title: Predictors of urine drug testing for patients with chronic pain: Results from a national cohort of U.S. veterans.
abstract: BACKGROUND
  Urine drug testing (UDT) is recommended for all patients who initiate chronic opioid therapy (COT) for the treatment of chronic pain; however, it is infrequently utilized. Some prior research has identified factors that may predict UDT, but studies have been limited. The purpose of this study is to examine the rate and predictors of UDT among a national sample of patients with chronic pain who had new initiations of COT.
  
  
  METHODS
  Administrative data were examined for all veterans receiving medical care at Department of Veterans Affairs medical facilities who had new initiations of chronic opioid therapy (COT) during fiscal year 2011.
  
  
  RESULTS
  Nineteen percent of patients who had new initiations of COT for chronic noncancer pain received UDT within 90 days of starting opioids. In adjusted analyses, patient-level factors that predicted increased likelihood of UDT included male gender (risk ratio [RR] = 1.23, 95% confidence interval [CI] = 1.02-1.49), Black race (RR = 1.20, 95% CI = 1.06-1.37), divorced/separated marital status (RR = 1.13, 95% CI = 1.02-1.25), higher pain intensity (RR = 1.03, 95% CI = 1.01-1.05), comorbid substance use disorder (RR = 1.42, 95% CI = 1.27-1.60), posttraumatic stress disorder (PTSD) (RR = 1.14, 95% CI = 1.01-1.29), bipolar disorder or schizophrenia (RR = 1.29, 95% CI = 1.08-1.53), having received UDT prior to initiating opioid therapy (RR = 1.43, 95% CI = 1.26-1.62), and a higher baseline opioid dose (RR = 1.38-1.81, 95% CIs = 1.20-1.58, 1.57-2.09). Age was also associated with UDT, in a nonlinear manner. Several factors were associated with lower likelihood of UDT, including living in a highly rural setting (RR = 0.62, 95% CI = 0.29-0.99), having a VA service-connected disability (RR = 0.85-0.89, 95% CIs = 0.75-0.97, 0.79-0.99), and having a nurse practitioner or physician assistant as one's primary care clinician (RR = 0.72, 95% CI = 0.61-0.85).
  
  
  CONCLUSIONS
  Urine drug testing was conducted with 19% of patients who had new initiations of COT. Factors that predicted UDT were multifaceted and included patient and clinician variables. Multidimensional system-level interventions may be needed to facilitate widespread implementation of UDT.
authors.affiliation: a Center to Improve Veteran Involvement in Care , VA Portland Health Care System , Portland , Oregon , USA.|b Department of Psychiatry , Oregon Health & Science University , Portland , Oregon , USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Morasco
authors.affiliation: c Department of Public Health & Preventive Medicine , Oregon Health & Science University , Portland , Oregon , USA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Peters
authors.affiliation: d Center for Chronic Disease Outcomes Research , Minneapolis VA Health Care System , University of Minnesota Medical School , Minneapolis , Minnesota , USA.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Krebs
authors.affiliation: a Center to Improve Veteran Involvement in Care , VA Portland Health Care System , Portland , Oregon , USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Kovas
authors.affiliation: a Center to Improve Veteran Involvement in Care , VA Portland Health Care System , Portland , Oregon , USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Hart
authors.affiliation: a Center to Improve Veteran Involvement in Care , VA Portland Health Care System , Portland , Oregon , USA.|b Department of Psychiatry , Oregon Health & Science University , Portland , Oregon , USA.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use / Q000652:urine; D059350:Chronic Pain / Q000188:drug therapy / Q000652:urine*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D015813:Substance Abuse Detection / Q000706:statistics & numerical data*; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Chronic pain; opioid medications; prescription opioid abuse; treatment guidelines; urine drug test