scholarly journals Patterns of Marijuana Use in a 6-Month Pain Management Sample in the United States

2017 ◽  
Vol 11 ◽  
pp. 117822181772478 ◽  
Author(s):  
Hope M Smiley-McDonald ◽  
Katherine N Moore ◽  
David C Heller ◽  
Jeri D Ropero-Miller ◽  
Gregory L McIntire ◽  
...  
Keyword(s):  
Pain Management ◽  
Drug Use ◽  
Prescription Drugs ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Marijuana Use ◽  
The United States ◽  
Prescription Drug Use ◽  
Urine Drug Testing ◽  
Urine Drug

This study is a 6-month retrospective analysis of urine drug testing (UDT) data from a pain management population among specimens with clinician-ordered marijuana testing (N = 194 809). Descriptive statistics about the specimen positivity of clinician-ordered marijuana UDT are provided as well as other drug positivity. Specimens from men and adults aged 18 to 34 years had the highest prevalence rates of marijuana positivity. The prevalence of past-month marijuana use among a comparative national population was lower than the prevalence of positive marijuana tests in the UDT specimens by all characteristics. Among the specimens tested for illicit drugs and marijuana, 4.0% were positive for amphetamine, 2.8% were positive for cocaine, and 0.9% were positive for heroin. The most common prescription drugs listed were opioids (64.7%), benzodiazepines (20.5%), and antidepressants (19.9%). In sum, the findings reflect previous research showing high rates of marijuana use, illicit drug use, and prescription drug use in a pain management population.

scholarly journals Repeated Quantitative Urine Toxicology Analysis May Improve Chronic Pain Patient Compliance with Opioid Therapy

2017 ◽  
Vol 2 (20;2) ◽  
pp. s135-s145 ◽  
Author(s):  
Nebojsa Nick Knezevic
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Retrospective Analysis ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Opioid Therapy ◽  
Urine Toxicology ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Improve Compliance

Background: Even though serious efforts have been undertaken by different medical societies to reduce opioid use for treating chronic benign pain, many Americans continue to seek pain relief through opioid consumption. Assuring compliance of these patients may be a difficult aspect of proper management even with regular behavioral monitoring. Objective: The purpose of this study was to accurately assess the compliance of chronic opioidconsuming patients in an outpatient setting and evaluate if utilizing repeated urine drug testing (UDT) could improve compliance. Study Design: Retrospective analysis of prospectively collected data. Setting: Outpatient pain management clinic. Methods: After Institutional Review Board (IRB) approval, a retrospective analysis of data for 500 patients was conducted. We included patients who were aged 18 years and older who were treated with opioid analgesic medication for chronic pain. Patients were asked to provide supervised urine toxicology specimens during their regular clinic visits, and were asked to do so without prior notification. The specimens were sent to an external laboratory for quantitative testing using liquid chromatography-tandem mass spectrometry. Results: Three hundred and eighty-six (77.2%) patients were compliant with prescribed medications and did not use any illicit drugs or undeclared medications. Forty-one (8.2%) patients tested positive for opioid medication(s) that were not prescribed in our clinic; 8 (1.6%) of the patients were positive for medication that was not prescribed by any physician and was not present in the Illinois Prescription Monitoring Program; 5 (1%) patients tested negative for prescribed opioids; and 60 (12%) patients were positive for illicit drugs (8.6% marijuana, 3.2% cocaine, 0.2% heroin). Repeated UDTs following education and disclosure, showed 49 of the 77 patients (63.6%) had improved compliance. Limitations: This was a single-site study and we normalized concentrations of opioids in urine with creatinine levels while specific gravity normalization was not used. Conclusions: Our results showed that repeated UDT can improve compliance of patients on opioid medications and can improve overall pain management. We believe UDT testing should be used as an important adjunctive tool to help guide clinical decision-making regarding opioid therapy, potentially increasing future quality of care. Key words: Urine toxicology analysis, chronic pain, opioids, compliance, pain management, urine drug testing, urine drug screening

scholarly journals Protocol for Accuracy of Point of Care (POC) or In-Office Urine Drug Testing (Immunoassay) in Chronic Pain Patients: A Prospective Analysis of Immunoassay and Liquid Chromatography Tandem Mass Spectometry (LC/MS/MS)

2010 ◽  
Vol 1;13 (1;1) ◽  
pp. E1-E22
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Diagnostic Accuracy ◽  
Prescription Drugs ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Point Of Care ◽  
Diagnostic Accuracy Study ◽  
Controlled Substances ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Accuracy Study

