Systematic urine drug testing for detecting and managing opioid misuse among chronic noncancer pain patients in primary care—The HARMS Program: A retrospective chart review of 77 patients

Niharika Shahi, HBSc; Ryan Patchett-Marble, BSc, MD, CCFP(AM)

doi:10.5055/jom.2020.0581

Authors

Niharika Shahi, HBSc
Ryan Patchett-Marble, BSc, MD, CCFP(AM)

DOI:

https://doi.org/10.5055/jom.2020.0581

Keywords:

addiction, chronic noncancer pain, opioid, primary care, remote, rural, urine drug testing

Abstract

The prevalence of opioid abuse has reached an epidemic level. National guidelines recommend safer opioid prescribing practices, including potentially monitoring patients with urine drug testing (UDT). There is limited research evidence surrounding the use of UDT in the context of chronic noncancer pain (CNCP). We evaluated the efficacy of systematic, randomized UDT to detect and manage opioid misuse among patients with CNCP in primary care. The Marathon Family Health Team (MFHT) designed and implemented a clinic-wide, randomized UDT program called the HARMS (High-yield Approach to Risk Mitigation and Safety) Program. This retrospective chart review includes 77 CNCP patients being prescribed opioids, who were initially stratified by their prescriber as “low-risk.” Each month, 10 percent of patients were selected for a random UDT with double testing (immunoassay and liquid chromatography-mass spectrometry). The primary outcome measure was UDT leading to a change in management plan. Of the 77 patients in the study, 55 (71 percent) completed at least one UDT during the 12-month study period. Overall, 22 patients had aberrant results. UDT led directly to changes in management in 15 of those patients. Four of those 15 patients were escalated to an addictions program, two were tapered from opioids with informed discussion, and nine were escalated to the high-risk monitoring stream. The results of this study show that in low-risk CNCP patients prescribed opioids, applying systematic UDT in a primary care setting is effective for detecting high risk behaviors and addiction, and altering management. Further research is needed with larger numbers using a prospective study design.

Author Biographies

Niharika Shahi, HBSc

Medical Student, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada

Ryan Patchett-Marble, BSc, MD, CCFP(AM)

Family Physician, Marathon Family Health Team, Marathon, Ontario, Canada; Professor, Medicine at the Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada

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