title: Aberrant Opioid Use and Urine Drug Testing in Outpatient Palliative Care.
abstract: Aberrant opioid use is a public health issue, which has not been adequately described in the palliative care literature. With the increasing integration of palliative care into oncologic care, palliative care clinicians are seeing patients earlier in the disease trajectory, and therefore, more outpatients with chronic pain requiring chronic opioid therapy. This may have resulted in a concomitant rise in the number of patients with aberrant opioid use. In this article, we report on two patients with aberrant opioid-related behavior seen at our palliative care clinic. A high suspicion of opioid abuse, misuse, or diversion based on certain behavioral cues necessitated the ordering of a urine drug test (UDT). The tests helped the medical team to confirm an already existing pattern of maladaptive opioid use. In both cases, we provided ample opioid education and implemented effective strategies to address their aberrant opioid use. These cases suggest the need for palliative care clinicians to develop strategies to effectively address this issue in our field of medicine. It also highlights the usefulness of UDT in the outpatient palliative care setting.
authors.affiliation: 1 Department of Palliative Care and Rehabilitation Medicine, University of Texas at MD Anderson Cancer Center , Houston, Texas.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Arthur
authors.affiliation: 1 Department of Palliative Care and Rehabilitation Medicine, University of Texas at MD Anderson Cancer Center , Houston, Texas.
authors.forename: Ali
authors.initials: A
authors.lastname: Haider
authors.affiliation: 2 Supportive Care Center, University of Texas at MD Anderson Cancer Center , Houston, Texas.
authors.forename: Tonya
authors.initials: T
authors.lastname: Edwards
authors.affiliation: 3 Pharmacy Clinical Programs, University of Texas at MD Anderson Cancer Center , Houston, Texas.
authors.forename: Jessica
authors.initials: J
authors.lastname: Waletich-Flemming
authors.affiliation: 1 Department of Palliative Care and Rehabilitation Medicine, University of Texas at MD Anderson Cancer Center , Houston, Texas.
authors.forename: Suresh
authors.initials: S
authors.lastname: Reddy
authors.affiliation: 1 Department of Palliative Care and Rehabilitation Medicine, University of Texas at MD Anderson Cancer Center , Houston, Texas.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.affiliation: 1 Department of Palliative Care and Rehabilitation Medicine, University of Texas at MD Anderson Cancer Center , Houston, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Hui
mesh_terms: D000701:Analgesics, Opioid; D006801:Humans; D009293:Opioid-Related Disorders; D010045:Outpatients; D010166:Palliative Care; D015813:Substance Abuse Detection
chemical_list: D000701:Analgesics, Opioid