Provider reasons for discontinuing long-term opioid therapy following aberrant urine drug tests differ based on the type of substance identified

Objective: Urine drug testing (UDT) is increasingly performed as a means of identifying aberrant behavior that may be grounds for discontinuation of long-term opioid therapy (LTOT). Little is known, however, about the ways in which positive UDT results may differentially inform decisions to discontinue LTOT based on the type of substance for which the UDT screened positive. The aim of this study was to examine the likelihood of clinician-initiated discontinuation of LTOT attributed to positive UDT results across three discrete categories of substances: (1) cannabis, (2) alcohol or illicit substances (excluding cannabis), and (3) controlled prescription medications that were not prescribed.Design: This retrospective study utilized the US Department of Veterans Affairs (VA) Health Care System. Corporate Data Warehouse to assemble a sample of 600 patients with substance use disorders and matched controls who were discontinued from LTOT in 2012. Comprehensive manual medical record review identified UDT results in the year prior to discontinuation and reason(s) for discontinuation.Patients, Participants: Patients with one or more UDTs positive for a single substance (N = 185) comprised the study sample.Main Outcome Measure(s): Likelihood of clinician-initiated discontinuation attributed to a positive UDT across the three categories. Results: Patients with one or more UDTs positive for cannabis were more likely to be discontinued from opioid therapy as a result of the positive UDT compared to those with one or more UDTs positive for nonprescribed prescription medication (adjusted odds ratio [OR] = 18.05, 95% CI = 7.29-44.66). Similarly, patients with UDTs positive for alcohol or illicit substances were more likely to be discontinued for the positive UDTs relative to patients who tested positive for nonprescribed prescription medications (adjusted OR = 13.10, 95% CI = 4.81-35.68). No difference in UDT-related discontinuation decisions was evident between patients with UDTs positive for alcohol/illicit substances versus cannabis (adjusted OR = 1.47, 95% CI = 0.57-3.77). Conclusions: High odds of UDT-related discontinuation were found in patients who tested positive for cannabis, alcohol, or illicit substances, relative to nonprescribed prescription medications.

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Urine Drug Testing in Long-term Opioid Therapy

Clinical Journal of Pain ◽

10.1097/01.ajp.0000435448.34761.c9 ◽

2014 ◽

Vol 30 (8) ◽

pp. 679-684 ◽

Cited By ~ 6

Author(s):

Gary M. Reisfield ◽

Karen J. Maschke

Keyword(s):

Drug Testing ◽

Opioid Therapy ◽

Urine Drug Testing ◽

Urine Drug

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Factors Related to Prescription Drug Monitoring Program Queries for Veterans Receiving Long-Term Opioid Therapy

Pain Medicine ◽

10.1093/pm/pnaa386 ◽

2020 ◽

Author(s):

Sarah B Andrea ◽

Tess A Gilbert ◽

Benjamin J Morasco ◽

Somnath Saha ◽

Kathleen F Carlson

Keyword(s):

Prescription Drug ◽

Drug Monitoring ◽

Monitoring Program ◽

Low Complexity ◽

Opioid Therapy ◽

Directed Acyclic Graphs ◽

Department Of Veterans Affairs ◽

Prescription Drug Monitoring Programs ◽

Urine Drug

Abstract Objective State prescription drug monitoring programs (PDMPs) identify controlled medications dispensed across providers and systems. Department of Veterans Affairs (VA) policy requires electronic health record documentation of PDMP queries at least annually for VA patients receiving controlled medications; however, queries are not uniformly conducted. We examined factors associated with PDMP queries for veterans receiving long-term opioid therapy. Methods Veterans with a VA provider who received long-term opioid therapy between August 2015 and August 2016 within a four-state region were identified; 9,879 were due for a PDMP query between August 2016 and February 2017. Likelihood of veterans’ PDMP queries during this follow-up period was modeled as a function of patient, provider, and facility characteristics of interest in mixed-effects modified Poisson models estimating relative risk and 95% confidence intervals. Multivariable models controlled for potential confounders identified through the use of directed acyclic graphs. Results PDMP queries were documented for 62.1% of veterans that were due for a PDMP query. Veterans were more likely to be queried if they were Hispanic or if they received methadone, had average daily milligram morphine equivalents >20, or received urine drug screening during the studied period. Veterans were less likely to be queried if they had a rural address, mail order medication, or cancer diagnosis. Likelihood of PDMP queries was also lower for veterans whose opioid-prescribing provider was an oncologist or working in a low-complexity facility. Conclusions Adherence to PDMP query policy within the VA varied by patient, clinician, and facility factors. Mechanisms to standardize the conduct of PDMP queries may be needed.

