What Do Clinicians Do in Response to Aberrant Urine Drug Test Results?
After aberrant urine drug testing, 17.5% of clinicians documented that they were discontinuing or changing the dose of opioid medication.
After an aberrant urine drug testing (UDT) result in patients on opioid therapy, the majority of clinicians were found to change opioid dosing or enact another strategy to reduce opioid-related risks, according to study results published in the Clinical Journal of Pain.
The study included patients consulting at a Department of Veterans Affairs center who had recently initiated opioid therapy. Random samples from 100 patients who had aberrant positive UDT results (positive for non-prescribed/illicit substance), 100 patients who had aberrant negative UDT results (negative for prescribed opioid), and 100 patients who had expected UDT results were selected, and the participants' medical records were examined to identify opioid prescribing changes and risk reduction strategy in the 12 months after UDT.
After an aberrant UDT, 17.5% of clinicians documented that they were discontinuing or changing the dose of opioid medication. An additional 52.5% of clinicians enacted another strategy to reduce opioid-related risks; in 85% of cases, having the participant complete an opioid treatment agreement or discussing with the patient how to take opioids safely.
Having an aberrant positive UDT or a higher prescription opioid dose were found to be associated with a planned change in opioid prescription status (odds ratio [OR], 30.77; 95% CI, 5.92-160.10 and OR, 1.01; 95% CI, 1.01-1.02, respectively). Having an aberrant positive UDT was also found to be associated with implementation of other risk reduction strategies (OR, 0.29; 95% CI, 0.16-0.55).
“Prospective and experimental studies are needed to examine the efficacy of different strategies for responding to aberrant urine drug testing results, with a focus on improving quality of life and minimizing treatment-related harms,” the researchers wrote.
Morasco BJ, Krebs EE, Adams MH, et al. Clinician response to aberrant urine drug test results of patients prescribed opioid therapy for chronic pain. [published online September 15, 2018]. Clin J Pain. doi:10.1097/AJP.0000000000000652