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Urine Drug Testing for Opioids in the Rehabilitation Patient

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Comprehensive Pain Management in the Rehabilitation Patient

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Abstract

Urine drug testing (UDT) is the most practical, necessary, and low-cost tool in monitoring opioid management in the outpatient clinical settings. Due to the high risk of misuse, tolerance, and dependence of opioids, it is crucial to monitor patient compliance. Besides other screening methods, which include pill counts, state-regulated registries, and opioid agreements, clinicians and patients alike benefit from UDT in delivering proper opioid maintenance therapy. Furthermore, monitoring is a requirement of federal, state, and local governments, medical clinics, as well as health insurance companies with a goal of preventing abuse of opioid analgesics and providing appropriate pain management. While UDT is one of the major tools of adherence monitoring to assess patient compliance, there are several limitations related to the reliability of the tests used, and limitations in the understanding of the pain physician as to how to interpret and use the results in the clinical setting. This chapter aims to address UDT, a simple, available, and useful method for monitoring the use of opioids and other drugs in chronic pain patients.

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References

  1. Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being. A World Health Organization study in primary care. JAMA. 1998;280:147–51.

    Article  CAS  PubMed  Google Scholar 

  2. Franklin ZC, Smith NC, Fowler NE. A qualitative investigation of factors that matter to individuals in the pain management process. Disabil Rehabil. 2016;4:1–9.

    Google Scholar 

  3. Victor L, Richeimer SH. Trustworthiness as a clinical variable: the problem of trust in the management of chronic, nonmalignant pain. Pain Med. 2005;6:385–91.

    Article  PubMed  Google Scholar 

  4. Kavukcu E, Akdeniz M, Avci HH, Altuğ M, Öner M. Chronic noncancer pain management in primary care: family medicine physicians’ risk assessment of opioid misuse. Postgrad Med. 2015;127(1):22–6.

    Article  PubMed  Google Scholar 

  5. Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016;64(50):1378–82.

    Google Scholar 

  6. Manchikanti L, Helm 2nd S, Fellows B, Janata JW, Pampati V, Grider JS, Boswell MV. Opioid epidemic in the United States. Pain Physician. 2012;15(3 Suppl):ES9–38.

    Article  PubMed  Google Scholar 

  7. Sehgal N, Colson J, Smith HS. Chronic pain treatment with opioid analgesics: benefits versus harms of long-term therapy. Expert Rev Neurother. 2013;13(11):1201–20.

    Article  CAS  PubMed  Google Scholar 

  8. Volkow ND, McLellan TA. Curtailing diversion and abuse of opioid analgesics without jeopardizing pain treatment. JAMA. 2011;305:1346–7.

    Article  CAS  PubMed  Google Scholar 

  9. Manchikanti L et al. American Society of Interventional Pain Physicians. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: part I—evidence assessment. Pain Physician. 2012;15(3 Suppl):S1–65.

    Article  PubMed  Google Scholar 

  10. Manchikanti L, Cash KA, Damron KS, Manchukonda R, Pampati V, McManus CD. Controlled substance abuse and illicit drug use in chronic pain patients: an evaluation of multiple variables. Pain Physician. 2006;9(3):215–25.

    PubMed  Google Scholar 

  11. Vaglienti RM, Huber SJ, Noel KR, Johnstone RE. Misuse of prescribed controlled substances defined by urinalysis. W V Med J. 2003;99:67–70.

    PubMed  Google Scholar 

  12. Compton P. The role of urine toxicology in chronic opioid analgesic therapy. Pain Manag Nurs. 2007;8:166–72.

    Article  PubMed  Google Scholar 

  13. Tellioglu T. The use of urine drug testing to monitor patients receiving chronic opioid therapy for persistent pain conditions. Med Health R I. 2008;91(9):279–80. 282

    PubMed  Google Scholar 

  14. Bhamb B, Brown D, Hariharan J, Anderson J, Balousek S, Fleming MF. Survey of select practice behaviors by primary care physicians on the use of opioids for chronic pain. Curr Med Res Opin. 2006;22(9):1859–65.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Manchikanti L, Manchukonda R, Pampati V, Damron KS, Brandon DE, Cash KA, McManus CD. Does random urine drug testing reduce illicit drug use in chronic pain patients receiving opioids? Pain Physician. 2006;9(2):123–9.

