BRIEF REPORT
Alicia Agnoli, MD, MPH, MHS; Rebecca Howe, MD; Elizabeth Magnan, MD, PhD; Anthony Jerant, MD; Daniel Colby, MD; Peter Franks, MD
Corresponding Author: Alicia Agnoli, MD, MPH, MHS; UC Davis Department of Family & Community Medicine
Email: aagnoli@ucdavis.edu
DOI: 10.3122/jabfm.2022.220360R1
Keywords: Chronic Pain, Logistic Regression, Medical Decision-Making, Opioids, Physician-Patient Relations, Retrospective Studies, Substance Abuse Testing
Dates: Submitted: 10-19-2022; Revised: 12-30-2022; Accepted: 01-03-2023
Status: In production for ahead of print.
INTRODUCTION: National guidelines recommend that patients with chronic non-cancer pain prescribed long-term opioid therapy (LTOT) undergo periodic urine drug testing (UDT), yet UDT is performed inconsistently, and little evidence supports the utility of this approach. We examined patient and prescriber factors associated with UDT.
METHODS: One-year retrospective cohort study of 5,690 patients prescribed LTOT by 689 clinicians in a network of 13 primary care and specialty clinics. Negative binomial regression examined patient and prescriber factors associated with the number of tests completed, and logistic regression examined prescriber propensity to order testing. Analyses were adjusted for patient and provider characteristics and accounted for patient clustering within prescribers.
RESULTS: A total of 2,256 patients (39.6%) had UDT completed at least once. More UDT completion was associated with Black patient race and receipt of more opioid prescriptions, as well as with their provider’s propensity to order UDT.
CONCLUSIONS: UDT was relatively infrequent in patients prescribed LTOT and associated with patient factors not known to confer greater opioid-related risk. Additionally, there was significant provider-driven variation in UDT. Given the uncertain clinical utility of such testing and potentially high consequences for clinical decision-making, these findings signal the need for strategies to address potential biases in the use of UDT.