Department of Anesthesiology, Pain Management Center, University of Virginia Health System, Charlottesville, Virginia; and.
Midwest Comprehensive Pain Care, Milwaukee, Wisconsin.
Ther Drug Monit. 2021 Feb 1;43(1):6-13. doi: 10.1097/FTD.0000000000000840.
The opioid crisis is a profound public health crisis in the United States. It has significantly increased morbidity and mortality in our nation. There are many contributing factors to the opioid crisis, including a strong national and international interest to treat pain as effectively as possible. To combat this crisis, numerous strategies have been implemented over the past few years at the legislative, health system, and patient levels. As a result of these efforts, for the first time since 1999, drug overdose deaths in the United States decreased from 2017 to 2018, when deaths involving all opioids, prescription opioids, and heroin decreased by 2%, 13.5%, and 4.1%, respectively. To continue to curb the opioid crisis, it is imperative to optimize pain control through multidisciplinary and multimodal approaches and to adhere to opioid prescribing guidelines from regulatory and professional organizations to minimize risks for opioid misuse and abuse. Urine drug testing is an important means to assist with opioid monitoring and safe opioid prescribing. There are challenges when ordering urine drug tests, collecting specimens, and interpreting test results. Inaccurate interpretations of laboratory results can have significantly negative impacts on patients care and life. There is a critical need for prescriber education by laboratory experts in the use of drug testing and interpretation of results. To interpret test results correctly and make safe prescribing decisions, it is very important for prescribers/providers to consult clinical toxicologists, laboratory directors, and reporting staff. This interaction is vital and provides excellence of care for patients. This review aims to provide information concerning the opioid crisis in the United States and summarizes the challenges ordering and interpreting opioid-related laboratory testing as well as pertinent guidelines and recommendations.
阿片类药物危机是美国一个严重的公共卫生危机。它显著增加了我国的发病率和死亡率。阿片类药物危机有许多促成因素，包括强烈的国家和国际兴趣，以尽可能有效地治疗疼痛。为了应对这一危机，在过去几年中，在立法、医疗系统和患者层面上实施了许多策略。由于这些努力，自 1999 年以来，美国的药物过量死亡人数首次从 2017 年下降到 2018 年，涉及所有阿片类药物、处方阿片类药物和海洛因的死亡人数分别下降了 2%、13.5%和 4.1%。为了继续遏制阿片类药物危机，必须通过多学科和多模式方法优化疼痛控制，并遵守监管和专业组织的阿片类药物处方指南，以最大程度地降低阿片类药物误用和滥用的风险。尿液药物检测是辅助阿片类药物监测和安全阿片类药物处方的重要手段。在订购尿液药物检测、收集标本和解释检测结果方面存在挑战。实验室结果的解释不准确会对患者的护理和生活产生重大负面影响。实验室专家在药物检测和结果解释方面对开处方者进行教育非常重要。为了正确解释检测结果并做出安全的处方决策，开处方者/提供者与临床毒理学家、实验室主任和报告人员进行咨询非常重要。这种互动至关重要，为患者提供了卓越的护理。本文旨在提供有关美国阿片类药物危机的信息，并总结订购和解释与阿片类药物相关的实验室检测的挑战以及相关的指南和建议。
