Treatment changes following aberrant urine drug test results for patients prescribed chronic opioid therapy.
OBJECTIVE
Urine drug testing (UDT) may be used to help screen for prescription opioid misuse. There are little data available describing usual pain care practices for patients who have aberrant UDT results. The goal of this research was to evaluate the clinical care for patients prescribed chronic opioid therapy (COT) and have an aberrant UDT.


METHODS
Retrospective cohort study.


METHODS
VA Medical Center in the Pacific Northwest.


METHODS
Patients with chronic pain who were prescribed COT and had a UDT result that was positive for an illicit or nonprescribed substance.


METHODS
This was an exploratory study designed to document usual care practices.


RESULTS
Participants' (n = 83) mean age was 49.5 (SD = 9.6) and 81.5 percent were male. The most common substances detected on UDT were marijuana (69 percent) or a nonprescribed opioid (25 percent); 18 percent had a UDT positive for two or more substances. Plans to modify treatment were documented in 69 percent of cases. The most common treatment change after aberrant UDT results was instituting more frequent UDTs, which occurred in 43 percent of cases. Clinicians documented plans to alter their opioid prescribing (eg, terminating opioids, requiring more frequent fills, changing opioid dose, or transitioning to another opioid) in 52 percent of cases, but implemented these changes in only 24 percent.


CONCLUSIONS
Current methods for optimizing treatment after obtaining aberrant UDT results should be enhanced. To improve the utility of UDT to reduce prescription opioid misuse, additional interventions and support for clinicians need to be developed and tested.
Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, Oregon; Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
Benjamin J
BJ
Morasco
Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Erin E
EE
Krebs
Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon.
Renee
R
Cavanagh
Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
Stephanie
S
Hyde
Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, Oregon; Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon.
Aysha
A
Crain
Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, Oregon; Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
Steven K
SK
Dobscha
D000328:Adult; D015415:Biomarkers / Q000652:urine; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000652:urine; D016903:Drug Monitoring / Q000379:methods*; D057915:Drug Substitution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use* / Q000652:urine*; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000652:urine; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015813:Substance Abuse Detection / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs; D016482:Urinalysis
D015415:Biomarkers; D009292:Narcotic Antagonists