title: Interviewing and Urine Drug Toxicology Screening in a Pediatric Pain Management Center: An Analysis of Analgesic Nonadherence and Aberrant Behaviors in Adolescents and Young Adults.
abstract: OBJECTIVE
  Many adolescents and young adults report having chronic pain. Urine drug toxicology (UDT) is not routinely used in the pediatric pain management population, despite more routine use in adults with pain, particularly those prescribed opioids. As a first step toward establishing monitoring practices in pediatric and adolescent pain management, the present study evaluated the role of UDT in conjunction with a standard clinical interview in identifying the rate of adherence to an established analgesic regimen. The study also aimed to assess the use of UDT in identifying possible aberrant behaviors in this population.
  
  
  METHODS
  Data were acquired from a convenience sample of 50 pediatric and adolescent pain management initial consultations, during which a clinical interview and UDT were conducted. Data were analyzed to determine adherence to an established analgesic prescription regimen, and for identification of aberrant behaviors including concurrent use of illicit substances and prescription medication misuse. Other pertinent demographic and clinical factors were examined as factors in adherence.
  
  
  RESULTS
  Opioid medications were prescribed for 42% of the sample receiving pain medications, and 22% of the sample was nonadherent to their prescription analgesic regimen. Factors associated with a higher likelihood of nonadherence were an older age and having an opioid prescription. The majority (90%) of those nonadherent to their analgesic regimen displayed some form of aberrant behavior. Among the nonadherent patients, 50% were identified by UDT alone, and 50% were identified by self-report during the clinical encounter.
  
  
  CONCLUSIONS
  These results highlight the challenges of identifying nonadherence to a prescription regimen among adolescents with chronic pain. In addition, this preliminary work suggests that UDT could be used in conjunction with careful clinical interviewing to substantiate patient report and increase the likelihood of detecting analgesic nonadherence and aberrant behaviors.
authors.affiliation: *Bayada Hospice. Norwich, VT †New York State Psychiatric Institute ‡Division on Substance Abuse, Department of Psychiatry, Columbia University Medical Center §Columbia University of Nursing, New York, New York ∥Alkermes, Inc., Waltham, MA.
authors.forename: John M
authors.initials: JM
authors.lastname: Saroyan
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Evans
authors.forename: Andrew
authors.initials: A
authors.lastname: Segoshi
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Vosburg
authors.forename: Debra
authors.initials: D
authors.lastname: Miller-Saultz
authors.forename: Maria A
authors.initials: MA
authors.lastname: Sullivan
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000700:Analgesics / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods* / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000700:Analgesics