Do Urine Drug Tests Reveal Substance Misuse Among Patients Prescribed Opioids for Chronic Pain?

Abstract

BACKGROUND: Urine drug testing (UDT) is a recommended risk mitigation strategy for patients prescribed opioids for chronic pain, but evidence that UDT supports identification of substance misuse is limited. OBJECTIVE: Identify the prevalence of UDT results that may identify substance misuse, including diversion, among patients prescribed opioids for chronic pain. DESIGN: Retrospective cohort study. SUBJECTS: Patients (n=638) receiving opioids for chronic pain who had one or more UDTs, examining up to eight substances per sample, during a one 1-year period. MAIN MEASURES: Experts adjudicated the clinical concern that UDT results suggest substance misuse or diversion as not concerning, uncertain, or concerning. KEY RESULTS: Of 638 patients, 48% were female and 49% were over age 55 years. Patients had a median of three UDTs during the intervention year. We identified 37% of patients (235/638) with ≥1 concerning UDT and a further 35% (222/638) having ≥1 uncertain UDT. We found concerning UDTs due to non-detection of a prescribed substance in 24% (156/638) of patients and detection of a non-prescribed substance in 23% (147/638). Compared to patients over 65 years, those aged 18-34 years were more likely to have concerning UDT results with an adjusted odds ratio (AOR) of 4.8 (95% confidence interval [CI] 1.9-12.5). Patients with mental health diagnoses (AOR 1.6 [95% CI 1.1-2.3]) and substance use diagnoses (AOR 2.3 [95% CI 1.5-3.7]) were more likely to have a concerning UDT result. CONCLUSIONS: Expert adjudication of UDT results identified clinical concern for substance misuse in 37% of patients receiving opioids for chronic pain. Further research is needed to determine if UDTs impact clinical practice or patient-related outcomes.

Development and validation of an electronic health records‐based opioid use disorder algorithm by expert clinical adjudication among patients with prescribed opioids

“…[4][5][6][7] The sensitivity and specificity of the ICD codes for opioid abuse and dependence OUD will allow adjustment of findings from previous studies making them more internally valid. 17,22 Future algorithm refinements include machine learning approaches for text mining, inclusion of urine testing results, 23 and comparison with ICD-10 OUD codes alone.…”

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

“…Cheatle et al demonstrated that primary care patients with chronic pain, who were carefully screened via several measures to identify comorbid psychiatric diagnoses, functional impairment, and substance use disorders (SUDs), had low rates of problematic substance use and almost no aberrant behaviors when treated with opioid medications. 17 Additionally, a chart review of urine drug test (UDT) results performed primarily by immunoassay testing (with its known limitations 18 ), suggested that 37 percent of patients with pain prescribed opioids had test results indicating illicit substance use and/or medication misuse. While this study was published recently, the UDT results were obtained between 2014 and 2016 and may not characterize today's opioid-treated patients with pain.…”