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Association Between Urine Drug Test Results and Treatment Outcome in High-Risk Chronic Pain Patients on Opioids

Barth, Kelly S. DO; Becker, William C. MD; Wiedemer, Nancy L. RN, MSN, CRNP; Mavandadi, Shahrzad PhD; Oslin, David W. MD; Meghani, Salimah H. PhD, CRNP; Gallagher, Rollin M. MD, MPH

doi: 10.1097/ADM.0b013e3181c379ed
Original Article

Objective: How to best use urine drug test (UDT) results in the management of opioid pharmacotherapy has not been elucidated. The purpose of this study was to describe how the results of UDTs gathered from a group of chronic pain patients in a high-risk monitored opioid pharmacotherapy program apply to treatment outcome.

Methods: Retrospective review of the medical records of 335 primary care patients on chronic opioids more than 22 months.

Results: Patients with a UDT containing unprescribed opioids were more likely to demonstrate resolution of aberrant behavior (P = 0.02) and less likely to be discharged from treatment (P = 0.04). Patients with cocaine, alone or in combination, in the UDT were less likely to resolve aberrant behavior (P = 0.007 and 0.001), and were more likely to be electively or administratively discharged from treatment (P = 0.012 and 0.001).

Discussion: In this group of high-risk pain patients on chronic opioids, information gained from UDT results can be used to predict treatment outcomes and inform appropriate interventions. Patients on chronic opioids who have a UDT positive for an illicit opioid or unprescribed opioids alone are more likely to respond to monitored opioid pharmacotherapy. Patients with a UDT positive for cocaine, alone or in combination, are less likely to resolve aberrant behavior within the structure of a monitored opioid pharmacotherapy program and are more likely to be discharged electively or administratively from the program without significant transition to addiction treatment. Further studies are needed to investigate which patient responded best to structured opioid pharmacotherapy programs and how to appropriately handle abnormal UDT results to improve the management and engagement in appropriate treatment for this population.

From the Department of Psychiatry and Behavioral Sciences (KSB), Medical University of South Carolina, Charleston, SC; Department of Internal Medicine (WCB), Yale University School of Medicine, New Haven, CT; Philadelphia VA Medical Center (NLW, DWO, RMG), Philadelphia, PA; and Department of Psychiatry (SM, DWO, RMG), Department of Anesthesia (RMG), and School of Nursing (SHM), University of Pennsylvania, Philadelphia, PA.

Received for publication July 30, 2009; accepted September 29, 2009.

Send correspondence and reprint requests to Kelly S. Barth, DO, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, PO Box 250861, Charleston, SC 29425. E-mail:

Supported by VISN-4 Competitive Pilot Project Funding (to N.S.L.).

© 2010 American Society of Addiction Medicine