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

Jessica Wyse, Benjamin Morasco, Steven Dobscha, Michael I. Demidenko, Thomas H.A. Meath, Travis Lovejoy

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)295-303
Number of pages9
JournalJournal of Opioid Management
Volume14
Issue number4
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

Fingerprint

Opioid Analgesics
Urine
Cannabis
Pharmaceutical Preparations
Prescriptions
Alcohols
Therapeutics
Odds Ratio
Veterans Health
Substance-Related Disorders
Medical Records
Retrospective Studies
Outcome Assessment (Health Care)
Delivery of Health Care

Keywords

  • Long-term opioid therapy
  • Opioid discontinuation
  • Substance abuse
  • Substance misuse
  • Urine drug test

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Anesthesiology and Pain Medicine

Cite this

@article{605968ec7b62407b90fb4aa483a4eb86,
title = "Provider reasons for discontinuing long-term opioid therapy following aberrant urine drug tests differ based on the type of substance identified",
abstract = "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.",
keywords = "Long-term opioid therapy, Opioid discontinuation, Substance abuse, Substance misuse, Urine drug test",
author = "Jessica Wyse and Benjamin Morasco and Steven Dobscha and Demidenko, {Michael I.} and Meath, {Thomas H.A.} and Travis Lovejoy",
year = "2018",
month = "7",
day = "1",
doi = "10.5055/jom.2018.0461",
language = "English (US)",
volume = "14",
pages = "295--303",
journal = "Journal of Opioid Management",
issn = "1551-7489",
publisher = "Weston Medical Publishing",
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TY - JOUR

T1 - Provider reasons for discontinuing long-term opioid therapy following aberrant urine drug tests differ based on the type of substance identified

AU - Wyse, Jessica

AU - Morasco, Benjamin

AU - Dobscha, Steven

AU - Demidenko, Michael I.

AU - Meath, Thomas H.A.

AU - Lovejoy, Travis

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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.

AB - 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.

KW - Long-term opioid therapy

KW - Opioid discontinuation

KW - Substance abuse

KW - Substance misuse

KW - Urine drug test

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DO - 10.5055/jom.2018.0461

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