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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
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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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      REFERENCES

        • Dowell D
        • Haegerich TM
        • Chou R
        CDC guideline for prescribing opioids for chronic pain–United States, 2016.
        JAMA. 2016; 315: 1624-1645
        • Jeffery MM
        • Hooten WM
        • Hess EP
        • et al.
        Opioid prescribing for opioid-naive patients in emergency departments and other settings: characteristics of prescriptions and association with long-term use.
        Ann Emerg Med. 2018; 71: 326-336.e19
      1. Manchikanti L, Abdi S, Atluri S, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: part I–evidence assessment. Pain Physician. 2012;15(3 suppl):S1–S65. https://www.painphysicianjournal.com/linkout?issn=&vol=15&page=S67. Accessed November 3, 2019.

        • Nuckols TK
        • Anderson L
        • Popescu I
        • et al.
        Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain.
        Ann Intern Med. 2014; 160: 38-47
        • Chou R
        • Fanciullo GJ
        • Fine PG
        • et al.
        Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.
        J Pain. 2009; 10: 113-130
        • Jannetto PJ
        • Bratanow NC
        • Clark WA
        • et al.
        Executive summary: American Association of Clinical Chemistry Laboratory Medicine Practice Guideline—using clinical laboratory tests to monitor drug therapy in pain management patients.
        J Appl Lab Med. 2018; 2: 489-526
      2. Owen GT, Burton AW, Schade CM, Passik S. Urine drug testing: current recommendations and best practices. Pain Physician. 2012;15(3 suppl):ES119–ES133. https://www.painphysicianjournal.com/linkout?issn=&vol=15&page=ES119. Accessed November 3, 2019.

        • Rolfs RT
        • Johnson E
        • Williams NJ
        • Sundwall DN
        Utah clinical guidelines on prescribing opioids for treatment of pain.
        J Pain Palliat Care Pharmacother. 2010; 24: 219-235
      3. Christo PJ, Manchikanti L, Ruan X, et al. Urine drug testing in chronic pain. Pain Physician. 2011;14(2):123–143. https://www.painphysicianjournal.com/linkout?issn=&vol=14&page=123. Accessed November 1, 2019.

      4. Manchikanti L, Manchukonda R, Pampati V, et al. Does random urine drug testing reduce illicit drug use in chronic pain patients receiving opioids. Pain Physician. 2006;9(2):123–129. https://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=9&page=123. Accessed October 28, 2019.

        • Matteliano D
        • Chang YP
        Describing prescription opioid adherence among individuals with chronic pain using urine drug testing.
        Pain Manag Nurs. 2015; 16: 51-59
        • Wiseman LK
        • Lynch ME
        The utility of universal urinary drug screening in chronic pain management.
        Can J Pain. 2018; 2: 37-47
        • Pergolizzi J
        • Pappagallo M
        • Stauffer J
        • et al.
        The role of urine drug testing for patients on opioid therapy.
        Pain Pract. 2010; 10: 497-507
        • Mahajan G
        Role of urine drug testing in the current opioid epidemic.
        Anesth Analg. 2017; 125: 2094-2104
        • Paice JA
        • Portenoy R
        • Lacchetti C
        • et al.
        Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline.
        J Clin Oncol. 2016; 34: 3325-3345
        • Argoff CE
        • Alford DP
        • Fudin J
        • et al.
        Rational urine drug monitoring in patients receiving opioids for chronic pain: consensus recommendations.
        Pain Med. 2018; 19: 97-117
        • Adams NJ
        • Plane MB
        • Fleming MF
        • Mundt MP
        • Saunders LA
        • Stauffacher EA
        Opioids and the treatment of chronic pain in a primary care sample.
        J Pain Symptom Manage. 2001; 22: 791-796
        • Bhamb B
        • Brown D
        • Hariharan J
        • Anderson J
        • Balousek S
        • Fleming MF
        Survey of select practice behaviors by primary care physicians on the use of opioids for chronic pain.
        Curr Med Res Opin. 2006; 22: 1859-1865
        • Boulanger A
        • Clark AJ
        • Squire P
        • Cui E
        • Horbay GL
        Chronic pain in Canada: have we improved our management of chronic noncancer pain.
        Pain Res Manag. 2007; 12: 39-47
        • Starrels JL
        • Becker WC
        • Weiner MG
        • Li X
        • Heo M
        • Turner BJ
        Low use of opioid risk reduction strategies in primary care even for high risk patients with chronic pain.
        J Gen Intern Med. 2011; 26: 958-964
        • Turner JA
        • Saunders K
        • Shortreed SM
        • et al.
        Chronic opioid therapy urine drug testing in primary care: prevalence and predictors of aberrant results.
        J Gen Intern Med. 2014; 29: 1663-1671
        • Zgierska AE
        • Vidaver RM
        • Smith P
        • et al.
        Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project.
        BMC Health Serv Res. 2018; 18: 415
      5. Optum. Clinformatics data mart. Eden Prairie, MN: Optum; Published 2017. https://www.optum.com/content/dam/optum/resources/productSheets/Clinformatics_for_Data_Mart.pdf. Accessed September 15, 2019.

