Profiles of Urine Drug Test in Clinical Pain Patients vs Pain Research Study Subjects

Abstract

Objective To examine similarities and differences in urine drug test (UDT) results in clinical pain patients and pain subjects participating in pain research studies. Design An observational study with retrospective chart review and data analysis. Methods We analyzed 1,874 urine drug test (UDT) results obtained from 1) clinical pain patients (Clinical Group; n=1,529) and 2) pain subjects consented to participate in pain research studies (Research Group; n=345). Since several medications such as opioids used in pain management are drugs of abuse (DOA) and can result in a positive UDT, we specifically identified those cases of positive UDT due to non-prescribed DOA and designated these cases as positive UDT with DOA (PUD). Results We found that 1) there was a higher rate of PUD in clinical pain patients (41.3%) than in pain research study subjects (14.8%); 2) although subjects in the Research Group were informed ahead of time that UDT will be conducted as a screening test, a substantial number (14.8%) of pain research study subjects still showed PUD; 3) there were different types of DOA between clinical pain patients (cannabinoids as the top DOA) and research study subjects (cocaine as the top DOA); and 4) a common factor associated with PUD was opioid therapy in both Clinical Group and Research Group. Conclusion These results support previous findings that PUD is a common finding in clinical pain patients, particularly in those prescribed opioid therapy, and we suggest that UDT be used as routine screening testing in pain research studies.

Utility of the Pain Medication Questionnaire to predict aberrant urine drug tests: Results from a longitudinal cohort study.

“…Previous research suggests that aberrant UDT results are more likely when the UDT is witnessed (Mallya et al, 2013); future research may benefit from additional details about the specific details of urine collection. Fourth, all participants were enrolled in a prospective research study, and prior data suggest that rates of aberrant UDT results may be higher among clinical patients than with research participants (Lee et al, 2016). Participants who volunteer to engage in research studies may differ in important ways from those who do not, and the results may change in clinical settings.…”

The utility of universal urinary drug screening in chronic pain management

“…This rate is similar to the rates of unexpected UDS results found in previous studies, which is between 8.8% and 41.3%. [18][19][20][21][22][23][24][25][26][27][28][29][30] A similar study, conducted in a hospital-based pain management program, examined unexpected UDS using gas chromatography/mass spectrometry. 20 Results showed that 20% of patients had an illicit substance in their urine, most commonly cannabis and cocaine.…”

“…The number of patients with CNCP who had an unexpected UDS result varied from 8.8% to 41.3%, with results primarily consisting of unexpected marijuana and cocaine use. [18][19][20][21][22][23][24][25][26][27][28][29][30] This large variability may be attributed to the type of UDS test used and how the physicians selected their patients for UDS. One study showed that UDS may reduce illicit drug use.…”