Recommendations for Urine Drug Monitoring as a Component of Opioid Therapy in the Treatment of Chronic Pain

Peppin, John F.; Passik, Steven D.; Couto, Joseph; Fine, Perry G.; Christo, Paul J.; Argoff, Charles E.; Aronoff, Gerald M.; Bennett, Daniel S.; Cheatle, Martin D.; Slevin, Kieran A.; Goldfarb, Neil I.

doi:10.1111/j.1526-4637.2012.01414.x

Cited by 70 publications

(61 citation statements)

References 43 publications

(46 reference statements)

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“…However, little evidence exists regarding UDT use for various patient subgroups. 12 Guidelines vary in their recommendations, with two 9,13 recommending mandatory testing for all COT patients, one advising testing for patients at risk for substance use disorders (SUDs), 8 and two 8,14 commenting that screening low-risk populations increases false-positive results and is less costeffective. 11 Knowledge regarding the risk factors for aberrant results could help inform evidence-based recommendations regarding UDTs for COT monitoring.…”

Section: Introductionmentioning

confidence: 99%

Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

et al. 2014

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BACKGROUND: Urine drug tests (UDTs) are recommended for patients on chronic opioid therapy (COT). Knowledge of the risk factors for aberrant UDT results could help optimize their use. OBJECTIVE: To identify primary care COT patient and opioid regimen characteristics associated with aberrant UDT results. DESIGN: Population-based observational. SAMPLE: 5,420 UDTs for Group Health integrated group practice COT patients. MEASURES: Group Health database measures of patient demographics, medical history, COT characteristics, and UDT results. RESULTS: Thirty percent of UDTs had aberrant results, including prescribed opioid non-detection (12.3 %), tetrahydrocannabinol (THC; 11.2 %), non-prescribed opioid (5.3 %), illicit drug (excluding THC; 0.6 %), nonprescribed benzodiazepine (1.7 %), and dilute (4.8 %). Adjusted odds ratios (95 % CI) of any aberrant result were higher for males than females CONCLUSIONS: In this primary care setting, results were aberrant for 30 % of UDTs of COT patients, largely because of prescribed opioid non-detection and THC. Aberrant results of almost all types were more likely among patients under the age of 45. Other risk factors varied across aberrancies, but commonly included current smoking and prior substance use disorder diagnosis.KEY WORDS: urine drug test; chronic opioid therapy; chronic pain; marijuana.

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Section: Introductionmentioning

confidence: 99%

Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

et al. 2014

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“…68 In addition, differential diagnoses for each result should be considered, for example, absence of prescribed drug in the urine could indicate non-access to required prescription, or diversion of the prescription. 37,69 These considerations should facilitate a discussion with the patient in order to improve care. Prior to the onset of opioid therapy, it is important to educate the patient and specify the objectives of UDS in the treatment agreement to avoid confrontation and uphold a strong physician-patient relationship.…”

Section: Monitoring During Chronic Opioid Therapymentioning

confidence: 99%

Opioid therapy for chronic non-cancer pain: guidelines for Hong Kong

et al. 2016

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“…20 According to the Institute for Clinical Systems Improvement, it is recommended that, even with the involvement of a pain specialist, PCPs still should ensure the responsible use of opioids through treatment agreements and UDT. 21 Peppin et al 22 list a number of additional recommendations for the use of UDT in patients taking opioids. All patients taking a short-or long-acting opioid for 3 months or longer should be tested.…”

Section: Case Study IVmentioning

confidence: 99%

“…For example zolpidem, coca leaf tea, salicylates, and fluconazole can cause a false positive for cocaine. 22 What are the options for the patient? By not attending the consultation with the addiction specialist, the patient has indicated that she is unable or unwilling to be adherent to the recommendations of the prescribing physician.…”

Section: Strategies and Recommendations For Management Of The Addictementioning

confidence: 99%

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Treating Pain in Addicted Patients: Recommendations from an Expert Panel

Cheatle

Comer

Wunsch³

et al. 2014

Population Health Management

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Clinicians may face pragmatic, ethical, and legal issues when treating addicted patients. Equal pressures exist for clinicians to always address the health care needs of these patients in addition to their addiction. Although controversial, mainly because of the lack of evidence regarding their long-term efficacy, the use of opioids for the treatment of chronic pain management is widespread. Their use for pain management in the addicted population can present even more challenges, especially when evaluating the likelihood of drug-seeking behavior. As the misuse and abuse of opioids continues to burgeon, clinicians must be particularly vigilant when prescribing chronic opioid therapy. The purpose of this article is to summarize recommendations from a recent meeting of experts convened to recommend how primary care physicians should approach treatment of chronic pain for addicted patients when an addiction specialist is not available for a referral. As there is a significant gap in guidelines and recommendations in this specific area of care, this article serves to create a foundation for expanding chronic pain guidelines in the area of treating the addicted population. This summary is designed to be a practical how-to guide for primary care physicians, discussing risk assessment, patient stratification, and recommended therapeutic approaches. (Population Health Management 2014;17:79-89)

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Recommendations for Urine Drug Monitoring as a Component of Opioid Therapy in the Treatment of Chronic Pain

Cited by 70 publications

References 43 publications

Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

Opioid therapy for chronic non-cancer pain: guidelines for Hong Kong

Treating Pain in Addicted Patients: Recommendations from an Expert Panel

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