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Clinician Response to Aberrant Urine Drug Test Results of Patients Prescribed Opioid Therapy for Chronic Pain

Morasco, Benjamin J., PhD*,†; Krebs, Erin E., MD, MPH‡,§; Adams, Melissa H., MA*,†; Hyde, Stephanie, MA*,†; Zamudio, Janet, MS*; Dobscha, Steven K., MD*,†

The Clinical Journal of Pain: January 2019 - Volume 35 - Issue 1 - p 1–6
doi: 10.1097/AJP.0000000000000652
Original Articles

Objective: Urine drug testing (UDT) is recommended for patients who are prescribed opioid medications, but little is known about the various strategies clinicians use to respond to aberrant UDT results. We sought to examine changes in opioid prescribing and implementation of other risk reduction activities following an aberrant UDT.

Methods: In a national cohort of Veterans Affairs patients with new initiations of opioid therapy through 2013, we identified a random sample of 100 patients who had aberrant positive UDTs (results positive for nonprescribed/illicit substance), 100 who had aberrant negative UDTs (results negative for prescribed opioid), and 100 who had expected UDT results. We examined medical record data for opioid prescribing changes and risk reduction strategies in the 12 months following UDT.

Results: Following an aberrant UDT, 17.5% of clinicians documented planning to discontinue or change the opioid dose and 52.5% initiated another strategy to reduce opioid-related risk. In multivariate analyses, variables associated with a planned change in opioid prescription status were having an aberrant positive UDT (odds ratio [OR], 30.77; 95% confidence interval [CI], 5.92-160.10) and higher prescription opioid dose (OR, 1.01; 95% CI, 1.01-1.02). The only variable associated with implementation of other risk reduction activities was having an aberrant positive UDT (OR, 0.29; 95% CI, 0.16-0.55).

Discussion: The majority of clinicians enacted some type of opioid prescribing or other change to reduce risk following an aberrant UDT, and the action depended on whether the result was an aberrant positive or aberrant negative UDT. Experimental studies are needed to develop and test strategies for managing aberrant UDT results.

*Center to Improve Veteran Involvement in Care, VA Portland Health Care System

Department of Psychiatry, Oregon Health & Science University, Portland, OR

Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System

§Department of Medicine, University of Minnesota Medical School, Minneapolis, MN

The content of this manuscript is solely the responsibility of the authors and does not represent the official views of the Department of Veterans Affairs, US Food & Drug Administration, or the National Institute on Drug Abuse.

Research reported in this manuscript was supported by awards from the US Food & Drug Administration (FD004508) and from the National Institute on Drug Abuse (034083). The work was also supported by resources from the VA Health Services Research and Development-funded Center to Improve Veteran Involvement in Care at the VA Portland Health Care System, Portland, OR (CIN 13-404). The authors declare no conflict of interest.

Reprints: Benjamin J. Morasco, PhD, VA Portland Health Care System (R&D99), 3710 SW, US Veterans Hospital Road, Portland, OR 97239 (e-mail:

Received January 22, 2018

Received in revised form May 25, 2018

Accepted September 3, 2018

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