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Is Urine Drug Testing a Good Idea for Patients on Chronic Opioid Therapy?

You’re Wrong, I’m Right ◽

10.1007/978-3-319-43169-7_107 ◽

2016 ◽

pp. 373-376

Author(s):

Chirag D. Shah ◽

M. Fahad Khan ◽

David S. Cheng

Keyword(s):

Drug Testing ◽

Opioid Therapy ◽

Chronic Opioid Therapy ◽

Urine Drug Testing ◽

Urine Drug

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Random urine drug testing among patients receiving opioid therapy for cancer pain

Cancer ◽

10.1002/cncr.33326 ◽

2020 ◽

Author(s):

Joseph A. Arthur ◽

Michael Tang ◽

Zhanni Lu ◽

David Hui ◽

Kristy Nguyen ◽

...

Keyword(s):

Cancer Pain ◽

Drug Testing ◽

Opioid Therapy ◽

Urine Drug Testing ◽

Urine Drug

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

Journal of Opioid Management ◽

10.5055/jom.2015.0253 ◽

2015 ◽

Vol 11 (1) ◽

Cited By ~ 2

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.

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Frequency, predictors, and outcomes of urine drug testing among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic

Cancer ◽

10.1002/cncr.30240 ◽

2016 ◽

Vol 122 (23) ◽

pp. 3732-3739 ◽

Cited By ~ 32

Author(s):

Joseph A. Arthur ◽

Tonya Edwards ◽

Zhanni Lu ◽

Suresh Reddy ◽

David Hui ◽

...

Keyword(s):

Supportive Care ◽

Advanced Cancer ◽

Drug Testing ◽

Opioid Therapy ◽

Chronic Opioid Therapy ◽

Care Clinic ◽

Urine Drug Testing ◽

Urine Drug ◽

Outpatient Supportive Care

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

January 2018 - Pain Physician ◽

10.36076/ppj.2017.s145 ◽

2017 ◽

Vol 2 (20;2) ◽

pp. s135-s145 ◽

Cited By ~ 8

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

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Immigrant Usage Patterns of Natural Health Products: Role in Pharmacoeconomics

Current Nutrition & Food Science ◽

10.2174/1573401315666181206120420 ◽

2020 ◽

Vol 16 (1) ◽

pp. 45-55

Author(s):

Dalya Abdulla

Keyword(s):

English Language ◽

Prescription Medication ◽

Natural Health Products ◽

Prescription Medications ◽

Natural Health ◽

Short Term ◽

Long Term Conditions ◽

Health Products ◽

Usage Patterns

Background: Understanding patterns and drivers for natural health product (NHP) usage among immigrants is essential in the provision of appropriate health care; many studies have elucidated NHP utilization among immigrants; however, few have considered impacts of concurrent NHP and prescription medication usage. Objective: The study aims to determine new immigrant NHP usage patterns (including concurrent usage with prescription medications) and to discern economic impacts driving concurrent usage. Methods: A survey questionnaire was administered to local new immigrants during English Language Training classes. Results: Most participants understood the NHP definition and would take an NHP for the same disease or condition they would normally take a prescription medication for. Many participants agreed that NHPs are not safe however were unable to provide robust examples of unsafe NHP usage. With regard to purchases of medicines for short and long term illnesses, a high percentage of participants would purchase the prescription medication for a short term illness over the NHP; however this percentage decreases in the event of a long term illness, with more participants relying on NHPs to remedy their long term illness symptoms. Conclusion: Pharmacoeconomics tends to be a major driver for immigrant utilization of NHPs, and is a stronger influencer of use compared to ethnicity or parenteral usage of such products. This pharmacoeconomic correlation in the preference to use NHPs over prescription medications tends to be more observable for chronic and long term conditions (compared to short term illnesses).

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