Considering the harms of our habits: The reflexive urine drug screen in opioid use disorder treatment

2020 ◽  
pp. 108258
Author(s):  
Utsha G. Khatri ◽  
Shoshana V. Aronowitz
Keyword(s):  
Opioid Use Disorder ◽  
Drug Screen ◽  
Urine Drug Screen ◽  
Opioid Use ◽  
Urine Drug ◽  
Disorder Treatment

scholarly journals Evaluation of buprenorphine/naloxone dose and use of sedating supportive medication on treatment outcomes in veterans with opioid use disorder

2017 ◽  
Vol 7 (6) ◽  
pp. 271-275 ◽  
Author(s):  
Amber Kapuganti ◽  
Traci Turner ◽  
Christopher J. Thomas
Keyword(s):  
Treatment Failure ◽  
Treatment Outcomes ◽  
Treatment Response ◽  
Opioid Use Disorder ◽  
Urine Drug Screen ◽  
Opioid Use ◽  
Time To Treatment ◽  
Time To Treatment Failure ◽  
Urine Drug ◽  
Lost To Follow Up

Abstract Introduction: This retrospective cohort study evaluated effects of buprenorphine/naloxone dose and concomitant use of selected sedating medications on treatment outcomes in patients with opioid use disorder. Methods: Patients enrolled in the buprenorphine/naloxone clinic at the study institution from 2009 until April 2013 were included. There were no exclusion criteria. Part 1 assessed treatment failure within 6 months and time to treatment failure with buprenorphine doses >8 mg and ≤8 mg. Part 2 assessed for treatment failure within 6 months and time to treatment failure with use of selected sedating medications. Sedating medications were cyproheptadine, hydroxyzine, quetiapine, and trazodone. Treatment failure was defined as documentation of illicit opioid use per patient report, urine drug screen showing opioid use, or patient lost to follow-up. Results: There were 132 patients included in this study, but 163 separate encounters due to multiple enrollments. Treatment failure was experienced within 6 months 51 times a patient was prescribed ≤8 mg (66.2%) and 26 times a patient was prescribed >8 mg (33.8%) (P = .0005). Average time to treatment failure was 5.1 months with ≤8 mg and 8.4 months with >8 mg. The 48% of patients who received sedating medications did not demonstrate any significant differences in treatment response at 6 months (P = .2746) or time to treatment failure (P = .2209). Discussion: Doses of buprenorphine/naloxone >8 mg demonstrated better treatment response and prolonged time to treatment failure. Concomitant sedating medications did not have a statistically significant effect on treatment response or time to treatment failure.

scholarly journals Retrospective Review of Physician Opioid Prescribing Practices in Patients with Aberrant Behaviors

2011 ◽  
Vol 4;14 (4;7) ◽  
pp. 383-389 ◽  
Author(s):  
Anita Gupta
Keyword(s):  
Chronic Pain ◽  
Prescribing Patterns ◽  
Prescription Opioid ◽  
Drug Screen ◽  
Urine Drug Screen ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Urine Drug ◽  
Aberrant Behaviors ◽  
Noncancer Pain

In the past few decades, opioid use for the treatment of chronic noncancer pain has slowly gained acceptance. With this increase in prescription opioid use, there has also been an increase in prescription opioid abuse. To help detect aberrant drug related behaviors, clinicians have utilized urine drug screens to determine patient noncompliance in outpatient pain clinics. The primary objective is to determine how the use of urine drug testing (UDT) affects health care outcomes. The secondary outcome is to evaluate these findings as it relates to pharmacoeconomics and aberrant behaviors in an outpatient clinical setting. In this study we will determine if UDT influences prescribing practices among physicians. Patients at an academic center’s chronic pain outpatient clinic were categorized as having urine screens that were “normal” (expected findings based on their prescribed drugs) or abnormal. Abnormal findings were those with either 1) the absence of a prescribed opioid, 2) the presence of an additional nonprescribed controlled substance, 3) detection of an illicit substance, or 4) an adulterated urine sample. We examined the incidence of such aberrant behaviors as well as concomitant pain diagnoses, psychiatric comorbidities, and the ultimate effect upon the prescribing patterns of the physicians in this clinic. Results of the study showed that the patients exhibiting aberrant drug behaviors have similar pain and psychiatric diagnoses as other chronic pain patients. The most common aberrancy detected was an abnormal urine drug screen, often with the presence of illegal substances. However, in the great majority of aberrancies detected, providers chose to continue prescribing opioids. We speculate on the reasons for this, and discuss the role of the urine drug screen in influencing prescriber behaviors. Key words: Chronic pain, noncancer pain, opioid, aberrant behavior, urine drug test, prescriber pattern, preference

scholarly journals COVID-19 Adaptations in the Care of Patients with Opioid Use Disorder: a Survey of California Primary Care Clinics

2021 ◽  
Author(s):  
Lauren Caton ◽  
Hannah Cheng ◽  
Hélène Chokron Garneau ◽  
Tammy Fisher ◽  
Briana Harris-Mills ◽  
...  
Keyword(s):  
Primary Care ◽  
Behavioral Health ◽  
Medication Management ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Primary Care Clinics ◽  
Urine Drug ◽  
Disorder Treatment ◽  
Primary Care Practices ◽  
The Impact

