Increased frequency of urine drug testing in chronic opioid therapy: rationale for strategies for enhancing patient adherence and safety

David J DiBenedetto; Kelly M Wawrzyniak; Michael E Schatman; Hannah Shapiro; Ronald J Kulich

doi:10.2147/JPR.S213536

Increased frequency of urine drug testing in chronic opioid therapy: rationale for strategies for enhancing patient adherence and safety

J Pain Res. 2019 Jul 23:12:2239-2246. doi: 10.2147/JPR.S213536. eCollection 2019.

Authors

David J DiBenedetto^{1

2}, Kelly M Wawrzyniak^{1

2}, Michael E Schatman^{1

3}, Hannah Shapiro^{1

4}, Ronald J Kulich^{2

5}

Affiliations

¹ Research and Network Development, Boston PainCare, Waltham, MA, USA.
² Department of Diagnostic Sciences, Tufts School of Dental Medicine, Boston, MA, USA.
³ Deparment of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA.
⁴ Department of Biopsychology, Tufts University, Medford, MA, USA.
⁵ Department of Anesthesia Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.

Abstract

Objective: To determine the average amount of time required to detect opioid aberrancy based upon varying frequencies of urine drug testing (UDT) in a community-based, tertiary care pain management center.

Subjects: This study was a retrospective analysis of 513 consecutive patients enrolled in a medication management program, receiving chronic opioid therapy between January 1, 2018 and December 31, 2018.

Methods: Data were extracted from medical records including age at start of the study period, sex, ethnicity, marital status, and smoking status. UDT was performed at each prescribing visit via semi-quantitative immunoassay, and at the discretion of the clinician, a sample was sent for external confirmation using gas chromatography or mass spectrometry testing to clarify questions of inconsistency with patients' reports or prescribed medications. For purposes of the study, "opioid aberrancy" was defined through inconsistent UDT.

Results: One hundred and fifteen patients (22.4%) had at least one inconsistent UDT during the study period, and 160 (2.8%) of all UDTs were inconsistent. At this rate of inconsistency, it was determined that with monthly screening, it would require up to 36 months to detect a single aberrancy, and semi-annual testing would require as long as 216 months to detect an aberrancy.

Conclusions: More frequent UDT can be helpful in terms of earlier detection of opioid aberrancy. This has significant implications for helping avoid misuse, overdose, and potential diversion. Furthermore, early detection will ideally result in earlier implementation of treatment of the emotional and behavioral factors causing aberrancy. Such early intervention is more likely to be successful in terms of reducing substance misuse in a chronic pain population, providing a higher degree of patient adherence and safety, as well as producing superior overall patient outcomes. Finally, economic benefits may include substantial savings through avoidance of the necessity for drug rehabilitation and the empirically established higher costs of treating opioid misuse comorbidities.

Keywords: economic benefits; frequency; opioid safety; urine drug testing.