Clinician Response to Aberrant Urine Drug Test Results of Patients Prescribed Opioid Therapy for Chronic Pain

Background: Previous data suggest that tapentadol, an atypical opioid with a putative dual mechanism of action, has relatively low rates of abuse. A better understanding of the rates of abuse among different prescription opioids may help clinicians when considering their potential risks and benefits. The results of urine drug tests (UDTs) may provide a unique opportunity to help answer this question.Method: To investigate different rates of prescription-opioid abuse in this retrospective study, we examined urine drug test results from patients seeking treatment at four facilities of an opioid-use-disorder (OUD) treatment program in Ohio. Urine specimens were collected on admission, one from each patient, in the regular course of care. The opioids reviewed in the present study were tapentadol, hydrocodone, oxycodone, hydromorphone, oxymorphone, and tramadol. Drug dispensing data, including morphine-milligram equivalents (MME) dispensed, were examined to adjust for the relative prevalence of each opioid being examined.Results: Data from 4,162 patients were examined. Tapentadol was the least common finding in UDT results in this cohort and remained so after adjusting for drug availability. The percentage of specimens positive for a given opioid ranged from 0.12 percent (tapentadol) to 7.04 percent (oxycodone). The availability and MME adjustments resulted in a change of rank order, with tapentadol remaining the lowest but tramadol replacing oxycodone as the prescription opioid with the highest rate of abuse.Conclusions: In this sample of UDT results from patients seeking treatment at an OUD program in Ohio, tapentadol was the least frequent finding among the opioids examined, and this remained true when adjusting for dispensing data. Factors potentially contributing to this difference may include pharmacological properties unique to tapentadol. Several important limitations notwithstanding, these findings are consistent with previous real-world evidence and warrant an ongoing line of inquiry.

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Rate of Fentanyl Positivity Among Urine Drug Test Results Positive for Cocaine or Methamphetamine

JAMA Network Open ◽

10.1001/jamanetworkopen.2019.2851 ◽

2019 ◽

Vol 2 (4) ◽

pp. e192851 ◽

Cited By ~ 23

Author(s):

Leah LaRue ◽

Robert K. Twillman ◽

Eric Dawson ◽

Penn Whitley ◽

Melissa A. Frasco ◽

...

Keyword(s):

Test Results ◽

Drug Test ◽

Urine Drug ◽

Urine Drug Test

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Evaluation of Trends of Near-Real-Time Urine Drug Test Results for Methamphetamine, Cocaine, Heroin, and Fentanyl

JAMA Network Open ◽

10.1001/jamanetworkopen.2019.18514 ◽

2020 ◽

Vol 3 (1) ◽

pp. e1918514 ◽

Cited By ~ 10

Author(s):

Robert K. Twillman ◽

Eric Dawson ◽

Leah LaRue ◽

Maria G. Guevara ◽

Penn Whitley ◽

...

Keyword(s):

Real Time ◽

Test Results ◽

Drug Test ◽

Urine Drug ◽

Urine Drug Test

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Buprenorphine Treatment for Opioid Use Disorder in Community‐Based Settings: Outcome Related to Intensity of Services and Urine Drug Test Results

American Journal on Addictions ◽

10.1111/ajad.13001 ◽

2020 ◽

Vol 29 (4) ◽

pp. 271-278

Author(s):

Marc Galanter ◽

John Femino ◽

Brooke Hunter ◽

Mary Hauser

Keyword(s):

Opioid Use Disorder ◽

Test Results ◽

Opioid Use ◽

Community Based ◽

Drug Test ◽

Urine Drug ◽

Urine Drug Test ◽

Buprenorphine Treatment

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Substance Use Disorder Treatment Following Clinician-Initiated Discontinuation of Long-Term Opioid Therapy Resulting from an Aberrant Urine Drug Test

Journal of General Internal Medicine ◽

10.1007/s11606-017-4084-0 ◽

2017 ◽

Vol 32 (10) ◽

pp. 1076-1082 ◽

Cited By ~ 4

Author(s):

Shannon M. Nugent ◽

Steven K. Dobscha ◽

Benjamin J. Morasco ◽

Michael I. Demidenko ◽

Thomas H. A. Meath ◽

...

Keyword(s):

Substance Use ◽

Substance Use Disorder ◽

Opioid Therapy ◽

Substance Use Disorder Treatment ◽

Drug Test ◽

Urine Drug ◽

Disorder Treatment ◽

Urine Drug Test

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Development of an Algorithm to Identify Cannabis Urine Drug Test Results within a Multi-Site Electronic Health Record System

Journal of Medical Systems ◽

10.1007/s10916-018-1021-7 ◽

2018 ◽

Vol 42 (9) ◽

Author(s):

Benjamin J. Morasco ◽

Sarah E. Shull ◽

Melissa H. Adams ◽

Steven K. Dobscha ◽

Travis I. Lovejoy

Keyword(s):

Electronic Health Record ◽

Electronic Health Record System ◽

Health Record ◽

Test Results ◽

Record System ◽

Drug Test ◽

Urine Drug ◽

Electronic Health ◽

Urine Drug Test

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Family physicians’ proficiency in urine drug test interpretation

Journal of Opioid Management ◽

10.5055/jom.2007.0022 ◽

2007 ◽

Vol 3 (6) ◽

pp. 333 ◽

Cited By ~ 33

Author(s):

Gary M. Reisfield, MD ◽

Fern J. Webb, PhD ◽

Roger L. Bertholf, PhD ◽

Paul A. Sloan, MD ◽

George R. Wilson, MD

Keyword(s):

Family Medicine ◽

Drug Testing ◽

Opioid Therapy ◽

Physician Education ◽

Test Interpretation ◽

Multiple Choice Questions ◽

Drug Test ◽

Urine Drug Testing ◽

Urine Drug ◽

Urine Drug Test

Objective: To determine the proficiency in urine drug test interpretation among family medicine physicians who order these tests to monitor adherence in their patients on chronic opioid therapy.Methods: A seven-question instrument, consisting of six, five-option, single-best-answer multiple choice questions and one yes/no question was administered to 80 family medicine physicians attending a University of Kentucky Family Medicine Review Course. We calculated frequencies and performed χ2 analyses to examine bivariate associations between urine drug test utilization and interpretive knowledge.Results: The instrument was completed by 60/80 (75 percent) of eligible physicians (44 order urine drug testing; 16 do not). None of the physicians who order urine drug testing answered more than five of the seven questions correctly, and only 20 percent answered more than half correctly. Physicians who order urine drug testing performed better than physicians who do not order urine drug testing on only four of the seven questions, although there were no statistically significant differences between the groups on any question.Conclusions: Family medicine physicians who order urine drug testing to monitor their patients on chronic opioid therapy are not proficient in their interpretation. This study highlights the need for improved physician education in this area. It is imperative for physicians to work closely with certified laboratory professionals when ordering and interpreting urine drug tests.

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