Do Urine Drug Tests Reveal Substance Misuse Among Patients Prescribed Opioids for Chronic Pain?

• Published in: Journal of general internal medicine : JGIM Vol. 37; no. 10; pp. 2365 - 2372
• Main Authors: Larochelle, Marc R., Cruz, Ricardo, Kosakowski, Sarah, Gourlay, Doug L., Alford, Daniel P., Xuan, Ziming, Krebs, Erin E., Yan, Shapei, Lasser, Karen E., Samet, Jeffrey H., Liebschutz, Jane M.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2022; Springer Nature B.V
• Subjects: Analgesics, Opioid - therapeutic use; Chronic pain; Chronic Pain - drug therapy; Chronic Pain - epidemiology; Drug testing; Female; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Mental health; Narcotics; Opioid-Related Disorders - diagnosis; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - epidemiology; Opioids; Original Research; Pain; Patients; Retrospective Studies; Risk reduction; Substance Abuse Detection - methods; Substance use; urine drug tests; chronic pain; opioid analgesics
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-021-07095-8

Background Urine drug testing (UDT) is a recommended risk mitigation strategy for patients prescribed opioids for chronic pain, but evidence that UDT supports identification of substance misuse is limited. Objective Identify the prevalence of UDT results that may identify substance misuse, including diversion, among patients prescribed opioids for chronic pain. Design Retrospective cohort study. Subjects Patients (n=638) receiving opioids for chronic pain who had one or more UDTs, examining up to eight substances per sample, during a one 1-year period. Main Measures Experts adjudicated the clinical concern that UDT results suggest substance misuse or diversion as not concerning, uncertain, or concerning. Key Results Of 638 patients, 48% were female and 49% were over age 55 years. Patients had a median of three UDTs during the intervention year. We identified 37% of patients (235/638) with ≥1 concerning UDT and a further 35% (222/638) having ≥1 uncertain UDT. We found concerning UDTs due to non-detection of a prescribed substance in 24% (156/638) of patients and detection of a non-prescribed substance in 23% (147/638). Compared to patients over 65 years, those aged 18–34 years were more likely to have concerning UDT results with an adjusted odds ratio (AOR) of 4.8 (95% confidence interval [CI] 1.9–12.5). Patients with mental health diagnoses (AOR 1.6 [95% CI 1.1–2.3]) and substance use diagnoses (AOR 2.3 [95% CI 1.5–3.7]) were more likely to have a concerning UDT result. Conclusions Expert adjudication of UDT results identified clinical concern for substance misuse in 37% of patients receiving opioids for chronic pain. Further research is needed to determine if UDTs impact clinical practice or patient-related outcomes.