Correlates of opiate misuse based on aberrant urine drug tests for patients on chronic opiate therapy in a safety-net, academic primary care clinic

Smita Bakhai, MD, MPH, FACP; Bright Thilagar, MD; Jessica L. Reynolds, PhD; Kenneth E. Leonard, PhD

doi:10.5055/jom.2018.0426

Authors

Smita Bakhai, MD, MPH, FACP
Bright Thilagar, MD
Jessica L. Reynolds, PhD
Kenneth E. Leonard, PhD

DOI:

https://doi.org/10.5055/jom.2018.0426

Keywords:

prescription opioid misuse, nonadherence, urine drug test, primary care, substance use disorder, chronic noncancer pain

Abstract

Objective: Determine correlates of opiate misuse based on urine drug test (UDT) among patients on chronic opiate therapy (COT) for chronic noncancer pain.

Design: A cross-sectional study.

Setting: Urban, academic clinic.

Participants: UDT performed in 206 patients on COT for at least 3 months duration within a one-year period. Patients were classified based on UDT results: (1) Appearance of Opiate Adherence: Positive UDT for prescribed opiate and negative for illicit drugs and nonprescribed control substances; (2) Opiate Misuse; Overt nonadherence: (a) Positive UDT for illicit drugs and/or nonprescribed controlled substances AND positive or negative for prescribed opiates (b) Overdose; (3) Possible opiate nonadherence: Negative for prescribed opiates and negative for illicit and nonprescribed controlled substances.

Interventions: None.

Main outcome measures: UDT results, patient demographics, medical history, healthcare adherence, and utilization measures.

Results: Of the 206 records analyzed, 80 (38 percent) had appearance of opiate adherence, 91 (44 percent) had misuse, and 35 (17 percent) had possible opiate nonadherence. Analysis was performed comparing misuse and appearance of opiate adherence groups. In bivariate analyses, history of smoking (OR 3.90, 95% CI 1.69-9.03), substance use (OR 7.02, 95% CI 2.56-19.20), missed medical appointments (OR 2.85, 95% CI 1.44-5.63), and nonadherence to other medications correlated with misuse group (OR 18.86, 95% CI 8.73-40.74). In logistic regression, only substance use history (OR 4.32, 95% CI 1.27-14.64) and nonadherence with nonopiate medications (OR 13.22, 95% CI 5.81-30.10) correlated with misuse.

Conclusions: Medication nonadherence and missed appointments for other chronic conditions were significant correlates of opiate misuse.

Author Biographies

Smita Bakhai, MD, MPH, FACP

Medical Director, Internal Medicine Center, Assistant Professor, Department of Internal Medicine, University at Buffalo, The State University of New York, Erie County Medical center, Buffalo, New York

Bright Thilagar, MD

University at Buffalo, Buffalo, New York

Jessica L. Reynolds, PhD

University at Buffalo, New York

Kenneth E. Leonard, PhD

Research Institute on Addictions, University at Buffalo, Buffalo, New York

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