Urine Drug Testing Among Patients Prescribed Long-Term Opioid Therapy: Patient and Clinician Factors

Article Figures & Data

Table 1.

Characteristics of Patients Prescribed Long-Term Opioid Therapy, by Urine Drug Testing Status

	Total	No UDT	UDT	p-Value
N	5690	3474	2216
Sex				0.78
Female	3520 (61.9%)	2154 (62.0%)	1366 (61.6%)
Race				<0.001
White	4312 (75.8%)	2669 (76.8%)	1643 (74.1%)
Black	559 (9.8%)	297 (8.5%)	262 (11.8%)
Asian	154 (2.7%)	109 (3.1%)	45 (2.0%)
Other	665 (11.7%)	399 (11.5%)	266 (12.0%)
Age				<0.001
<30	130 (2.3%)	96 (2.8%)	34 (1.5%)
30 to 49	1085 (19.1%)	650 (18.7%)	435 (19.6%)
50 to 64	2260 (39.7%)	1332 (38.3%)	928 (41.9%)
65 to 84	1993 (35.0%)	1232 (35.5%)	761 (34.3%)
85+	222 (3.9%)	164 (4.7%)	58 (2.6%)
Medicaid insurance	152 (2.7%)	118 (3.4%)	34 (1.5%)	<0.001
English speaking	5514 (96.9%)	3351 (96.5%)	2163 (97.6%)	0.015
No. opioid prescriptions, median (IQR)	7.0 (4.0, 12.0)	6.0 (4.0, 10.0)	11.0 (7.0, 14.0)	<0.001
Max. daily dose opioids, mean (SD)	83.6 (257.3)	75.6 (137.3)	96.0 (374.5)	0.004
No. office visits/year, median (IQR)	9.0 (5.0, 15.0)	9.0 (5.0, 15.0)	10.0 (6.0, 15.0)	0.14
Prescriber specialty				<0.001
Family Medicine	3289 (57.8%)	2004 (57.7%)	1285 (58.0%)
Internal Medicine	1482 (26.0%)	727 (20.9%)	755 (34.1%)
Specialist	919 (16.2%)	743 (21.4%)	176 (7.9%)
Female prescriber	2871 (50.5%)	1709 (49.2%)	1162 (52.4%)	0.017

Notes: Sample represents 5690 individual patients within a large primary care network prescribed at least 3 months of opioid therapy. All data extracted from electronic medical record.
Abbreviations: UDT, urine drug test; Max daily dose, highest MME (morphine milliequivalent) per day during the study year; IQR, interquartile range; SD, standard deviation.

Table 2.

Adjusted Association of Urine Drug Testing by Patient and Prescriber Factors

	aIRR (95% CI)	p-Value
Female sex (vs male)	0.9 (0.9,1.0)	0.21
Race (vs White)
Black	1.2 (1.0,1.4)	0.01
Asian	0.7 (0.5,1.0)	0.04
Other	1.0 (0.8,1.2)	0.91
Age, years (vs <30)
30 to 49	1.4 (1.0,2.0)	0.08
50 to 64	1.3 (0.9,1.9)	0.13
65 to 84	1.3 (0.9,1.8)	0.18
85+	0.8 (0.5,1.3)	0.42
Medicaid (vs other insurance)	1.0 (0.7,1.4)	0.9
English language preferred (vs non-English)	1.0 (0.7,1.4)	0.92
No. opioid prescriptions	1.1 (1.1,1.1)	<0.01
Max. daily dose opioids	1.0 (1.0,1.0)	0.94
No. office visits	1.0 (1.0,1.0)	0.27
Prescriber specialty (vs Family Medicine)
Internal Medicine	1.6 (1.3,1.9)	<0.01
Specialist	0.6 (0.5,0.7)	<0.01
Female prescriber (vs male)	1.3 (1.0,1.5)	0.02

Notes: Negative binomial regression modeling the adjusted association between patient and prescriber factors and urine drug testing. Statistical significance set at P < .05.
Abbreviations: aIRR, adjusted incidence rate ratio; Max daily dose opioids, highest MME (morphine milliequivalent) per day during the study year; CI, confidence interval.