Definitive urine drug test findings in patients prescribed opioids for pain from a large national database

Abstract

Objective: Clinicians and policymakers have been wrestling with the appropriateness and safety of opioid therapy during the opioid crisis. Policy and clinical decisions have often been made without much current data on trends in drug use in patients with pain. Thus, we evaluated definitive urine drug test (UDT) results in patients being treated for pain to see if those taking their prescribed opioids were less likely to be positive for the primary illicit drugs currently driving overdose deaths: cocaine, heroin, fentanyl, and methamphetamine.Design, setting, and patients: A cross-sectional study of UDT results from January 1, 2015 to September 30, 2021, from 600,000 patient specimens submitted for testing by pain management specialists.Interventions: UDT by liquid chromatography-tandem mass spectrometry as ordered by the treating clinician.Main outcome measures: Presence of other substances stratified by whether a patient's prescribed opioid was found.Results: The presence of cocaine, heroin, fentanyl, and methamphetamine for the total population was low (5 percent). Of the 347,092 patients prescribed opioids, 76 percent (n = 264,961) were positive on UDT for their prescribed opioid (“consistent”). Compared to patients without their prescribed opioid present (“inconsistent”), patients consistent with therapy were 54 percent (incidence rate ratio (IRR) 1.54, 95 percent confidence interval (CI) 1.47-1.59) less likely to be positive for cocaine, 47 percent [IRR 1.47, 95 percent CI 1.34-1.57] less likely to be positive for heroin, and 35 percent [IRR 1.35, 95 percent CI 1.24-1.45] less likely to be positive for methamphetamine, p 0.001. Differences between the groups for fentanyl were not significant.Conclusions: Overall positivity rates for cocaine, heroin, fentanyl, and methamphetamine were low. Patients with prescribed opioid present were less likely to be positive for cocaine, heroin, or methamphetamine. Patterns of substance use within this pain management population should be used to inform ongoing policy decisions.

An Evaluation of the Clinical Tools Used to Monitor Illicit Methamphetamine Use Among Chronic Pain Patients: A Cross Sectional Retrospective Study

“…Among those with cLBP, 9% used methamphetamine versus 5% of those surveyed without cLBP. 2 In a study done by Guevara et al, 3 600 000 urine drug specimens were analyzed from January 1, 2015 to September 30, 2021. It was concluded that among the 347 092 patients who were prescribed opiates, those with an inconsistent urine were 2.5 times more likely to test positive for methamphetamines than the consistent urine group.…”

“…It was concluded that among the 347 092 patients who were prescribed opiates, those with an inconsistent urine were 2.5 times more likely to test positive for methamphetamines than the consistent urine group. 3 The researchers defined consistent as positive for their prescribed opiates and inconsistent as negative for their prescribed opiate.…”

“…It was concluded that among the 347 092 patients who were prescribed opiates, those with an inconsistent urine were 2.5 times more likely to test positive for methamphetamines than the consistent urine group. 3 The researchers defined consistent as positive for their prescribed opiates and inconsistent as negative for their prescribed opiate.One of the most common ways to monitor illicit drug use and adherence to a controlled substance agreement is by conducting regular, random urine drug tests (UDT), which include both urine drug screens and confirmatory drug tests. The immunoassay (IA) drug test, or urine drug screen, is the first test conducted on urine specimens because it is fast,…”