Journal of General Internal Medicine

, Volume 29, Issue 2, pp 305–311

Chronic Opioid Therapy Risk Reduction Initiative: Impact on Urine Drug Testing Rates and Results

  • Judith A. Turner
  • Kathleen Saunders
  • Susan M. Shortreed
  • Suzanne E. Rapp
  • Stephen Thielke
  • Linda LeResche
  • Kim M. Riddell
  • Michael Von Korff
Original Research

ABSTRACT

BACKGROUND

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.

OBJECTIVE

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.

DESIGN

Pre-post observational study.

PATIENTS

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).

INTERVENTION

Multi-faceted opioid risk reduction initiative.

MAIN MEASURES

Annual rates of UDTs and UDT results.

KEY 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.

CONCLUSIONS

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 WORDS

urine drug test urine drug screen chronic opioid therapy chronic pain opioid risk reduction 

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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Judith A. Turner
    • 1
    • 2
    • 3
  • Kathleen Saunders
    • 4
  • Susan M. Shortreed
    • 4
  • Suzanne E. Rapp
    • 3
  • Stephen Thielke
    • 1
    • 5
  • Linda LeResche
    • 6
  • Kim M. Riddell
    • 7
  • Michael Von Korff
    • 4
  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleUSA
  2. 2.Department of Rehabilitation MedicineUniversity of WashingtonSeattleUSA
  3. 3.Department of Anesthesiology and Pain MedicineUniversity of WashingtonSeattleUSA
  4. 4.Group Health Research InstituteSeattleUSA
  5. 5.Geriatric Research, Education, and Clinical Center, Puget Sound Veterans Affairs Medical CenterSeattleUSA
  6. 6.Department of Oral MedicineUniversity of WashingtonSeattleUSA
  7. 7.Group HealthSeattleUSA

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