Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA.
Oncologist. 2020 Feb;25(2):99-104. doi: 10.1634/theoncologist.2019-0525. Epub 2019 Oct 11.
Urine drug test (UDT) is an effective tool used in chronic opioid therapy to ensure patient adherence to treatment and detect nonmedical opioid use. The two main types of UDT used in routine clinical practice are the screening tests or immunoassays and the confirmatory tests or laboratory-based specific drug identification tests such as gas chromatography-mass spectrometry, liquid chromatography-mass spectrometry, or tandem mass spectrometry. UDT produces objective data on some nonmedical opioid use that may otherwise go undetected, such as the use of undisclosed medications, the nonuse of prescribed medications, and the use of illegal drugs. It allows clinicians to initiate an open and effective conversation about nonmedical opioid use with their patients. However, the test has certain limitations that sometimes compromise its use. Its interpretation can be challenging to clinicians because of the complexity of the opioid metabolic pathways. Clear guidelines or recommendations regarding the use of UDT in cancer pain is limited. As a result, UDT appears to be underused among patients with cancer pain receiving opioid therapy. More studies are needed to help standardize the integration and use of UDT in routine cancer pain management. IMPLICATIONS FOR PRACTICE: Despite its potential benefits, urine drug testing (UDT) appears to be underused among patients with cancer pain receiving opioid therapy. This is partly because its interpretation can be challenging owing to the complexity of the opioid metabolic pathways. Information regarding the use of UDT in opioid therapy among patients with cancer is limited. This review article will improve clinician proficiency in UDT interpretation and assist oncologists in developing appropriate treatment plans during chronic opioid therapy.
尿液药物检测（UDT）是慢性阿片类药物治疗中用于确保患者遵医嘱治疗和检测非医疗性阿片类药物使用的有效工具。在常规临床实践中使用的两种主要 UDT 类型是筛选测试或免疫测定以及确认测试或基于实验室的特定药物鉴定测试，例如气相色谱-质谱法、液相色谱-质谱法或串联质谱法。UDT 可提供一些非医疗性阿片类药物使用的客观数据，否则这些数据可能无法被发现，例如使用未公开的药物、未使用规定的药物和使用非法药物。它使临床医生能够与患者就非医疗性阿片类药物使用问题展开公开有效的对话。然而，该测试具有一定的局限性，有时会影响其使用。由于阿片类药物代谢途径的复杂性，其解释对临床医生来说具有挑战性。关于癌症疼痛患者中 UDT 的使用，目前明确的指南或建议有限。因此，接受阿片类药物治疗的癌症疼痛患者中 UDT 的使用似乎不足。需要更多的研究来帮助规范 UDT 在常规癌症疼痛管理中的整合和使用。
尽管尿液药物检测（UDT）具有潜在的益处，但在接受阿片类药物治疗的癌症疼痛患者中，UDT 的使用似乎不足。这在一定程度上是因为由于阿片类药物代谢途径的复杂性，其解释具有挑战性。关于癌症患者中阿片类药物治疗中 UDT 使用的信息有限。本文综述将提高临床医生对 UDT 解释的熟练程度，并帮助肿瘤学家在慢性阿片类药物治疗期间制定适当的治疗计划。
