Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA.
Private Practice, Hamilton, ON, Canada.
J Gen Intern Med. 2022 Aug;37(10):2365-2372. doi: 10.1007/s11606-021-07095-8. Epub 2021 Aug 17.
Urine drug testing (UDT) is a recommended risk mitigation strategy for patients prescribed opioids for chronic pain, but evidence that UDT supports identification of substance misuse is limited.
Identify the prevalence of UDT results that may identify substance misuse, including diversion, among patients prescribed opioids for chronic pain.
Retrospective cohort study.
Patients (n=638) receiving opioids for chronic pain who had one or more UDTs, examining up to eight substances per sample, during a one 1-year period.
Experts adjudicated the clinical concern that UDT results suggest substance misuse or diversion as not concerning, uncertain, or concerning.
Of 638 patients, 48% were female and 49% were over age 55 years. Patients had a median of three UDTs during the intervention year. We identified 37% of patients (235/638) with ≥1 concerning UDT and a further 35% (222/638) having ≥1 uncertain UDT. We found concerning UDTs due to non-detection of a prescribed substance in 24% (156/638) of patients and detection of a non-prescribed substance in 23% (147/638). Compared to patients over 65 years, those aged 18-34 years were more likely to have concerning UDT results with an adjusted odds ratio (AOR) of 4.8 (95% confidence interval [CI] 1.9-12.5). Patients with mental health diagnoses (AOR 1.6 [95% CI 1.1-2.3]) and substance use diagnoses (AOR 2.3 [95% CI 1.5-3.7]) were more likely to have a concerning UDT result.
Expert adjudication of UDT results identified clinical concern for substance misuse in 37% of patients receiving opioids for chronic pain. Further research is needed to determine if UDTs impact clinical practice or patient-related outcomes.
尿液药物检测（UDT）是为慢性疼痛患者开处阿片类药物的推荐风险缓解策略，但支持 UDT 识别药物滥用的证据有限。
确定接受慢性疼痛阿片类药物治疗的患者中，UDT 结果可能识别出药物滥用（包括药物转移）的发生率。
回顾性队列研究。
在一个为期 1 年的时间内，接受阿片类药物治疗慢性疼痛且接受过一次或多次 UDT 的患者（n=638），每次检测最多可检测 8 种物质。
专家对 UDT 结果提示药物滥用或药物转移的临床关注程度进行了判断，将结果分为不关注、不确定和关注三种情况。
638 名患者中，48%为女性，49%年龄超过 55 岁。患者在干预年内平均进行了三次 UDT。我们发现 37%（235/638）的患者至少有一次 UDT 结果为关注，另有 35%（222/638）的患者至少有一次 UDT 结果为不确定。我们发现，24%（156/638）的患者因未检测到处方药物而出现关注性 UDT，23%（147/638）的患者因检测到非处方药物而出现关注性 UDT。与 65 岁以上的患者相比，年龄在 18-34 岁之间的患者出现关注性 UDT 结果的可能性更大，调整后的优势比（AOR）为 4.8（95%置信区间 [CI] 1.9-12.5）。有精神健康诊断（AOR 1.6 [95% CI 1.1-2.3]）和物质使用诊断（AOR 2.3 [95% CI 1.5-3.7]）的患者更有可能出现关注性 UDT 结果。
对 UDT 结果进行专家判断，确定了接受慢性疼痛阿片类药物治疗的患者中有 37%存在药物滥用的临床关注。需要进一步研究以确定 UDT 是否会影响临床实践或患者相关结局。
