Abstract
Background/objective: Urine drug testing (UDT) may be used to help screen for prescription opioid misuse. There are little data available describing usual pain care practices for patients who have aberrant UDT results. The goal of this research was to evaluate the clinical care for patients prescribed chronic opioid therapy (COT) and have an aberrant UDT. Design: Retrospective cohort study. Setting: VA Medical Center in the Pacific Northwest. Participants: Patients with chronic pain who were prescribed COT and had a UDT result that was positive for an illicit or nonprescribed substance. Main outcome measures: This was an exploratory study designed to document usual care practices. Results: Participants' (n = 83) mean age was 49.5 (SD = 9-6) and 81.5percent were male. The most common substances detected on UDT were marijuana (69 percent) or a nonprescribed opioid (25 percent); 18 percent had a UDT positive for two or more substances. Plans to modify treatment were documented in 69 percent of cases. The most common treatment change after aberrant UDT results was instituting more frequent UDTs, which occurred in 43 percent of cases. Clinicians documented plans to alter their opioid prescribing (eg, terminating opioids, requiring more frequent fills, changing opioid dose, or transitioning to another opioid) in 52 percent of cases, but implemented these changes in only 24 percent. Discussion: Current methods for optimizing treatment after obtaining aberrant UDT results should be enhanced. To improve the utility of UDT to reduce prescription opioid misuse, additional interventions and support for clinicians need to be developed and tested.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 45-51 |
| Number of pages | 7 |
| Journal | Journal of Opioid Management |
| Volume | 11 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2015 |
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Keywords
- Chronic pain
- Clinical treatment guidelines
- Prescription opioid misuse
- Primary care
- Urine drug test
ASJC Scopus subject areas
- Pharmacology (medical)
- Anesthesiology and Pain Medicine
- Medicine(all)
Cite this
Treatment changes following aberrant urine drug test results for patients prescribed chronic opioid therapy. / Morasco, Benjamin; Krebs, Erin E.; Cavanagh, Renee; Hyde, Stephanie; Crain, Aysha; Dobscha, Steven.
In: Journal of Opioid Management, Vol. 11, No. 1, 01.01.2015, p. 45-51.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Treatment changes following aberrant urine drug test results for patients prescribed chronic opioid therapy
AU - Morasco, Benjamin
AU - Krebs, Erin E.
AU - Cavanagh, Renee
AU - Hyde, Stephanie
AU - Crain, Aysha
AU - Dobscha, Steven
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Background/objective: Urine drug testing (UDT) may be used to help screen for prescription opioid misuse. There are little data available describing usual pain care practices for patients who have aberrant UDT results. The goal of this research was to evaluate the clinical care for patients prescribed chronic opioid therapy (COT) and have an aberrant UDT. Design: Retrospective cohort study. Setting: VA Medical Center in the Pacific Northwest. Participants: Patients with chronic pain who were prescribed COT and had a UDT result that was positive for an illicit or nonprescribed substance. Main outcome measures: This was an exploratory study designed to document usual care practices. Results: Participants' (n = 83) mean age was 49.5 (SD = 9-6) and 81.5percent were male. The most common substances detected on UDT were marijuana (69 percent) or a nonprescribed opioid (25 percent); 18 percent had a UDT positive for two or more substances. Plans to modify treatment were documented in 69 percent of cases. The most common treatment change after aberrant UDT results was instituting more frequent UDTs, which occurred in 43 percent of cases. Clinicians documented plans to alter their opioid prescribing (eg, terminating opioids, requiring more frequent fills, changing opioid dose, or transitioning to another opioid) in 52 percent of cases, but implemented these changes in only 24 percent. Discussion: Current methods for optimizing treatment after obtaining aberrant UDT results should be enhanced. To improve the utility of UDT to reduce prescription opioid misuse, additional interventions and support for clinicians need to be developed and tested.
AB - Background/objective: Urine drug testing (UDT) may be used to help screen for prescription opioid misuse. There are little data available describing usual pain care practices for patients who have aberrant UDT results. The goal of this research was to evaluate the clinical care for patients prescribed chronic opioid therapy (COT) and have an aberrant UDT. Design: Retrospective cohort study. Setting: VA Medical Center in the Pacific Northwest. Participants: Patients with chronic pain who were prescribed COT and had a UDT result that was positive for an illicit or nonprescribed substance. Main outcome measures: This was an exploratory study designed to document usual care practices. Results: Participants' (n = 83) mean age was 49.5 (SD = 9-6) and 81.5percent were male. The most common substances detected on UDT were marijuana (69 percent) or a nonprescribed opioid (25 percent); 18 percent had a UDT positive for two or more substances. Plans to modify treatment were documented in 69 percent of cases. The most common treatment change after aberrant UDT results was instituting more frequent UDTs, which occurred in 43 percent of cases. Clinicians documented plans to alter their opioid prescribing (eg, terminating opioids, requiring more frequent fills, changing opioid dose, or transitioning to another opioid) in 52 percent of cases, but implemented these changes in only 24 percent. Discussion: Current methods for optimizing treatment after obtaining aberrant UDT results should be enhanced. To improve the utility of UDT to reduce prescription opioid misuse, additional interventions and support for clinicians need to be developed and tested.
KW - Chronic pain
KW - Clinical treatment guidelines
KW - Prescription opioid misuse
KW - Primary care
KW - Urine drug test
UR - http://www.scopus.com/inward/record.url?scp=84929264268&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84929264268&partnerID=8YFLogxK
U2 - 10.5055/jom.2015.0251
DO - 10.5055/jom.2015.0251
M3 - Article
C2 - 25750164
AN - SCOPUS:84929264268
VL - 11
SP - 45
EP - 51
JO - Journal of Opioid Management
JF - Journal of Opioid Management
SN - 1551-7489
IS - 1
ER -