title: Chronic opioid therapy risk reduction initiative: impact on urine drug testing rates and results.
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.
  
  
  METHODS
  Pre-post observational study.
  
  
  METHODS
  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).
  
  
  METHODS
  Multi-faceted opioid risk reduction initiative.
  
  
  METHODS
  Annual rates of UDTs and UDT results.
  
  
  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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, Seattle, WA, 98195-6560, USA, jturner@uw.edu.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Turner
authors.forename: Kathleen
authors.initials: K
authors.lastname: Saunders
authors.forename: Susan M
authors.initials: SM
authors.lastname: Shortreed
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Rapp
authors.forename: Stephen
authors.initials: S
authors.lastname: Thielke
authors.forename: Linda
authors.initials: L
authors.lastname: LeResche
authors.forename: Kim M
authors.initials: KM
authors.lastname: Riddell
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000652:urine*; D040242:Risk Reduction Behavior; D015813:Substance Abuse Detection / Q000592:standards / Q000639:trends*; D016482:Urinalysis / Q000592:standards / Q000639:trends*
chemical_list: D000701:Analgesics, Opioid