Urine drug screen findings among ambulatory oncology patients in a supportive care clinic

Rauenzahn, Sherri; Sima, Adam P.; Cassel, Brian; Noreika, Danielle; Gomez, Teny Henry; Ryan, Lynn; Wolf, Carl E.; Legakis, Luke P; Fabbro, Egidio Del

doi:10.1007/s00520-017-3575-1

Cited by 46 publications

(42 citation statements)

References 17 publications

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“…Among the patients who did undergo UDS, >50% had abnormal results . Rauenzhan et al also observed that 60 of 82 patients with cancer (70%) who were receiving supportive care had abnormal UDS results, which indicated that clinicians ordered UDS based on their clinical judgment of patients' risk of aberrant drug misuse . Abnormal results included the presence of nonprescribed opioids, benzodiazepines, or potent illicit drugs (such as heroin or cocaine) discovered on UDS.…”

Section: Discussionmentioning

confidence: 99%

“…5 Rauenzhan et al also observed that 60 of 82 patients with cancer (70%) who were receiving supportive care had abnormal UDS results, , taken medication other than the way that it was prescribed; item 8, treated for an alcohol or drug problem; item 9, medications have been lost or stolen; item 10, others expressed concern over your use of medication; item 11, felt a craving for medication; item 12, asked to give a urine screen for substance abuse; item 13 Cancer October 1, 2018 which indicated that clinicians ordered UDS based on their clinical judgment of patients' risk of aberrant drug misuse. 25 Abnormal results included the presence of nonprescribed opioids, benzodiazepines, or potent illicit drugs (such as heroin or cocaine) discovered on UDS.…”

Section: Discussionmentioning

confidence: 99%

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Predicting the risk for aberrant opioid use behavior in patients receiving outpatient supportive care consultation at a comprehensive cancer center

Yennurajalingam

Edwards

Arthur

et al. 2018

Cancer

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predicting the risk for aberrant opioid use behavior in patients receiving outpatient supportive care consultation at a comprehensive cancer center

Yennurajalingam

Edwards

Arthur

et al. 2018

Cancer

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“…In the wake of the recent opioid overdose crisis, it is imperative that nurses make efforts to distinguish such patients from those who merit unrestricted access to opioids for their pain. In outpatient settings, the use of validated risk assessment tools such as the Screener and Opioid Assessment for Patients With Pain questionnaire, 39,40 urine drug screens, 41,42 prescription drug monitoring programs, 43,44 and close observation of patient behavioral patterns related to opioid use 45 are some of the strategies used to aid in therapeutic decision making. Future studies are needed to develop similar strategies to assist nurses caring for patients receiving opioids in the inpatient setting.…”

Section: Discussionmentioning

confidence: 99%

Practices and perceptions regarding intravenous opioid infusion and cancer pain management

Arthur

Reddy

Smith

et al. 2019

Cancer

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BACKGROUND: In view of the recent opioid crisis, ways to promote safe and effective opioid-related practices are needed. Faster intravenous (iv) opioid infusion rates can result in increased adverse effects and risk for nonmedical opioid use. Data on best practices regarding safe iv opioid administration for cancer pain are limited. This study examined iv opioid bolus infusion practices and perceptions about opioids in cancer pain among 4 groups of inpatient oncology nurses. METHODS: An anonymous cross-sectional survey was conducted among oncology nurses working in medical, surgical, intensive care unit (ICU), and emergency department (ED) settings. An iv opioid bolus infusion speed less than 120 seconds was considered too fast. RESULTS: The participant response rate was 59% (731 of 1234). Approximately 58%, 54%, and 58% of all nurses administered morphine, hydromorphone, and fentanyl, respectively, in less than 120 seconds. The median morphine infusion speeds were 55, 60, 60, and 85 seconds for ICU, surgical, ED, and medical unit nurses, respectively (P = .0002). The odds ratios for infusing too fast were 2.04 and 2.52 for ED (P = .039) and ICU nurses (P = .003), respectively, in comparison with medical unit nurses, and they were 0.27 and 0.18 with frequent (P = .003) and very frequent use of a timing device (P = .0001), respectively, in comparison with no use. CONCLUSIONS: More than half the nurses working in the inpatient setting reported administering iv opioids too fast. ICU nurses administered opioids the fastest. Nurses who frequently used a timing device were less likely to infuse too fast. Further research is needed to standardize and improve the safe intermittent administration of iv opioids to patients with cancer. Cancer 2019;125:3882-3889.

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“…Universal precautions may include several strategies, including the use of urine toxicology , standardized contracts or agreements , and review of the data accessed from the state PDMP . More information is needed regarding which of these strategies are most beneficial, as well as cost and time effective, in the oncology setting.…”

Section: Risk Assessment and Monitoringmentioning

confidence: 99%

Risk Assessment and Monitoring of Patients with Cancer Receiving Opioid Therapy

Paice

2019

The Oncologist

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The primary objective of this article is to assist oncologists and advanced practice prescribers to safely and effectively minimize risk when providing opioids for cancer pain relief. The majority of people with cancer are unlikely to misuse or divert opioid medications, yet the prescriber is often unaware of those who are at risk for these behaviors. To provide skillful pain management to each patient in the oncology setting, while limiting harm to the community, all prescribers must consider the potential for risk of misuse, addiction, or diversion. To minimize this risk to the greatest degree possible, it is imperative to include a thorough risk assessment when conducting a comprehensive pain evaluation. This information is then used to triage pain relief interventions based upon the degree of risk, including whether or not to incorporate opioids into the plan of care. Risk mitigation strategies, incorporating universal precautions, are implemented to assess, monitor, and reduce the potential for opioid misuse. Universal precautions include strategies such as the use of urine toxicology, state prescription drug monitoring programs, and agreements. Ongoing monitoring is conducted with the goal being to identify aberrant behaviors early so that they can be addressed and managed appropriately. Referral to addiction specialists may be warranted when substance use disorder precludes safe use of opioids. Implications for Practice Throughout the trajectory of cancer care, opioid use is often indicated, and, in fact, it may be unethical to limit or prohibit the use of opioids when pain is severe. Oncologists face the significant challenge of providing cancer pain control that is safe and effective, while limiting individual risk for abuse or overdose and keeping the community free of diverted substances. Most oncology providers report inadequate training in chronic pain principles and in managing addiction. Risk assessment and mitigation measures can be incorporated within oncology care to enhance effective pain management while reducing the potential for harm.

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Urine drug screen findings among ambulatory oncology patients in a supportive care clinic

Abstract: UDS on the 82 oncology patients at high risk for substance misuse were frequently positive (46%) for non-prescribed opioids, benzodiazepines or potent illicit drugs such as heroin or cocaine, and 39% had inappropriately negative UDS, raising concerns for diversion.

Cited by 46 publications

References 17 publications

Predicting the risk for aberrant opioid use behavior in patients receiving outpatient supportive care consultation at a comprehensive cancer center

Predicting the risk for aberrant opioid use behavior in patients receiving outpatient supportive care consultation at a comprehensive cancer center

Practices and perceptions regarding intravenous opioid infusion and cancer pain management

Risk Assessment and Monitoring of Patients with Cancer Receiving Opioid Therapy

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