title: Evaluation of concomitant methylphenidate and opioid use in patients with pain.
abstract: Methylphenidate is a central nervous system simulant that is used for management of opioid-induced sedation. Sparse data exist regarding use patterns of methylphenidate and opioids in patients with pain. This retrospective data analysis evaluated concomitant methylphenidate and opioid use from physician-reported medication lists and in urine specimens of patients with pain. All specimens were analyzed and quantified with LC-MS-MS. Concomitant methylphenidate and opioid use (e.g., sample population) were compared with a baseline population of patients taking opioids. There were 3,326 patients with physician-reported use of methylphenidate. Of these, 1,089 patients were tested for the presence of methylphenidate in urine. Methylphenidate was positive in urine for 551 patients (detection rate of 50.6%). Ritalinic acid was positive in 776 patients (detection rate of 71.3%). The current study observed differences in the use pattern of methylphenidate based on opioid type. Physician-reported use revealed methadone had the highest percent difference between the sample and baseline populations (77%, P ≤ 0.05). Fentanyl, morphine and hydromorphone also had higher percent differences of 19.6, 25.3 and 32.3%, respectively. Further studies need to examine the apparent discrepancies between the physician-reported medication lists and urine drug testing of concomitant methylphenidate and opioid use in patients with pain.
authors.affiliation: University of California, San Diego (UC San Diego), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA.
authors.forename: Joy Y
authors.initials: JY
authors.lastname: Jiang
authors.affiliation: University of California, San Diego (UC San Diego), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA UC San Diego, Department of Pediatrics, Rady's Children's Hospital, San Diego, CA, USA.
authors.forename: Brookie M
authors.initials: BM
authors.lastname: Best
authors.affiliation: University of California, San Diego (UC San Diego), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA Diabetes Intense Medical Management Clinic, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA.
authors.forename: Candis M
authors.initials: CM
authors.lastname: Morello
authors.affiliation: University of California, San Diego (UC San Diego), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA Doris A. Howell Palliative Care Services, San Diego, CA, USA.
authors.forename: Rabia S
authors.initials: RS
authors.lastname: Atayee
authors.affiliation: University of California, San Diego (UC San Diego), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA Doris A. Howell Palliative Care Services, San Diego, CA, USA joema@ucsd.edu.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Ma
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use / Q000652:urine*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use / Q000652:urine*; D002851:Chromatography, High Pressure Liquid; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D057230:Limit of Detection; D008774:Methylphenidate / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use / Q000652:urine*; D010146:Pain / Q000188:drug therapy* / Q000652:urine; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D000697:Central Nervous System Stimulants; D008774:Methylphenidate; C009189:ritalinic acid