A study published in the August issue of the peer-reviewed journal Population Health Management revealed that the majority of patients prescribed opioids for chronic pain were unlikely to be taking their medicine in a manner consistent with their prescribed regimen. In the study, titled “Inappropriate Drug Use in the Chronic Pain Population,” 938,586 urine toxicology tests conducted on over 500,000 patients prescribed chronic opioid therapy were analyzed using proprietary and state of the art screening methods offered by Ameritox®. The analysis showed that 38% of patients had no detectable level of their prescribed medication (typically an opioid or benzodiazepine type drug); 27% had a drug level higher than expected; 15% had a drug level lower than expected; 11% had major illicit drugs such as cocaine or methamphetamines detected in their urine; and 29% had a medication in their system that the doctor was likely unaware of. In summary, urine toxically testing showed that only 25% of the patients were definitively taking their medications as prescribed, with no evidence of illicit drug use or misuse of prescribed drugs.

“This large-scale, comprehensive study sheds light on how beneficial pain medication monitoring can be for identifying whether prescribed opioids are appropriately being used by patients and, as a result, whether they are achieving optimal pain management,” said Harry L. Leider, M.D., M.B.A., Chief Medical Officer of Ameritox and one of the study investigators. “Monitoring is a critical tool that physicians can use in combination with clinical expertise, intuition and their knowledge of each patient’s history to initiate a conversation about proper use of controlled substances and ultimately improve outcomes for patients with chronic pain.”

The study confirmed previously reported findings that inappropriate use of prescribed medication s all demographic groups, although to different degrees. The primary gender difference observed in this study was that males were significantly more likely to have an illicit drug detected than females. Illicit drug use was nearly twice as likely in patients between the ages of 12 and 21 as in patients between the ages of 35 and 50. In addition, patients 35-50 were over 30% more likely than patients 12-21 to have no prescribed medication detected in their urine – raising concerns of potential drug diversion within this group of patients vs. non-adherence due to side effects or other factors.

“Urine medication monitoring not only helps physicians to detect illegal drugs that may be in the patient’s system,” said Hammam Akbik, M.D., Assistant Professor of Anesthesiology and Pain Management at the University of Cincinnati College of Medicine and Director of Pain Management for the University’s Division of Pain Management, “but also helps identify legal prescription medications they may be taking that could result in harmful interactions. It allows physicians to more accurately measure overall patient compliance and determine if changing the number of medications a patient is prescribed is appropriate. Medication monitoring also plays an important role in helping physicians identify potentially harmful side effects/interactions with over the counter remedies the patient may be taking.”

The latest guidelines issued by the American Pain Society for the treatment of patients recommends that physicians conduct formal assessments of patients who are candidates for chronic opioid therapy to determine the risk of medication abuse and addiction by using formal screening questionnaires. The guidelines also recommend that physicians conduct periodic urine drug testing in patients at high risk for misuse, abuse, and diversion, as well as consideration of periodic urine testing in all patients on chronic opioid therapy, even those who are not at high risk for misuse.

“Urine medication monitoring has evolved into an essential and integral component of pain management,” said Dr. Akbik, M.D., “and is part of the risk map that opiate prescribers must follow when prescribing narcotic mediations.” About the Study

Data were collected from 938,586 urine toxicology tests conducted during routine clinic visits from January 2006 to January 2009. Urine screening was performed using Ameritox’s Rx GuardianSM testing process, which consists of two distinct phases. The first phase screened for opiates, benzodiazepines, illicit drugs, and other related medications. If positive, these immunoassays were then followed with confirmatory testing using mass spectrometry assays. The second phase of testing used patient demographic data, urine drug test results, urine pH, and specific gravity to calculate a normalized patient result using a proprietary methodology offered by Ameritox. These normalized results were then compared with a set of expected ranges developed from tests of known compliant patients.

In addition to Dr. Leider, study authors included Joseph E. Couto, Pharm.D., M.B.A., Pharmacoeconomics & Outcomes Research Fellow at Jefferson School of Population Health; Martha C. Romney, M.S., R.N., Esq., project director at Jefferson School of Population Health; Smiriti Sharma of Jefferson Medical College; and Neil I. Goldfarb, associate dean for research at Jefferson School of Population Health.

Pain.com