Shorter drug testing intervals are associated with improved drug misuse rates

Jeff Gudin, MD; Neel Mehta, MD; F. Leland McClure, PhD; Justin K. Niles, MA; Harvey W. Kaufman, MD

doi:10.5055/jom.2020.0591

Authors

Jeff Gudin, MD
Neel Mehta, MD
F. Leland McClure, PhD
Justin K. Niles, MA
Harvey W. Kaufman, MD

DOI:

https://doi.org/10.5055/jom.2020.0591

Keywords:

repeat drug testing, follow-up time intervals, opioids, nonprescribed drug use, prescription drug compliance

Abstract

Objective: The Centers for Disease Control and Prevention (CDC) recommend that clinicians prescribing opioids for chronic pain should consider at least annual urine drug testing (UDT). We evaluated whether shorter intervals for repeat UDT are associated with decreased rates of drug misuse.

Design: Retrospective analysis of deidentified serial UDT and matched prescribing data.

Setting: We analyzed Quest Diagnostics 2016-2017 UDT results from new patients being monitored for prescription drug adherence, in nonsubstance use disorder (SUD) treatment environments.

Main Outcome Measures: Drug misuse was defined as the absence of a prescribed substance or the presence of a nonprescribed substance. Patients with ≥3 sets of the UDT results were included.

Results: UDT results from 49,601 patients (148,803 specimens) were tested. Declines in misuse between the first and second UDT were highest for those tested at the shortest intervals: approximately weekly, 19 percent; monthly, 15 percent; bimonthly, 12 percent; quarterly, 9 percent; semiannually, 3 percent; misuse rates increased by 1 percent for patients tested annually. Declines in misuse were more pronounced for opioids than other drug groups. Substantial declines in positivity were noted for heroin (32 percent) and nonprescribed fentanyl (10 percent). Declines in misuse between the second and third UDT followed a similar pattern.

Conclusions: UDT intervals of ≤ quarterly were associated with marked declines, but testing annually or semiannually was not associated with consistent decreases. Our findings suggest that clinical strategies that include serial testing conducted quarterly or sooner may be instrumental in decreasing drug misuse. Testing more frequently than “at least once annually” should be considered by clinicians monitoring potential drug misuse.

Author Biographies

Jeff Gudin, MD

Quest Diagnostics, Secaucus, New Jersey; Rutgers New Jersey Medical School, Newark, New Jersey

Neel Mehta, MD

Weill Cornell Pain Management, New York-Presbyterian Hospital, New York

F. Leland McClure, PhD

Quest Diagnostics, Secaucus, New Jersey

Justin K. Niles, MA

Quest Diagnostics, Secaucus, New Jersey

Harvey W. Kaufman, MD

Senior Medical Director, Medical Informatics—Quest Diagnostics, Secaucus, New Jersey

References

Hedegaard H, Miniño AM, Warner M: Drug overdose deaths in the United States, 1999-2017. NCHS Data Brief, no 329. Hyattsville, Maryland: National Center for Health Statistics; 2018. Available at https://www.cdc.gov/nchs/products/databriefs/db329.htm. Accessed February 12, 2019.

Scholl L, Seth P, Kariisa M, et al.: Drug and opioid-involved overdose deaths—United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2019; 67: 1419-1427.

Buchanich JM, Balmert LC, Williams KE, et al.: The effect of incomplete death certificates on estimates of unintentional opioid-related overdose deaths in the United States, 1999-2015. Public Health Rep. 2018; 133: 423-431.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016; 65: 1-49.

Gilbert JW, Wheeler GR, Mick GE, et al.: Importance of urine drug testing in the treatment of chronic noncancer pain: Implications of recent medicare policy changes in Kentucky. Pain Phys. 2010; 13(2): 167-186.

Standridge JB, Adams SM, Zotos AP: Urine drug screening: A valuable office procedure. Am Fam Phys. 2010; 81(5): 635-640.

Consensus Statement. Appropriate use of drug testing in clinical addiction medicine. Available at https://www.asam.org/docs/default-source/quality-science/appropriate_use_of_drug_testing_in_clinical-1-(7).pdf?sfvrsn=2. Accessed September 11, 2018.

McCarberg BH: A critical assessment of opioid treatment adherence using urine drug testing in chronic pain management. Postgrad Med 2011; 123(6): 124-131.

Katz N, Fanciullo GJ: Role of urine toxicology testing in the management of chronic opioid therapy. Clin J Pain. 2002; 18(4 Suppl): S76-S82.

Blum K, Han D, Femino J, et al.: Systematic evaluation of “compliance” to prescribed treatment medications and “abstinence” from psychoactive drug abuse in chemical dependence programs: Data from the comprehensive analysis of reported drugs. PLoS ONE. 2014; 9(9): e104275.

Pesce A, West C, Rosenthal M, et al.: Illicit drug use in the pain patient population decreases with continued drug testing. Pain Phys. 2011; 14: 189-193.

Manchikanti L, Manchukonda R, Pampati V, et al.: Does random urine drug testing reduce illicit drug use in chronic pain patients receiving opioids? Pain Phys. 2006; 9(2): 123-129.

Starrels JL, Becker WC, Alford DP, et al.: Systematic review: Treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain. Ann Intern Med. 2010; 152(11): 712-720.

Jamison RN, Ross EL, Michna E, et al.: Substance misuse treatment for high-risk chronic pain patients on opioid therapy: A randomized trial. Pain. 2010; 150(3): 390-400.

United States Department of Agriculture Economic Research Service: Rural-urban continuum codes. Available at http://www.ers.usda.gov/data-products/rural-urban-continuum-codes/.aspx. Accessed January 10, 2019.