Chronic Opioid Therapy Risk Reduction Initiative: Impact on Urine Drug Testing Rates and Results
- First Online:
In response to epidemic levels of prescription opioid overdose, abuse, and diversion, routine urine drug tests (UDTs) are recommended for patients receiving chronic opioid therapy (COT) for chronic pain. However, UDT ordering for COT patients is inconsistent in primary care, and little is known about how to increase UDT ordering or the impact of increased testing on rates of aberrant results.
To compare rates and results of UDTs for COT patients before versus after implementation of an opioid risk reduction initiative in a large healthcare system.
Pre-post observational study.
Group Health patients on COT October 2008–September 2009 (N = 4,821), October 2009–September 2010 (N = 5,081), and October 2010–September 2011 (N = 5,498).
Multi-faceted opioid risk reduction initiative.
Annual rates of UDTs and UDT results.
Half of COT patients received at least one UDT in the year after the initiative was implemented, compared to only 7 % 2 years prior. The adjusted odds of COT patients having at least one UDT in the first year of the opioid initiative were almost 16 times (adjusted OR = 15.79; 95 % CI: 13.96–17.87) those 2 years prior. The annual rate of UDT detection of marijuana and illicit drugs did not change (12.6 % after initiative implementation), and largely reflected marijuana use (detected in 11.1 % of all UDTs in the year after initiative implementation). In the year after initiative implementation, 10.7 % of UDTs were negative for opioids.
The initiative appeared to dramatically increase urine drug testing of COT patients in the healthcare system without impacting rates of aberrant results. The large majority of aberrant results reflected marijuana use or absence of opioids in the urine. The utility of increased urine drug testing for COT patient safety and prevention of diversion remains uncertain.
KEY WORDSurine drug test urine drug screen chronic opioid therapy chronic pain opioid risk reduction
- 2.Warner M, Chen LH, Makuc DM, Anderson RN, Minino AM. Drug poisoning deaths in the United States, 1980–2008. NCHS data brief, no. 81. Hyattsville, MD, 2011.Google Scholar
- 7.Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality. The DAWN report: highlights of the 2010 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. Rockville, MD, July 2, 2012.Google Scholar
- 8.Substance Abuse and Mental Health Services Administration. Treatment Episode Data Set (TEDS) 1999–2009: National Admissions to Substance Abuse Treatment Services [Accessed September 5, 2013]. Available at: http://www.samhsa.gov/data/DASIS/teds09/TEDS2k9NTbl1.1a.htm.
- 30.Washington State Agency Medical Directors’ Group. Interagency guideline on opioid dosing for chronic non-cancer pain: an educational aid to improve care and safety with opioid therapy, 2010 update. Olympia, WA. 2010. www.agencymeddirectors.wa.gov/opioiddosing.asp. Accessed September 5 2013.