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Research Brief| Volume 60, ISSUE 4, P546-551, April 2021

Trends in Urine Drug Testing Among Long-term Opioid Users, 2012–2018

  • Shaden A. Taha
    Correspondence
    Address correspondence to: Shaden A. Taha, MS, Department of Nutrition and Metabolism, University of Texas Medical Branch, 301 University Boulevard, Galveston TX 77555.
    Affiliations
    Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas

    Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas
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  • Jordan R. Westra
    Affiliations
    Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas

    Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas
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  • Mukaila A. Raji
    Affiliations
    Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas

    Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
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  • Yong F. Kuo
    Affiliations
    Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas

    Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas

    Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas

    Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
    Search for articles by this author
Published:December 05, 2020DOI:https://doi.org/10.1016/j.amepre.2020.10.011

      Introduction

      Long-term opioid therapy increases the risk of opioid overdose death. Government agencies and medical societies, including the Center for Disease Control and Prevention and the American Society for Clinical Oncology, emphasized risk mitigation strategies, including urine drug testing, in published guidelines. Urine drug testing rates, time trends, and covariates among long-term opioid therapy users were examined to gauge guideline adherence.

      Methods

      Using Optum's De-identified Clinformatics DataMart, an incidence cohort (n=28,790) and prevalence cohort (n=621,449) were created to measure baseline and annual urine drug testing, respectively, from 2012 to 2018. Urine drug testing time trends were evaluated by demographics, pain conditions, and Elixhauser comorbidity index. A multivariable generalized estimating model was developed in 2020 to examine the factors associated with urine drug testing.

      Results

      Annual urine drug testing rates doubled from 25.6% in 2012 to 52.2% in 2018, whereas baseline urine drug testing also increased from 3.75% to 11.1%. Annual urine drug testing increased within each age group over time; however, older patients (OR=0.21, 95% CI=0.21, 0.22, aged >79 years) and patients with cancer (OR=0.82, 95% CI=0.80, 0.84) were less likely to receive urine drug testing. Patients residing in the South (OR=1.99, 95% CI=1.96, 2.01) and those with back pain (OR=2.04, 95% CI=2.02, 2.06) or with other chronic pain (OR=1.64, 95% CI=1.62, 1.66) were significantly more likely to be tested. Independent predictors of baseline urine drug testing were similar to predictors of annual urine drug testing.

      Conclusions

      Despite increasing urine drug testing trends from 2012 to 2018, annual and baseline urine drug testing remained low in 2018, relative to numerous guideline recommendations. Findings suggest a need for research on better guideline implementation strategies and the effectiveness of urine drug testing on patient outcomes.
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