Urine Drug Testing in Cancer Pain Management

Abstract

Urine drug test (UDT) is an effective tool used in chronic opioid therapy to ensure patient adherence to treatment and detect nonmedical opioid use. The two main types of UDT used in routine clinical practice are the screening tests or immunoassays and the confirmatory tests or laboratory‐based specific drug identification tests such as gas chromatography–mass spectrometry, liquid chromatography–mass spectrometry, or tandem mass spectrometry. UDT produces objective data on some nonmedical opioid use that may otherwise go undetected, such as the use of undisclosed medications, the nonuse of prescribed medications, and the use of illegal drugs. It allows clinicians to initiate an open and effective conversation about nonmedical opioid use with their patients. However, the test has certain limitations that sometimes compromise its use. Its interpretation can be challenging to clinicians because of the complexity of the opioid metabolic pathways. Clear guidelines or recommendations regarding the use of UDT in cancer pain is limited. As a result, UDT appears to be underused among patients with cancer pain receiving opioid therapy. More studies are needed to help standardize the integration and use of UDT in routine cancer pain management. Implications for Practice Despite its potential benefits, urine drug testing (UDT) appears to be underused among patients with cancer pain receiving opioid therapy. This is partly because its interpretation can be challenging owing to the complexity of the opioid metabolic pathways. Information regarding the use of UDT in opioid therapy among patients with cancer is limited. This review article will improve clinician proficiency in UDT interpretation and assist oncologists in developing appropriate treatment plans during chronic opioid therapy.

Managing Nonmedical Opioid Use Among Patients With Cancer Pain During the COVID-19 Pandemic Using the CHAT Model and Telehealth

“…The two cases support emerging evidence that NMOU may be more prevalent among patients with cancer pain than was previously thought to be. 8,15 Opioids are the gold standard for treating cancer-related pain 10,16 . An increase in disease burden, chronicity of cancer, poor prognosis, and early access to opioids, are a few of the many factors that can lead to chemical coping or NMOU (Box 1) among advanced cancer patients 7,10,16 .…”

“…As a part of the program, the center developed a specialized interdisciplinary team model called The Compassionate High-Alert Team (CHAT) to manage the subset of patients who engage in NMOU 7,8 . With the onset of the COVID-19 pandemic, it became increasingly challenging to J o u r n a l P r e -p r o o f utilize this important intervention due to unintended disruptions in patient care.…”

Factors Influencing Pain Expression in Patients with Cancer: An Expert Opinion

“…Surveys in patients of a palliative care program in the USA reported that about half of respondents, including patients and family members, were positive at screening urine tests [45][46][47][48][49].…”

“…The aberrant behaviors that may render the opioid treatment more complex are reported in Table 1 [ 46 , 47 ].…”

Random urine drug testing among patients receiving opioid therapy for cancer pain

“…Urine drug testing (UDT) is an effective risk monitoring tool during chronic opioid therapy 3,4 because it provides support for clinicians during therapeutic decision making and has been endorsed in numerous opioid prescribing guidelines for chronic nonmalignant pain 5‐7 . On the other hand, there is very limited evidence to guide the integration of UDT into routine cancer pain management, 8,9 and no universally approved standardized protocol currently exists. Usually, patients are selected to undergo UDT on the basis of their level of risk for NMOU (targeted patient selection), 10 but sometimes they may undergo the test regardless of their risk for NMOU (random patient selection) 8…”