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

2014 ◽  
Vol 10 (2) ◽  
pp. 111 ◽  
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.

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

scholarly journals Demand for Interpretation of a Urine Drug Testing Panel Reflects the Changing Landscape of Clinical Needs; Opportunities for the Laboratory to Provide Added Clinical Value

2020 ◽  
Vol 5 (5) ◽  
pp. 858-868
Author(s):  
Yifei K Yang ◽  
Kamisha L Johnson-Davis ◽  
Brian N Kelly ◽  
Gwendolyn A McMillin
Keyword(s):  
Drug Testing ◽  
Patient Adherence ◽  
Direct Detection ◽  
Traditional Approach ◽  
Clinical Value ◽  
Medication Information ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Test Ordering ◽  
Result Interpretation

Abstract Background The direct detection of drugs and metabolites in urine using a targeted panel offers sensitive and specific detection in comparison to the traditional approach to urine drug testing (screen with reflex of samples with positive results to confirmation testing). The purpose of this study was to evaluate changes in clinical demand for the laboratory to provide interpretation of patient adherence and abstinence, based on reconciling laboratory results and individual patient medication information provided by the clinician. The shifts in toxicology testing likely reflect the inherent complexity of the data and associated interpretation. Methods Retrospective testing results associated with a targeted urine drug panel and its related interpretation were collected from our laboratory. We examined the associated testing volume and positivity rates of each reported analyte over 5 consecutive years (2015–2019). Requests from clinicians for consultation regarding this test and use of interpretive comments for the most recent year (2019), as well as access to publicly available educational resources over two years (2018–2019) were collected. Results The changes in test ordering patterns demonstrate shifting of clinical demands for toxicology testing, by increased adoption of a targeted panel for which laboratory-based interpretation is provided. Positivity rates reflect national shifts in controlled substance prescriptions. Several consultative services were accessed by clinicians suggesting interest and need. Conclusion The value of clinical urine drug testing is improved by providing laboratory-based result interpretation and consultative services.

Legal issues related to drug testing in the clinical laboratory.

1988 ◽  
Vol 34 (3) ◽  
pp. 633-636 ◽  
Author(s):  
R T Chamberlain
Keyword(s):  
Drug Testing ◽  
Clinical Laboratory ◽  
Scientific Evidence ◽  
Legal Issues ◽  
Third Party ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Chain Of Custody ◽  
Urine Drug Test ◽  
The Many

Abstract As has been reported many times by the lay press, urine drug testing may pose some unique challenges. The clinical laboratory interested in industrial drug testing (typically known as employee drug testing) should be aware of the many challenges that may be brought on by the fact that the result may be contested in an adversarial proceeding. This is what makes the urine drug test a forensic test. It may be one piece of evidence or the only piece of evidence used in an adversarial proceeding that may decide on punitive or rehabilitative action against an employee. As a result, unique standards for governmental contract laboratories have been proposed from the National Institute on Drug Abuse, and special proficiency testing and accreditation procedures have been promoted by professional societies. These standards illustrate the sensitive nature of the results. Because the results are subject to adversarial proceedings, all parties concerned in the testing process should be aware of the legal issues surrounding urine drug testing. There are constitutional and statutory issues as well as tort issues such as negligence, defamation, invasion of privacy, battery, infliction of emotional distress, and others. Laboratories should be especially aware of these issues, since they may be brought in as a third-party defendant to a suit or brought in as a participant in gathering the evidence. The laboratory should also be aware of other legal ramifications such as chain of custody, expert testimony, and the acceptability of scientific evidence.

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 > 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.

scholarly journals Urine Drug Testing of Chronic Pain Patients. II. Prevalence Patterns of Prescription Opiates and Metabolites

2010 ◽  
Vol 34 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Rebecca Heltsley ◽  
Anne Zichterman ◽  
David L. Black ◽  
Beverly Cawthon ◽  
Tim Robert ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Drug Testing ◽  
Chronic Pain Patients ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Pain Patients

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 Shorter drug testing intervals are associated with improved drug misuse rates

2020 ◽  
Vol 16 (5) ◽  
pp. 357-373
Author(s):  
Jeff Gudin, MD ◽  
Neel Mehta, MD ◽  
F. Leland McClure, PhD ◽  
Justin K. Niles, MA ◽  
Harvey W. Kaufman, MD
Keyword(s):  
Chronic Pain ◽  
Drug Testing ◽  
Drug Misuse ◽  
Drug Adherence ◽  
Potential Drug ◽  
Serial Testing ◽  
Urine Drug Testing ◽  
Clinical Strategies ◽  
Urine Drug ◽  
Control And Prevention

Objective: The Centers for Disease Control and Prevention (CDC) recommend that clinicians prescribing opioids for chronic pain should consider at least annual urine drug testing (UDT). We evaluated whether shorter intervals for repeat UDT are associated with decreased rates of drug misuse.Design: Retrospective analysis of deidentified serial UDT and matched prescribing data.Setting: We analyzed Quest Diagnostics 2016-2017 UDT results from new patients being monitored for prescription drug adherence, in nonsubstance use disorder (SUD) treatment environments.Main Outcome Measures: Drug misuse was defined as the absence of a prescribed substance or the presence of a nonprescribed substance. Patients with ≥3 sets of the UDT results were included.Results: UDT results from 49,601 patients (148,803 specimens) were tested. Declines in misuse between the first and second UDT were highest for those tested at the shortest intervals: approximately weekly, 19 percent; monthly, 15 percent; bimonthly, 12 percent; quarterly, 9 percent; semiannually, 3 percent; misuse rates increased by 1 percent for patients tested annually. Declines in misuse were more pronounced for opioids than other drug groups. Substantial declines in positivity were noted for heroin (32 percent) and nonprescribed fentanyl (10 percent). Declines in misuse between the second and third UDT followed a similar pattern.Conclusions: UDT intervals of ≤ quarterly were associated with marked declines, but testing annually or semiannually was not associated with consistent decreases. Our findings suggest that clinical strategies that include serial testing conducted quarterly or sooner may be instrumental in decreasing drug misuse. Testing more frequently than “at least once annually” should be considered by clinicians monitoring potential drug misuse.

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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