Millennium Health, San Diego, California. ORCID: https://orcid.org/0000-0002-4854-4280.
Millennium Health, San Diego, California. ORCID: https://orcid.org/0000-0002-1628-1607.
J Opioid Manag. 2022 Jul-Aug;18(4):361-375. doi: 10.5055/jom.2022.0723.
Clinicians and policymakers have been wrestling with the appropriateness and safety of opioid therapy during the opioid crisis. Policy and clinical decisions have often been made without much current data on trends in drug use in patients with pain. Thus, we evaluated definitive urine drug test (UDT) results in patients being treated for pain to see if those taking their prescribed opioids were less likely to be positive for the primary illicit drugs currently driving overdose deaths: cocaine, heroin, fentanyl, and methamphetamine.
DESIGN, SETTING, AND PATIENTS: A cross-sectional study of UDT results from January 1, 2015 to September 30, 2021, from 600,000 patient specimens submitted for testing by pain management specialists.
UDT by liquid chromatography-tandem mass spectrometry as ordered by the treating clinician.
Presence of other substances stratified by whether a patient's prescribed opioid was found.
The presence of cocaine, heroin, fentanyl, and methamphetamine for the total population was low (<5 percent). Of the 347,092 patients prescribed opioids, 76 percent (n = 264,961) were positive on UDT for their prescribed opioid ("consistent"). Compared to patients without their prescribed opioid present ("inconsistent"), patients consistent with therapy were 54 percent (incidence rate ratio (IRR) 1.54, 95 percent confidence interval (CI) 1.47-1.59) less likely to be positive for cocaine, 47 percent [IRR 1.47, 95 percent CI 1.34-1.57] less likely to be positive for heroin, and 35 percent [IRR 1.35, 95 percent CI 1.24-1.45] less likely to be positive for methamphetamine, p < 0.001. Differences between the groups for fentanyl were not significant.
Overall positivity rates for cocaine, heroin, fentanyl, and methamphetamine were low. Patients with prescribed opioid present were less likely to be positive for cocaine, heroin, or methamphetamine. Patterns of substance use within this pain management population should be used to inform ongoing policy decisions.
在阿片类药物危机期间，临床医生和决策者一直在权衡阿片类药物治疗的适当性和安全性。政策和临床决策往往是在缺乏当前有关疼痛患者药物使用趋势的大量数据的情况下做出的。因此，我们评估了正在接受疼痛治疗的患者的明确尿液药物检测（UDT）结果，以确定服用规定阿片类药物的患者是否不太可能对目前导致过量死亡的主要非法药物呈阳性：可卡因、海洛因、芬太尼和冰毒。
设计、地点和患者：这是一项横断面研究，对 2015 年 1 月 1 日至 2021 年 9 月 30 日期间由疼痛管理专家送检的 60 万份患者样本的 UDT 结果进行分析。
根据治疗医生的要求进行液相色谱-串联质谱法 UDT。
是否存在其他物质，按患者规定的阿片类药物是否存在进行分层。
总人群中可卡因、海洛因、芬太尼和冰毒的存在率较低（<5%）。在 347092 名服用阿片类药物的患者中，76%（n=264961）UDT 检测到规定的阿片类药物呈阳性（“一致”）。与没有规定的阿片类药物存在的患者（“不一致”）相比，与治疗一致的患者呈可卡因阳性的可能性低 54%（发病率比[IRR]1.54，95%置信区间[CI]1.47-1.59），呈海洛因阳性的可能性低 47%[IRR 1.47，95%CI 1.34-1.57]，呈冰毒阳性的可能性低 35%[IRR 1.35，95%CI 1.24-1.45]，p<0.001。芬太尼两组之间的差异无统计学意义。
可卡因、海洛因、芬太尼和冰毒的总体阳性率较低。存在规定的阿片类药物的患者呈可卡因、海洛因或冰毒阳性的可能性较低。在这个疼痛管理人群中，物质使用模式应被用来为正在进行的政策决策提供信息。