        • Amari E
        • Rehm J
        • Goldner E
        • Fischer B
        Nonmedical prescription opioid use and mental health and pain comorbidities: a narrative review.
        Can J Psychiatry. 2011; 56: 495-502
        • Elixhauser A
        • Steiner C
        • Harris DR
        • Coffey RM
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27
        • Seal KH
        • Shi Y
        • Cohen G
        • et al.
        Association of mental health disorders with prescription opioids and high-risk opioid use in U.S. veterans of Iraq and Afghanistan [published correction appears in JAMA 2012;307(23):2489].
        JAMA. 2012; 307: 940-947
      6. Centers for Disease Control and Prevention. Common elements in guidelines for prescribing opioids for chronic pain. Atlanta, GA: Centers for Disease Control and Prevention.https://www.cdc.gov/drugoverdose/pdf/common_elements_in_guidelines_for_prescribing_opioids-a.pdf. Published December 15, 2016. Accessed April 2, 2020.

      7. Davis C. Appendix B: state-by-state summary of opioid prescribing regulations and guidelines. Edina, MN: The Network for Public Health law, Southeastern Region Office & the National Health Law Program.https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf. Published August 18, 2017. Accessed April 30, 2020.

        • Arthur JA
        Urine drug testing in cancer pain management.
        Oncologist. 2020; 25: 99-104
        • Johnson SP
        • Chung KC
        • Zhong L
        • et al.
        Risk of prolonged opioid use among opioid-naïve patients following common hand surgery procedures.
        J Hand Surg Am. 2016; 41: 947-957.e3
        • Campbell CI
        • Weisner C
        • Leresche L
        • et al.
        Age and gender trends in long-term opioid analgesic use for noncancer pain.
        Am J Public Health. 2010; 100: 2541-2547
        • Chau DL
        • Walker V
        • Pai L
        • Cho LM
        Opiates and elderly: use and side effects.
        Clin Interv Aging. 2008; 3: 273-278
        • National Institute on Drug Abuse, NIH, HHS
        Abuse of prescription (Rx) drugs affects young adults most.
        National Institute on Drug Abuse, NIH, HHS, Bethesda, MDPublished 2016
        • Gaither JR
        • Gordon K
        • Crystal S
        • et al.
        Racial disparities in discontinuation of long-term opioid therapy following illicit drug use among black and white patients.
        Drug Alcohol Depend. 2018; 192: 371-376
        • Yee DA
        • Hughes MM
        • Guo AY
        • et al.
        Observation of improved adherence with frequent urine drug testing in patients with pain.
        J Opioid Manag. 2014; 10: 111-118
        • Setnik B
        • Roland CL
        • Pixton GC
        • Sommerville KW
        Prescription opioid abuse and misuse: gap between primary-care investigator assessment and actual extent of these behaviors among patients with chronic pain.
        Postgrad Med. 2017; 129: 5-11
        • Heit HA
        • Gourlay DL
        Urine drug testing in pain medicine.
        J Pain Symptom Manage. 2004; 27: 260-267
      8. Laboratory registry. Centers for Medicare and Medicaid Services. https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Laboratory_Registry.html. Updated July 17, 2020. Accessed June 26, 2016.