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Urine Toxicology Screening Among Chronic Pain Patients on Opioid Therapy: Frequency and Predictability of Abnormal Findings

Michna, Edward MD, JD*; Jamison, Robert N. PhD* †; Pham, Loc-Duyen BS*; Ross, Edgar L. MD*; Janfaza, David MD*; Nedeljkovic, Srdjan S. MD*; Narang, Sanjeet MD*; Palombi, Diane RN*; Wasan, Ajay D. MD, MSc* †

doi: 10.1097/AJP.0b013e31802b4f95
Original Articles

Objective To examine the incidence of abnormal urine toxicology screening among chronic pain patients prescribed opioids for their pain and to relate these results to patient descriptors and type, number, and dose of prescribed opioids.

Methods A retrospective analysis of data from 470 patients who had urine screening at a pain management program in an urban teaching hospital was performed. Urine samples were analyzed using gas chromatography-mass spectrometry. Patients were categorized as having urine screens that were “normal” (expected findings based on their prescribed drugs) or abnormal. Abnormal findings were those of (1) absence of a prescribed opioid, (2) presence of an additional nonprescribed controlled substance, (3) detection of an illicit substance, and (4) an adulterated urine sample.

Results Forty-five percent of the patients were found to have abnormal urine screens. Twenty percent were categorized as having an illicit substance in their urine. Illicit substances and additional drugs were found more frequently in younger patients than in older patients (P<0.001). No other variables were found to predict abnormal urine screen results.

Discussion These results confirm past findings that random urine toxicology screens among patients prescribed opioids for pain reveal a high incidence of abnormal findings. Common patient descriptors, and number, type, and dose of prescribed opioids were found to be poor predictors of abnormal results.

*Department of Anesthesiology, Perioperative and Pain Medicine

Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Reprints: Ajay D. Wasan, MD, MSc, Pain Management Center, 850 Boylston St, Suite 320, Chestnut Hill, MA 02467 (e-mail:

Received for publication June 12, 2006; accepted October 8, 2006

© 2007 Lippincott Williams & Wilkins, Inc.