title: Urine drug screen findings among ambulatory oncology patients in a supportive care clinic.
abstract: Professional organizations provide no guidelines regarding assessment and management of opioid abuse risk in cancer. Universal precautions (UP) developed for non-cancer pain, include assessments for aberrant behavior, screening questionnaires, and urine drug screens (UDS). The role of UDS for identifying opioid abuse risk in cancer is uncertain. Our aim is to characterize inappropriate UDS, and identify a potential role for UDS in therapeutic decision-making.
  
  
  
  An observational retrospective chart review of 232 consecutive supportive care clinic patients were seen during the study. Twenty-eight of the two hundred thirty-two did not meet inclusion criteria. One hundred fifty of the two hundred four had active cancer, while 54 had no evidence of active disease. Clinicians ordered UDS based on their clinical judgment of patients' substance misuse risk. Edmonton symptom assessment scores, history of substance abuse, alcohol use, tobacco use, aberrant behavior, and morphine equivalent daily dose (MEDD) were obtained.
  
  
  
  Pain scores and MEDD were higher (p = 0.021; p < 0.001) in the UDS group vs non-UDS. Forty percent of the patients (n = 82/204) had at least one UDS and 70% (60/82) had an inappropriate result. Thirty-nine percent (32) were inappropriately negative, showing no prescribed opioids. Forty-nine of the eighty-two were positive for non-prescribed opioids, benzodiazepine, or illicit substance. Eleven of the forty-nine had only cannabis metabolites in their urine. There were no significant differences between appropriate and inappropriate UDS groups regarding pain scores, MEDD or referral to psychology, psychiatry, or substance abuse specialists.
  
  
  
  UDS on the 82 oncology patients at high risk for substance misuse were frequently positive (46%) for non-prescribed opioids, benzodiazepines or potent illicit drugs such as heroin or cocaine, and 39% had inappropriately negative UDS, raising concerns for diversion.
authors.affiliation: Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA, 23298-0230, USA.
authors.forename: Sherri
authors.initials: S
authors.lastname: Rauenzahn
authors.affiliation: Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA, 23298-0230, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Sima
authors.affiliation: Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA, 23298-0230, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Cassel
authors.affiliation: Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA, 23298-0230, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Noreika
authors.affiliation: Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA, 23298-0230, USA.
authors.forename: Teny Henry
authors.initials: TH
authors.lastname: Gomez
authors.affiliation: Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA, 23298-0230, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Ryan
authors.affiliation: Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA, 23298-0230, USA.
authors.forename: Carl E
authors.initials: CE
authors.lastname: Wolf
authors.affiliation: Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA, 23298-0230, USA.
authors.forename: Luke
authors.initials: L
authors.lastname: Legakis
authors.affiliation: Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA, 23298-0230, USA. egidio.delfabbro@vcuhealth.org.
authors.forename: Egidio
authors.identifier: 0000-0003-1245-6307
authors.initials: E
authors.lastname: Del Fabbro
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D004353:Drug Evaluation, Preclinical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000652:urine*; D012189:Retrospective Studies; D018570:Risk Assessment; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000652:urine*
keywords: Opioid pain management; Outpatient palliative care; Risk stratification; Universal precautions; Urine drug screen