Abstract Background With the onset of the COVID-19 crisis, many federal agencies relaxed policies regulating opioid use disorder treatment. The impact of these changes has been minimally documented. The abrupt nature of these shifts provides a naturalistic opportunity to examine adaptations for opioid use disorder treatment in primary care. Objective To examine change in medical and behavioral health appointment frequency, visit type, and management of patients with opioid use disorder in response to COVID-19. Design A 14-item survey queried primary care practices that were enrolled in a medications for opioid use disorder statewide expansion project. Survey content focused on changes in service delivery because of COVID-19. The survey was open for 18 days. Participants We surveyed 338 clinicians from 57 primary care clinics located in California, including federally qualified health centers and look-alikes. A representative from all 57 clinics (100%) and 118 staff (34.8% of all staff clinicians) participated in the survey. Main Measures The survey consisted of seven dimensions of practice: medical visits, behavioral health visits, medication management, urine drug screenings, workflow, perceived patient demand, and staff experience. Key Results A total of 52 of 57 (91.2%) primary care clinics reported practice adaptations in response to COVID-19 regulatory changes. Many clinics indicated that both medical (40.4%) and behavioral health visits (53.8%) were now exclusively virtual. Two-thirds (65.4%) of clinics reported increased duration of buprenorphine prescriptions and reduced urine drug screenings (67.3%). The majority (56.1%) of clinics experienced an increase in patient demand for behavioral health services. Over half (56.2%) of clinics described having an easier or unchanged experience retaining patients in care. Conclusions Many adaptations in the primary care approach to patients with opioid use disorder may be temporary reactions to COVID-19. Further evaluation of the impact of these adaptations on patient outcomes is needed to determine whether changes should be maintained post-COVID-19.

Characteristics Associated with Success for Opioid Use Disorder Treatment in Court-involved Patients

2020 ◽  
Vol 04 (06) ◽  
Author(s):  
Li Li ◽  
Bianca M Bryant ◽  
Christina Cenczyk ◽  
Brian Gawronski
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Use ◽  
Disorder Treatment ◽  
Court Involved

Opioid use disorder treatment for people experiencing homelessness: A scoping review

2021 ◽  
pp. 108717
Author(s):  
Matthew F. McLaughlin ◽  
Rick Li ◽  
Nicolás Domínguez Carrero ◽  
Paul A. Bain ◽  
Avik Chatterjee
Keyword(s):  
Scoping Review ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Disorder Treatment

scholarly journals Evaluation of an opioid risk mitigation initiative for veterans undergoing hip or knee arthroplasty at San Francisco Veterans Affairs Heath Care System

2020 ◽  
Author(s):  
Tessa Rife ◽  
Christina Tat ◽  
Mahsa Malakootian
Keyword(s):  
San Francisco ◽  
Knee Arthroplasty ◽  
Risk Mitigation ◽  
Opioid Therapy ◽  
Veterans Affairs ◽  
Drug Screen ◽  
Urine Drug Screen ◽  
Urine Drug ◽  
Medication Disposal ◽  
Urine Drug Screening

Abstract Purpose Guidelines recommend evaluating the risk of opioid-related adverse events prior to initiating opioid therapy. The orthopedic service at San Francisco Veterans Affairs Health Care System (SFVHCS) has not routinely used risk assessment tools such as the Stratification Tool for Opioid Risk Mitigation, prescription drug monitoring program data, and urine drug screening prior to opioid prescribing. A quality improvement project was conducted to evaluate the number of pharmacist-provided opioid risk mitigation recommendations implemented by orthopedic providers for patients who underwent total hip or knee arthroplasty at SFVHCS. Summary A pharmacist-led workflow for completing risk mitigation reviews was developed in collaboration with orthopedic providers, and urine drug screening was added to the preoperative laboratory testing protocol. The following recommendations were communicated via electronic medical record: limit postoperative opioids to a 7- or 14-day supply based on risk of suicide and/or overdose, offer naloxone and a medication disposal bag, and order a urine drug screen if not already completed. Risk reviews were completed for 75 patients. Among 64 patients with 2-month postdischarge data available, 88% (7 of 8) of 7-day and 79% (44 of 56) of 14-day opioid supply recommendations were implemented; 41% (26 of 59) of recommendations to issue a medication disposal bag, 17% (2 of 12) recommendations to order a missing urine drug screen, and 9% (5 of 55) of recommendations to offer naloxone were implemented. Conclusion Pharmacist-performed risk mitigation reviews paired with individualized recommendations led to high rates of orthopedic provider acceptance of limiting postdischarge opioid day supplies for patients who had total hip or knee arthroplasty. Alternative strategies may increase access to naloxone. Future research should examine the impact of risk mitigation tools in reducing prescribing of long-term opioid therapy and adverse events among orthopedic surgical patients.

Gatifloxacin Interference with Opiate Urine Drug Screen

2006 ◽  
Vol 26 (3) ◽  
pp. 435-439 ◽  
Author(s):  
Craig M Straley ◽  
Eric J Cecil ◽  
Mark P Herriman
Keyword(s):  
Drug Screen ◽  
Urine Drug Screen ◽  
Urine Drug

The Impact of Chronic Pain on Opioid Use Disorder Treatment Outcomes

2021 ◽  
Author(s):  
R. Ross MacLean ◽  
Suzanne Spinola ◽  
Gabriella Garcia-Vassallo ◽  
Mehmet Sofuoglu
Keyword(s):  
Chronic Pain ◽  
Treatment Outcomes ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Disorder Treatment ◽  
The Impact
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