing on all patients prescribed opioids for noncancer pain and as a required element in all opioid analgesic studies.

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

“…Reasons for limited urine drug testing by primary care physicians might include lack of knowledge about the tests, 35,36 concerns that patients will feel stigmatized, 37 and a limited evidence base. 11 However, urine drug testing performs better in identifying misuse than clinician judgment 38 or patient self-report. 39,40 Physicians who monitor with urine drug tests report enhanced communication with their patients and improved safety of prescribed opioids.…”

Adherence to Clinical Guidelines for Opioid Therapy for Chronic Pain in Patients with Substance Use Disorder

“…These data are important, as psychological interventions have consistently strong outcome data in treating pain and improving function 33 , including studies of patients with pain and SUD 34 , and regular UDS monitoring is central for the provision of safe treatment with opioids and improves the detection of aberrant medication use. 35 However, only half of CNCP patients with SUD received at least one UDS and 35% received substance abuse treatment, suggesting that additional steps are needed to increase guideline adherence. In addition, despite patients with SUD being at higher risk, there was no significant difference in the likelihood of receiving more intensive treatment in primary care, receiving a long-acting opioid, participating in physical therapy, or receiving a prescription for an antidepressant medication.…”

The Subjective, Reinforcing, and Analgesic Effects of Oxycodone in Patients with Chronic, Non-Malignant Pain who are Maintained on Sublingual Buprenorphine/Naloxone

“…Aberrant opioid use behaviors among patients with pain include: obtaining prescriptions from multiple prescribers, forging prescriptions, 'borrowing' or stealing opioids, aggressively seeking more medication from physicians, and escalating doses without the physician's knowledge (Cowan et al, 2001;Martell et al, 2007;Passik et al, 2006). The exact prevalence of opioid abuse among patients with chronic pain is difficult to determine, although two studies conducted in the United States estimated that over 40% of patients with chronic pain exhibited aberrant drug-related behavior (Katz et al, 2003;Passik et al, 2006).…”