Background: Therapeutic use, overuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain continues to be an issue for physicians and patients. It has been stated that physicians, along with the public and federal, state, and local government; professional associations; and pharmaceutical companies all share responsibility for preventing abuse of controlled prescription drugs. The challenge is to eliminate or significantly curtail abuse of controlled prescription drugs while still assuring the proper treatment of those patients. A number of techniques, instruments, and tools have been described to monitor controlled substance use and abuse. Thus, multiple techniques and tools available for adherence monitoring include urine drug testing in conjunction with prescription monitoring programs and other screening tests. However, urine drug testing is associated with multiple methodological flaws. Multiple authors have provided conflicting results in relation to diagnostic accuracy with differing opinions about how to monitor adherence in a non-systematic fashion. Thus far, there have not been any studies systematically assessing the diagnostic accuracy of immunoassay with laboratory testing. Study Design: A diagnostic accuracy study of urine drug testing. Study Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objective: To compare the information obtained by point of care (POC) or in-office urine drug testing (index test) to the information found when all drugs and analytes are tested by liquid chromatography tandem mass spectroscopy (LC/MS/MS) reference test in the same urine sample. Methods: The study is designed to include 1,000 patients with chronic pain receiving controlled substances. The primary outcome measure is the diagnostic accuracy. Patients will be tested for various controlled substances, including opioids, benzodiazepines, and illicit drugs. The diagnostic accuracy study is performed utilizing the Standards for Reporting of Diagnostic Accuracy Studies (STARD) initiative which established reporting guidelines for diagnostic accuracy studies to improve the quality of reporting. The prototypical flow diagram of diagnostic accuracy study as described by STARD will be utilized. Results: Results of diagnostic accuracy and correlation of clinical factors in relation to threshold levels, prevalence of abuse, false-positives, false-negatives, influence of other drugs, and demographic characteristics will be calculated. Limitations: The limitations include lack of availability of POC testing with lower cutoff levels. Conclusion: This article presents a protocol for a diagnostic accuracy study of urine drug testing. The protocol also will permit correlation of various clinical factors in relation to threshold levels, prevalence of abuse, false-positives, false-negatives, influence of other drugs, and demographic characteristics. Clinical Trial Registration: NCT 01052155 Key words: Controlled substances, opioids, benzodiazepines, illicit drugs, abuse, diversion, adherence monitoring, prescription monitoring programs

scholarly journals Illicit Drug Use in the Pain Patient Population Decreases with Continued Drug Testing

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. 189-193 ◽  
Author(s):  
Amadeo Pesce
Keyword(s):  
Drug Use ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Pain Patient ◽  
Spearman Correlation ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Pain Patients

Background: A major concern of physicians treating pain patients with chronic opioid therapy and similar drugs is determining whether the patients are also using illicit drugs. This is commonly determined by urine drug testing (UDT). However, there are few studies on whether or not monitoring patients by this technique decreases illicit drug use. Objective: To determine if the presence of illicit drugs decreases over a number of physician visits where UDT was performed. Method: The method involved a retrospective study of tests for the illicit drugs marijuana, cocaine, methamphetamine, ecstacy (MDMA) phencyclidine (PCP) and the heroin metabolite, 6-acetylmorphine as confirmed by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). A database of 150,000 patient visits was examined for the presence of any of these 6 drugs. Results: A total of 87,000 patients were initially tested. The number of patients who were repeatedly tested decreased over time. The percentage of patients positive for any of these illicit drugs decreased from 23% to 9% after 14 visits where UDT was performed. When graphed there was a trend to decreasing use. The Spearman correlation = -0.88, P < 0.0001. The major illicit drug was marijuana. When this was removed from the analysis, there was an even greater correlation with decreased illicit drug use. Spearman correlation = -0.92 (P < 0.0001) using a weighted correlation. Limitation: Patients continuing to use illicit drugs might be dismissed from practices thus biasing the study towards illicit drug avoidance. Conclusion: Continued UDT might decrease illicit drug use among pain patients. Key words: Pain patients, UDT, urine drug testing, LC-MS/MS, illicit drugs, decrease drug use

Reduced urinary opioid levels from pain management patients associated with marijuana use

2019 ◽  
Vol 9 (5) ◽  
pp. 441-447
Author(s):  
Melissa M Goggin ◽  
Breane J Shahriar ◽  
Andy Stead ◽  
Gregory C Janis
Keyword(s):  
Pain Management ◽  
Drug Testing ◽  
Marijuana Use ◽  
Potential Interaction ◽  
Test Results ◽  
Opioid Use ◽  
Target Drug ◽  
Urine Drug ◽  
Urine Drug Test ◽  
Lower Urinary

Aim: Marijuana use has been postulated to modulate opioid use, dependence and withdrawal. Broad target drug testing results provide a unique perspective to identify any potential interaction between marijuana use and opioid use. Materials & methods: Using a dataset of approximately 800,000 urine drug test results collected from pain management patients of a time from of multiple years, creatinine corrected opioid levels were evaluated to determine if the presence of the primary marijuana marker 11-nor-carboxy-tetrahydrocannabinol (THC-COOH) was associated with statistical differences in excreted opioid concentrations. Results & conclusion: For each of the opioids investigated (codeine, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, fentanyl and buprenorphine), marijuana use was associated with statistically significant lower urinary opiate levels than in samples without indicators of marijuana use.

Financial viability of screening for drugs of abuse

1995 ◽  
Vol 41 (5) ◽  
pp. 805-808 ◽  
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 &gt; 90% of companies with &gt; 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.

