Provider reasons for discontinuing long-term opioid therapy following aberrant urine drug tests differ based on the type of substance identified

Jessica J. Wyse, PhD; Benjamin J. Morasco, PhD; Steven K. Dobscha, MD; Michael I. Demidenko, BS; Thomas H. A. Meath, MPH; Travis I. Lovejoy, PhD, MPH

doi:10.5055/jom.2018.0461

Authors

Jessica J. Wyse, PhD
Benjamin J. Morasco, PhD
Steven K. Dobscha, MD
Michael I. Demidenko, BS
Thomas H. A. Meath, MPH
Travis I. Lovejoy, PhD, MPH

DOI:

https://doi.org/10.5055/jom.2018.0461

Keywords:

urine drug test, long-term opioid therapy, substance misuse, substance abuse, opioid discontinuation

Abstract

Objective: Urine drug testing (UDT) is increasingly performed as a means of identifying aberrant behavior that may be grounds for discontinuation of long-term opioid therapy (LTOT). Little is known, however, about the ways in which positive UDT results may differentially inform decisions to discontinue LTOT based on the type of substance for which the UDT screened positive. The aim of this study was to examine the likelihood of clinician-initiated discontinuation of LTOT attributed to positive UDT results across three discrete categories of substances: (1) cannabis, (2) alcohol or illicit substances (excluding cannabis), and (3) controlled prescription medications that were not prescribed.

Design: This retrospective study utilized the US Department of Veterans Affairs (VA) Health Care System. Corporate Data Warehouse to assemble a sample of 600 patients with substance use disorders and matched controls who were discontinued from LTOT in 2012. Comprehensive manual medical record review identified UDT results in the year prior to discontinuation and reason(s) for discontinuation.

Patients, Participants: Patients with one or more UDTs positive for a single substance (N = 185) comprised the study sample.

Main Outcome Measure(s): Likelihood of clinician-initiated discontinuation attributed to a positive UDT across the three categories.

Results: Patients with one or more UDTs positive for cannabis were more likely to be discontinued from opioid therapy as a result of the positive UDT compared to those with one or more UDTs positive for nonprescribed prescription medication (adjusted odds ratio [OR] = 18.05, 95% CI = 7.29-44.66). Similarly, patients with UDTs positive for alcohol or illicit substances were more likely to be discontinued for the positive UDTs relative to patients who tested positive for nonprescribed prescription medications (adjusted OR = 13.10, 95% CI = 4.81-35.68). No difference in UDT-related discontinuation decisions was evident between patients with UDTs positive for alcohol/illicit substances versus cannabis (adjusted OR = 1.47, 95% CI = 0.57-3.77).

Conclusions: High odds of UDT-related discontinuation were found in patients who tested positive for cannabis, alcohol, or illicit substances, relative to nonprescribed prescription medications.

Author Biographies

Jessica J. Wyse, PhD

Postdoctoral Fellow, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; Research Assistant Professor, OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon

Benjamin J. Morasco, PhD

Core Investigator, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; Associate Professor, Department of Psychiatry, Oregon Health & Science University, Portland, Oregon

Steven K. Dobscha, MD

Director, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; Professor, Department of Psychiatry, Oregon Health & Science University, Portland, Oregon

Michael I. Demidenko, BS

Graduate Student, Department of Psychology, University of Michigan, Ann Arbor, Michigan

Thomas H. A. Meath, MPH

Research Associate, Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon

Travis I. Lovejoy, PhD, MPH

Core Investigator, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; Assistant Professor, Department of Psychiatry and School of Public Health, Oregon Health & Science University, Portland, Oregon

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