ABSTRACT
BACKGROUND
In response to epidemic levels of prescription opioid overdose, abuse, and diversion, routine urine drug tests (UDTs) are recommended for patients receiving chronic opioid therapy (COT) for chronic pain. However, UDT ordering for COT patients is inconsistent in primary care, and little is known about how to increase UDT ordering or the impact of increased testing on rates of aberrant results.
OBJECTIVE
To compare rates and results of UDTs for COT patients before versus after implementation of an opioid risk reduction initiative in a large healthcare system.
DESIGN
Pre-post observational study.
PATIENTS
Group Health patients on COT October 2008–September 2009 (N = 4,821), October 2009–September 2010 (N = 5,081), and October 2010–September 2011 (N = 5,498).
INTERVENTION
Multi-faceted opioid risk reduction initiative.
MAIN MEASURES
Annual rates of UDTs and UDT results.
KEY RESULTS
Half of COT patients received at least one UDT in the year after the initiative was implemented, compared to only 7 % 2 years prior. The adjusted odds of COT patients having at least one UDT in the first year of the opioid initiative were almost 16 times (adjusted OR = 15.79; 95 % CI: 13.96–17.87) those 2 years prior. The annual rate of UDT detection of marijuana and illicit drugs did not change (12.6 % after initiative implementation), and largely reflected marijuana use (detected in 11.1 % of all UDTs in the year after initiative implementation). In the year after initiative implementation, 10.7 % of UDTs were negative for opioids.
CONCLUSIONS
The initiative appeared to dramatically increase urine drug testing of COT patients in the healthcare system without impacting rates of aberrant results. The large majority of aberrant results reflected marijuana use or absence of opioids in the urine. The utility of increased urine drug testing for COT patient safety and prevention of diversion remains uncertain.
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Acknowledgements
Contributors
The authors thank Lisa C. Murphy, MD, Group Health, for her helpful comments regarding the study results.
Funders
The study was funded by NIH NIA grant 1R01 AG034181. The findings and conclusions do not necessarily represent views of Group Health.
Prior Presentations
Portions of this work were presented as a poster at the annual meeting of the American Pain Society, May 17, 2012; and at the International Association for the Study of Pain World Congress on Pain, August 29, 2012.
Conflict of Interest
Dr. Von Korff has received grant funding to Group Health Research Institute from Janssen Pharmaceuticals, which also supported Dr. Turner, Dr. LeResche, and Ms. Saunders. Dr. Von Korff has also received grant funding to Group Health Research Institute from Pfizer. Dr. Shortreed has served as a biostatistician on a grant to Group Health Research Institute from Pfizer. Ms. Saunders owns stock in Merck. The other authors declare that they do not have any conflicts of interest.
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Turner, J.A., Saunders, K., Shortreed, S.M. et al. Chronic Opioid Therapy Risk Reduction Initiative: Impact on Urine Drug Testing Rates and Results. J GEN INTERN MED 29, 305–311 (2014). https://doi.org/10.1007/s11606-013-2651-6
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DOI: https://doi.org/10.1007/s11606-013-2651-6