title: Quantification of oxycodone and morphine analytes in urine: Assessment of adherence.
abstract: OBJECTIVE
  To use urine drug testing (UDT) results and other covariates to develop a model for the assessment of opioid medication prescription adherence.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  The Pain Management Clinic at one center of a large, private, multispecialty healthcare system (consisting of 52 regional centers) in northcentral and western Wisconsin.
  
  
  METHODS
  Seven hundred thirty-three Pain Management Clinic patients with an opioid prescription and UDT between June 1, 2007 and May 17, 2010. UDT results were available for 2,615 individual drug screens from 2,364 urine samples.
  
  
  METHODS
  Patient characteristics, drug dosage, quantitative urine creatinine and drug/analyte levels, and reported adherence/nonadherence were abstracted from the electronic medical record.
  
  
  METHODS
  Adherence was categorized for all UDT results using an objective set of criteria. Drug adherence was modeled excluding samples for clinically observed adherence issues, detection of illicit substances, diagnosed addictive disorders, and/or metabolic reasons.
  
  
  RESULTS
  Considerable variability was observed for primary urine analytes, even among those prescribed the same dose and believed to be adherent and free of confounding medical issues. For all medications evaluated, only urine creatinine contributed significantly (p < 0.0001) to predictive models of adherence based on dose alone. Simulated underuse and review of identified overuse and underuse suggest that this model could provide useful adherence information.
  
  
  CONCLUSIONS
  Predictive models based on urine analyte levels and clinical covariates, particularly urine creatinine, may be clinically useful for assessing opioid adherence. Future work should evaluate whether genetics or other factors can improve predictive accuracy of these models.
authors.affiliation: Clinical Psychologist, Department of Pain Management, Marshfield Clinic Health System - Minocqua Center, Minocqua, Wisconsin.
authors.forename: Michael E M
authors.initials: ME
authors.lastname: Larson
authors.affiliation: Senior Biostatistician, Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Berg
authors.affiliation: Clinical Chemist, Section Head, Chemistry and Toxicology, Marshfield Labs, Marshfield Clinic Health Systems Marshfield, Wisconsin.
authors.forename: Joyce
authors.initials: J
authors.lastname: Flanagan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000652:urine*; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000652:urine*; D010098:Oxycodone / Q000652:urine*; D010349:Patient Compliance
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D003404:Creatinine; D010098:Oxycodone