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Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

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A Capsule Commentary to this article was published on 12 November 2014

Abstract

BACKGROUND

Urine drug tests (UDTs) are recommended for patients on chronic opioid therapy (COT). Knowledge of the risk factors for aberrant UDT results could help optimize their use.

OBJECTIVE

To identify primary care COT patient and opioid regimen characteristics associated with aberrant UDT results.

DESIGN

Population-based observational.

SAMPLE

5,420 UDTs for Group Health integrated group practice COT patients.

MEASURES

Group Health database measures of patient demographics, medical history, COT characteristics, and UDT results.

RESULTS

Thirty percent of UDTs had aberrant results, including prescribed opioid non-detection (12.3 %), tetrahydrocannabinol (THC; 11.2 %), non-prescribed opioid (5.3 %), illicit drug (excluding THC; 0.6 %), non-prescribed benzodiazepine (1.7 %), and dilute (4.8 %). Adjusted odds ratios (95 % CI) of any aberrant result were higher for males than females (1.24 [1.07, 1.43]), patients with versus without prior substance use disorder diagnoses (1.42 [1.17, 1.72]), and current smokers versus non-smokers (1.50 [1.30, 1.73]). Odds ratios were lower for patients aged 45–64 (0.77 [0.65, 0.92]) and 65+ (0.40 [0.32, 0.50]) versus patients aged 20–44 and for patients on long-acting opioids only (0.72 [0.55, 0.95]) or long-acting plus short-acting (0.67 [0.54, 0.83]) versus short-acting only. Adjusted odds of prescribed opioid non-detection were lower for patients aged 45–64 (0.79 [0.63, 0.998]) and 65+ (0.44 [0.32, 0.59]) versus patients aged 20–44, for those on 40–<120 mg daily morphine-equivalent dose (0.52 [0.39, 0.70]) or 120+ mg (0.22 [0.11, 0.43]) versus <40 mg, and for patients on long-acting (0.35 [0.21, 0.57]) or long-acting plus short-acting (0.35 [0.24, 0.50]) opioids (versus short-acting only); and odds ratios were higher for patients with versus without prior diagnoses of substance use disorder (1.70 [1.31, 2.20]).

CONCLUSIONS

In this primary care setting, results were aberrant for 30 % of UDTs of COT patients, largely because of prescribed opioid non-detection and THC. Aberrant results of almost all types were more likely among patients under the age of 45. Other risk factors varied across aberrancies, but commonly included current smoking and prior substance use disorder diagnosis.

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Acknowledgments

Contributors

The authors thank Ryan N. Hansen, PharmD, PhD, RPh, and Stephen Thielke, MD, for helpful contributions to this work.

Funders

Funding for this research was provided by NIH grant 1R01 AG034181 from the National Institutes of Health National Institute on Aging. The findings and conclusions do not necessarily represent the views of Group Health.

Prior Presentation

Preliminary results of this study were presented in a poster at the annual meeting of the American Pain Society in Tampa, Florida, in May 2014 (Turner JA, Saunders K, Shortreed SM, LeResche L, Von Korff M.: Chronic opioid therapy urine drug testing in primary care: Rates and predictors of aberrant results.).

Conflict of Interest

Dr. Von Korff is the principal investigator of research grants awarded to the Group Health Research Institute from Pfizer. These grants also support Ms. Saunders. Dr. Shortreed served as a biostatistician on a grant to Group Health Research Institute from Bristol-Myers Squibb. Ms. Saunders owns stock in Merck. The other authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA

    Judith A. Turner PhD

  2. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA

    Judith A. Turner PhD

  3. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA

    Judith A. Turner PhD & Suzanne E. Rapp MD

  4. Group Health Research Institute, Seattle, WA, USA

    Kathleen Saunders PhD, Susan M. Shortreed PhD & Michael Von Korff ScD

  5. Department of Oral Medicine, University of Washington, Seattle, WA, USA

    Linda LeResche ScD

  6. Group Health, Seattle, WA, USA

    Kim Riddell MD

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  1. Judith A. Turner PhD
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Correspondence to Judith A. Turner PhD.

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Turner, J.A., Saunders, K., Shortreed, S.M. et al. Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results. J GEN INTERN MED 29, 1663–1671 (2014). https://doi.org/10.1007/s11606-014-3010-y

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  • DOI: https://doi.org/10.1007/s11606-014-3010-y

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