Urine drug testing in pain medicine

Heit, Howard A.; Gourlay, Douglas

doi:10.1016/j.jpainsymman.2003.07.008

Cited by 163 publications

(129 citation statements)

References 29 publications

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“…39,40 Physicians who monitor with urine drug tests report enhanced communication with their patients and improved safety of prescribed opioids. [41][42][43] To our knowledge, this is the first analysis of the frequency of primary care office visits during opioid treatment. Surprisingly, only half of patients met this minimum recommended frequency of office-based monitoring of patients on long-term opioid therapy.…”

Section: Discussionmentioning

confidence: 99%

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

et al. 2011

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“…Unfortunately, fentanyl detection requires specific testing and is not readily detected on most routine opioid drug screens used in clinical settings [24][25][26]. Thus, if a lab is not testing for fentanyl, its presence will go undetected.…”

Section: Case Groupmentioning

confidence: 99%

Fentanyl-associated Fatalities Among Illicit Drug Users in Wayne County, Michigan (July 2005–May 2006)

Algren¹,

Monteilh²,

Punja³

et al. 2013

J. Med. Toxicol.

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Background During the summer of 2005, multiple cities in the United States began to report outbreaks of fentanyl-associated fatalities among illicit drug users. The objectives of this study were to (1) determine if an outbreak of fentanyl-associated fatalities occurred in mid-2005 to mid-2006 and (2) to examine trends and compare features of fentanyl-contaminated heroinassociated fatalities (FHFs) with non-fentanyl, heroinassociated fatalities (NFHFs) among illicit drug users. Methods Baseline prevalence of fentanyl-and heroinassociated deaths was estimated from January to May 2005 based on recorded cause of death (determined by the medical examiner (ME)) using the Wayne County, MI, USA toxicology database. The database was then queried for both FHFs and NFHFs between July 1, 2005 and May 12, 2006. A FHF was defined as having fentanyl or norfentanyl (metabolite) detected in any postmortem biological sample and either (1) detection of heroin or its metabolite (6-acetylmorphine) and/or cocaine or its metabolite (benzoylecgonine) in a postmortem biological specimen or (2) confirmation of fentanyl abuse as the cause of death by the ME or a medical history available sufficient enough to exclude prescription fentanyl or other therapeutic opioid use. A NFHF was defined as detection of heroin, 6-acetylmorphine (heroin metabolite) or morphine in any postmortem biological specimen, heroin overdose listed as the cause of death by the ME, and absence of fentanyl detection on postmortem laboratory testing. Information was systematically collected, trended for each group and then compared between the two groups with regard to demographic, exposure, autopsy, and toxicology data. Logistic regression was performed using SAS v 9.1 examining the effects of age, gender, and marital status with fentanyl group status.Results Monthly prevalence of fentanyl-associated fatalities among illicit drug users increased from an average of two in early 2005 to a peak of 24 in May, 2006. In total, 101 FHFs and 90 NFHFs were analyzed. The median age of decedents was 46 and 45 years for the fentanyl and non-fentanyl groups, respectively. Fentanyl-contaminated heroin-associated fatalities (FHFs) were more likely to be female (p=0.003). Women aged over 44 years (OR=4.67;) and divorced/widowed women (OR = 14.18;95 % CI = 1.59-127.01) were more likely to be FHFs when compared to women aged less than 44 years and single, respectively. A significant interaction occurred between gender and age, and gender and marital status. Most FHFs had central (heart) blood samples available for fentanyl testing (n=96; 95 %): fentanyl was detected in most (n=91; 95 %). Of these, close to half had no detectable heroin (or 6-acetylmorphine) concentrations (n=37; 40.7 %). About half of these samples had detectable cocaine concentrations (n=20; 54 %). Median fentanyl concentration in central blood samples was 0.02 μg/ml (n=91, range <0.002-0.051 μg/ml) and 0.02 μg/ml (n=32, range <0.004-0.069 μg/ml) in peripheral blood samples. The geometric mean of the ratio of ...

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“…9 -15 In addition, inappropriately negative UDT results can help to identify diversion, the sale or transfer of prescribed opioids to others. 16,17 Interpreting urine drug test results is complicated, and mistakes can have serious consequences for patient care. 18,19 Correct interpretation of UDT requires knowledge of the sensitivity and specificity of the assay for detecting drugs of interest, causes of false positive results, metabolic pathways, and detection times in urine for each drug.…”

Section: Introductionmentioning

confidence: 99%

They Don’t Know What They Don’t Know: Internal Medicine Residents’ Knowledge and Confidence in Urine Drug Test Interpretation for Patients with Chronic Pain

et al. 2012

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BACKGROUND: Urine drug testing (UDT) can help identify misuse or diversion of opioid medications among patients with chronic pain. However, misinterpreting results can lead to false reassurance or erroneous conclusions about drug use. OBJECTIVE: To examine the relationship between resident physicians' knowledge about UDT interpretation and confidence in their ability to interpret UDT results. DESIGN: Cross-sectional survey. PARTICIPANTS: Internal medicine residents in a university health system in the Bronx, from 2010 to 2011. MAIN MEASURES:We assessed knowledge using a 7-item scale (UDT knowledge score), and confidence in UDT interpretation using a single statement ("I feel confident in my ability to interpret the results of urine drug tests"). We conducted chi-square tests, t-tests, and logistic regression to determine the association between knowledge and confidence, and in exploratory analyses to examine whether resident characteristics (gender, training level, and UDT use) moderated the relationship between knowledge and confidence. KEY RESULTS: Among 99 residents, the mean UDT knowledge score was 3.0 out of 7 (SD 1.2). Although 55 (56 %) of residents felt confident in their ability to interpret UDT results, 40 (73 %) of confident residents had a knowledge score of 3 or lower. Knowledge score was not associated with confidence among the full sample or when stratified by training level or UDT use. The association between knowledge and confidence differed significantly by gender (interaction term p< 0.01). Adjusting for training level and UDT use, knowledge was positively associated with confidence among females (AOR 1.79, 95 % CI: 1.06, 3.30), and negatively associated with confidence among males (AOR 0.47, 95 % CI: 0.23, 0.98). CONCLUSIONS: Despite poor knowledge about UDT interpretation, most resident physicians felt confident in their ability to interpret UDT results. Gender differences warrant further exploration, but even confident physicians who use UDT should evaluate their proficiency in interpreting UDT results. Educational initiatives should emphasize the complexities of UDT interpretation.KEY WORDS: urine drug testing; chronic pain; opioid medications; physician self-assessment.

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Urine drug testing in pain medicine

Cited by 163 publications

References 29 publications

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

Fentanyl-associated Fatalities Among Illicit Drug Users in Wayne County, Michigan (July 2005–May 2006)

They Don’t Know What They Don’t Know: Internal Medicine Residents’ Knowledge and Confidence in Urine Drug Test Interpretation for Patients with Chronic Pain

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