    PubMed  Google Scholar 

  16. Pergolizzi J, Pappagallo M, Stauffer J, Gharibo C, Fortner N, De Jesus MN, Brennan MJ, Richmond C, Hussey D, Integrated Drug Compliance Study Group (IDCSG). The role of urine drug testing for patients on opioid therapy. Pain Pract. 2010;10(6):497–507.

    Article  PubMed  Google Scholar 

  17. Kirchheiner J, Schmidt H, Tzvetkov M, Keulen JT, Lötsch J, Roots I, Brockmöller J. Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to CYP2D6 duplication. Pharmacogenomics J. 2007;7:257–65.

    Article  CAS  PubMed  Google Scholar 

  18. Bernard JP, Opdal MS, Karinen R, Mørland J, Khiabani HZ. Relationship between methadone and EDDP (2-ethy-lidene-1,5-dimethyl-3,3-diphenyl-pyrrolidine) in urine samples from Norwegian prisons. Eur J Clin Pharmacol. 2007;63:777–82.

    Article  CAS  PubMed  Google Scholar 

  19. Coopman V, Cordonnier J, Pien K, Van Varenbergh D. LC-MS/MS analysis of fentanyl and norfentanyl in a fatality due to application of multiple Durogesic transdermal therapeutic systems. Forensic Sci Int. 2007;169(2-3):223–7.

    Article  CAS  PubMed  Google Scholar 

  20. Manchikanti L et al. Protocol for accuracy of point of care (POC) or in-office urine drug testing (Immunoassay) in chronic pain patients: a prospective analysis of immunoassay and liquid chromatography tandem mass spectometry (LC/MS/MS). Pain Physician. 2010;13:E1–E22.

    Article  PubMed  Google Scholar 

  21. Moeller KE, Lee KC, Kissack JC. Urine drug screening: practical guide for clinicians. Mayo Clin Proc. 2008;83(1):66–76.

    Article  CAS  PubMed  Google Scholar 

  22. Christo PJ, Manchikanti L, Ruan X, Bottros M, Hansen H, Solanki DR, Jordan AE, Colson J. Urine drug testing in chronic pain. Pain Physician. 2011;14(2):123–43.

    Article  PubMed  Google Scholar 

  23. Greene MS, Chambers RA. Pseudoaddiction: fact or fiction? An investigation of the medical literature. Curr Addict Rep. 2015;2(4):310–7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Drug Testing: A White Paper of the American Society of Addiction Medicine (ASAM). http://www.asam.org/docs/default-source/publicy-policy-statements/drug-testing-a-white-paper-by-asam.pdf. Accessed 26 Oct 2013.

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Authors and Affiliations

  1. Division of Substance Use Disorders, Department of Psychiatry, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA

    Tahir Tellioglu M.D.

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  1. Tahir Tellioglu M.D.
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Correspondence to Tahir Tellioglu M.D. .

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Editors and Affiliations

  1. Department of Neurosurgery, Brown University, Warren Alpert Medical School, Providence, USA

    Alexios Carayannopoulos DO, MPH

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Tellioglu, T. (2017). Urine Drug Testing for Opioids in the Rehabilitation Patient. In: Carayannopoulos DO, MPH, A. (eds) Comprehensive Pain Management in the Rehabilitation Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-16784-8_32

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  • DOI: https://doi.org/10.1007/978-3-319-16784-8_32

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16783-1

  • Online ISBN: 978-3-319-16784-8

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