Urine Drug Testing of Chronic Pain Patients. V. Prevalence of Propoxyphene Following its Withdrawal from the United States Market

Background: The precise role of urine drug testing (UDT) in the practice of pain medicine is currently being defined. Confusion exists as to best practices, and even to what constitutes standard of care. A member survey by our state pain society revealed variability in practice and a lack of consensus. Objective: The authors sought to further clarify the importance of routine UDT as an important part of an overall treatment plan that includes chronic opioid prescribing. Further, we wish to clarify best practices based on consensus and data where available. Methods: A 20-item membership survey was sent to Texas Pain Society members. A group of chronic pain experts from the Texas Pain Society undertook an effort to review the best practices in the literature. The rationale for current UDT practices is clarified, with risk management strategies outlined, and recommendations for UDT outlined in detail. A detailed insight into the limitations of point-of-care (enzyme-linked immunosorbent assay, test cups, test strips) versus the more sensitive and specific laboratory methods is provided. Limitations: Our membership survey was of a limited sample size in one geographic area in the United States and may not represent national patterns. Finally, there is limited data as to the efficacy of UDT practices in improving compliance and curtailing overall medication misuse. Conclusions: UDT must be done routinely as part of an overall best practice program in order to prescribe chronic opioid therapy. This program may include risk stratification; baseline and periodic UDT; behavioral monitoring; and prescription monitoring programs as the best available tools to monitor chronic opioid compliance. Key words: Urine drug screening, urine toxicology screening, urine drug testing, chronic pain, addiction, forensic testing

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Impact of the COVID-19 pandemic on chronic pain management

Srpski medicinski casopis Lekarske komore ◽

10.5937/smclk2-32971 ◽

2021 ◽

Vol 2 (3) ◽

pp. 197-212

Author(s):

Andrew Auyeung ◽

Hank Wang ◽

Iulia Pirvulescu ◽

Nebojša Knežević

Keyword(s):

United States ◽

Chronic Pain ◽

Pain Management ◽

The United States ◽

Chronic Pain Management ◽

Steroid Use ◽

Chronic Pain Patients ◽

Interventional Pain Management ◽

Tools And Techniques ◽

Pain Patients

Introduction: The COVID-19 pandemic has generated considerable turmoil in the interventional pain management (IPM) community. Due to IPM being classified as 'elective', numerous pain practices across the United States were forced to close during the pandemic, leaving chronic pain patients untreated for indefinite periods, and IPM physicians with increased stress and burnout. Results: In response to these detrimental effects, various re-opening tools and techniques have been created to facilitate a cautious resumption of in-person interventional pain practice. Due to their ability to minimize person-to-person contact, telehealth and pharmacotherapy played a more significant role in IPM during the pandemic, but their increased utilization has also led to the exacerbation of substance abuse and the opioid epidemic. The interplay between steroid use and its immunosuppressive effects, in relation to the COVID-19 infection and the COVID-19 vaccine, has also arisen as an issue of concern. Conclusion: As practices begin to safely re-open throughout the United States, the effects felt by chronic pain patients during the pandemic must be emphasized and not ignored. This review emphasizes the struggles pain patients have had to face during the pandemic and the need to update and redefine regulations regarding interventional and chronic pain management.

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Observation of improved adherence with frequent urine drug testing in patients with pain

Journal of Opioid Management ◽

10.5055/jom.2014.0200 ◽

2014 ◽

Vol 10 (2) ◽

pp. 111 ◽

Cited By ~ 4

Author(s):

David A. Yee, BS ◽

Michelle M. Hughes, BA ◽

Alexander Y. Guo, MS ◽

Neveen H. Barakat, BS ◽

Stephanie A. Tse, BS ◽

...

