Gudin Jeff, Mehta Neel, McClure F Leland, Niles Justin K, Kaufman Harvey W
Quest Diagnostics, Secaucus, New Jersey; Rutgers New Jersey Medical School, Newark, New Jersey.
Weill Cornell Pain Management, New York-Presbyterian Hospital, New York.
J Opioid Manag. 2020;16(5):357-373. doi: 10.5055/jom.2020.0591.
The Centers for Disease Control and Prevention (CDC) recommend that clinicians prescribing opioids for chronic pain should consider at least annual urine drug testing (UDT). We evaluated whether shorter intervals for repeat UDT are associated with decreased rates of drug misuse.
Retrospective analysis of deidentified serial UDT and matched prescribing data.
We analyzed Quest Diagnostics 2016-2017 UDT results from new patients being monitored for prescription drug adherence, in nonsubstance use disorder (SUD) treatment environments.
Drug misuse was defined as the absence of a prescribed substance or the presence of a nonprescribed substance. Patients with ≥3 sets of the UDT results were included.
UDT results from 49,601 patients (148,803 specimens) were tested. Declines in misuse between the first and second UDT were highest for those tested at the shortest intervals: approximately weekly, 19 percent; monthly, 15 percent; bimonthly, 12 percent; quarterly, 9 percent; semiannually, 3 percent; misuse rates increased by 1 percent for patients tested annually. Declines in misuse were more pronounced for opioids than other drug groups. Substantial declines in positivity were noted for heroin (32 percent) and nonprescribed fentanyl (10 percent). Declines in misuse between the second and third UDT followed a similar pattern.
UDT intervals of ≤ quarterly were associated with marked declines, but testing annually or semiannually was not associated with consistent decreases. Our findings suggest that clinical strategies that include serial testing conducted quarterly or sooner may be instrumental in decreasing drug misuse. Testing more frequently than "at least once annually" should be considered by clinicians monitoring potential drug misuse.
美国疾病控制与预防中心（CDC）建议，为慢性疼痛开具阿片类药物的临床医生应至少每年进行一次尿液药物检测（UDT）。我们评估了缩短重复进行UDT的间隔时间是否与药物滥用率降低有关。
对匿名的系列UDT和匹配的处方数据进行回顾性分析。
我们分析了奎斯特诊断公司2016 - 2017年在非物质使用障碍（SUD）治疗环境中对新患者进行处方药依从性监测的UDT结果。
药物滥用定义为未检测到处方药物或检测到非处方药物。纳入有≥3组UDT结果的患者。
对49,601名患者（148,803份样本）的UDT结果进行了检测。在首次和第二次UDT之间，检测间隔时间最短的患者滥用率下降幅度最大：大约每周检测一次的患者下降了19%；每月检测一次的患者下降了15%；每两个月检测一次的患者下降了12%；每季度检测一次的患者下降了9%；每半年检测一次的患者下降了3%；每年检测一次的患者滥用率上升了1%。与其他药物组相比，阿片类药物滥用率的下降更为明显。海洛因（32%）和非处方芬太尼（10%）的阳性率大幅下降。第二次和第三次UDT之间滥用率的下降遵循类似模式。
每季度或更短时间的UDT间隔与显著下降相关，但每年或每半年检测一次与持续下降无关。我们的研究结果表明，包括每季度或更短时间进行系列检测的临床策略可能有助于减少药物滥用。监测潜在药物滥用的临床医生应考虑比“至少每年一次”更频繁地进行检测。