Trends in drug use from urine drug testing of addiction treatment clients

2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Kenneth L. Kirsh, PhD ◽  
Howard A. Heit, MD ◽  
Angela Huskey, PharmD, CPE ◽  
Jennifer Strickland, PharmD, BCPS ◽  
Kathleen Egan City, MA, BSN, RN ◽  
...  
Keyword(s):  
Drug Use ◽  
Drug Testing ◽  
Addiction Treatment ◽  
National Laboratory ◽  
Prescription Medication ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Liquid Chromatography Tandem Mass ◽  
Testing Company ◽  
National Trends

Objective: Urine drug testing (UDT) can play an important role in the care of patients in recovery from addiction, and it has become necessary for providers and programs to utilize specific, accurate testing beyond what immunoassay (IA) provides.Design: A database of addiction treatment and recovery programs was sampled to demonstrate national trends in drug abuse and to explore potential clinical implications of differing results due to the type of testing utilized.Setting: Deidentified data was selected from a national laboratory testing company that had undergone liquid chromatography tandem mass spectrometry (LCMS/MS).Patients/Participants: A total of 4,299 samples were selected for study.Interventions: Descriptive statistics of the trends are presented. Results: In total, 48.5 percent (n = 2,082) of the samples were deemed in full agreement between the practice reports and the results of LC-MS/MS testing. The remaining 51.5 percent of samples fell into one of seven categories of unexpected results, with the most frequent being detection of an unreported prescription medication (n = 1,097).Conclusions: Results of UDT demonstrate that more than half of samples yield unexpected results from specimens collected in addiction treatment. When comparing results of IA and LC-MS/MS, it is important to consider the limits of IA in the detection of drug use by these patients.

scholarly journals Urine Drug Testing: Current Recommendations and Best Practices

2012 ◽  
Vol 3S;15 (3S;7) ◽  
pp. ES119-ES133
Author(s):  
Allen W. Burton
Keyword(s):  
Chronic Pain ◽  
Best Practices ◽  
Drug Testing ◽  
Point Of Care ◽  
Treatment Plan ◽  
Management Strategies ◽  
The United States ◽  
Enzyme Linked Immunosorbent Assay ◽  
Urine Drug Testing ◽  
Urine Drug

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

Drug Tourists and Drug Policy on the U.S.-Mexican Border: An Ethnographic Investigation of the Acquisition of Prescription Drugs

1997 ◽  
Vol 27 (4) ◽  
pp. 879-898 ◽  
Author(s):  
Avelardo Valdez ◽  
Stephen J. Sifaneck
Keyword(s):  
United States ◽  
Prescription Drugs ◽  
Drug Users ◽  
Illicit Drugs ◽  
Social Dynamics ◽  
The United States ◽  
Pharmaceutical Drugs ◽  
Field Methods ◽  
Hidden Population ◽  
Prescription Drug Use

Recent increases in the prevalence of non-medical prescription drug use across the United States have prompted national concern about the sources of these drugs. The focus of this study is the process by which prescription drugs enter the United States from Mexico through “drug tourism.” Drug tourism refers to the phenomenon by which persons become attracted to a particular location because of the accessibility of licit or illicit drugs and related services. A loophole in U.S. Customs laws enables Americans to legally bring pharmaceutical drugs into the United States when accompanied by a Mexican prescription. Using ethnographic field methods, this study (1) describes the acquisition process, (2) develops a typology of consumers, and (3) explores the interaction between the actors in this process. This study provides a better understanding of the social dynamics of a “gray market” in prescription drugs, and identifies a hidden population of drug users.

Specimen validity testing in urine drug monitoring of medications and illicit drugs: Clinical implications

2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Kenneth L. Kirsh, PhD ◽  
Paul J. Christo, MD, MBA ◽  
Howard Heit, MD ◽  
Katherine Steffel, PharmD ◽  
Steven D. Passik, PhD
Keyword(s):  
Drug Testing ◽  
Illicit Drugs ◽  
Patient Adherence ◽  
Adherence Behavior ◽  
Medical Problems ◽  
Clinical Role ◽  
Validity Testing ◽  
Therapeutic Decisions ◽  
Urine Drug Testing ◽  
Urine Drug

Objective: To discuss the importance of specimen validity testing (SVT) in urine drug testing (UDT) and the clinical role it plays in identifying efforts to subvert the UDT process.Methods: A discussion of the clinical impact of SVT is presented.Results: A discussion of pH, specific gravity, creatinine, and oxidation for monitoring the adulteration of UDT samples is presented along with the clinical significance of such tests.Significance: SVT has a significant place in healthcare efforts to measure patient adherence, behavior, and honesty in communication with clinicians. SVT is typically ordered by treating clinicians who use the results to make therapeutic decisions regarding specific medical problems of their patient, including those related to medication and illicit drug use. In the absence of SVT, a healthcare provider may fail to identify a patient's adulteration of their urine sample in an attempt at deceiving the provider. Moreover, the presence of some underlying medical conditions may obfuscate the UDT results.

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