Keyword(s):

Chronic Pain ◽

Drug Testing ◽

Patient Adherence ◽

Parent Drug ◽

The United States ◽

Limit Of Quantitation ◽

Urine Drug Testing ◽

Urine Drug ◽

Urine Drug Test ◽

The Relationship

Objective: To determine the relationship between urine drug testing (UDT) frequency and patient adherence for prescribed buprenorphine, carisoprodol, fentanyl, hydrocodone, methadone, morphine, and oxycodone. Setting: Patients with pain routinely seen by private practitioners. Design: A retrospective analysis was conducted on urinary excretion data analyzed by Millennium Laboratories between March 2008 and May 2011.Patient participants: Patients in the United States with chronic pain who underwent routine UDT to confirm adherence for prescribed medications. Interventions: Adherence for the urine drug test was defined as the presence of parent drug and/or metabolite(s) greater than or equal to the lower limit of quantitation. The percent of adherence for prescribed medications was compared to the average percent of the same in subjects with five or more visits.Main outcomes: Correlation analyses were used to determine the relationship between adherence for prescribed medications and number of visits.Results: There were 255,168 specimens submitted for testing from 166,755 individuals. When monitoring with more frequent visits (>=5 visits) adherence was higher by 1 percent for buprenorphine (89 percent vs 88 percent); 8 percent for carisoprodol (77 percent vs 69 percent); 5 percent for fentanyl (95 percent vs 90 percent); 7 percent for hydrocodone (83 percent vs 76 percent); 3 percent for methadone (96 percent vs 93 percent); 5 percent for morphine (92 percent vs 87 percent); and 8 percent for oxycodone (90 percent vs 82 percent).Conclusions: Adherence for prescribed medications is higher with frequent urine monitoring. UDT can be used as tool that may help improve this in patients with chronic pain.

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Survey of Spinal Cord Stimulation Hardware Currently Available for the Treatment of Chronic Pain in the United States

Frontiers in Pain Research ◽

10.3389/fpain.2020.572907 ◽

2020 ◽

Vol 1 ◽

Author(s):

Josephine A. Clingan ◽

Ashish Patel ◽

Dermot P. Maher

Keyword(s):

United States ◽

Spinal Cord ◽

Chronic Pain ◽

The United States ◽

Analysis Techniques ◽

Chronic Pain Patients ◽

The Us ◽

Optimal Patient Care ◽

Pain Patients ◽

Selection Of

Background: The number of spinal cord stimulator (SCS) units sold in the United States (US) for the treatment of chronic pain has increased with a corresponding expansion in the number of different SCS platforms available. Each marketed stimulator has several unique features, indications, and limitations, which distinguish one from the other and makes the selection of appropriate hardware possible for optimal patient care. There are an even greater number of similar and overlapping features between SCS.Measures: We used market analysis techniques to survey the currently available SCS technology. We then reviewed published device specifications and manuals for comparison of features.Outcomes: As of 2020, there are nine commonly used SCS platforms made by four manufacturers including four SCS units from Abbott, three from Boston Scientific, and one each from Medtronic and Nevro.Conclusions: A working understanding of each SCS product's nuances is needed for selecting the most appropriate device with which to manage chronic pain patients. Here we present a brief survey of currently available SCS hardware in the US and the features that make each product unique.

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Financial viability of screening for drugs of abuse

Clinical Chemistry ◽

10.1093/clinchem/41.5.805 ◽

1995 ◽

Vol 41 (5) ◽

pp. 805-808 ◽

Cited By ~ 18

Author(s):

M A Peat

Keyword(s):

Drug Testing ◽

Drugs Of Abuse ◽

The United States ◽

Economic Benefits ◽

Postal Service ◽

Test Results ◽

United States Postal Service ◽

Financial Benefits ◽

Urine Drug Testing ◽

Urine Drug

Abstract Urine drug testing is now a common practice in the American workplace; a recent survey indicated that > 90% of companies with > 5000 employees have some type of testing program. These programs have indeed reduced the rate of drug-positive test results; for example, recent data from the Federal Aviation Agency show that the rate for 1993 was 0.82% compared with 0.95% for 1992. Many corporations have stated that urine drug testing, as a component of a substance abuse policy, results in significant savings, e.g., from decreased absenteeism and turnover. The United States Postal Service recently completed a longitudinal study on the economic benefits and found that, over the average tenure of an annual intake of employees, there were savings of more than $100 million. Although this study clearly demonstrates the financial benefits of preemployment drug testing, the decision to test is not based solely on this but also on the regulatory environment and on the potential impact of a major accident attributable to the use of drugs or alcohol in the workplace.

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