Krishnan Chakravarthy1,2, Aneesh Goel3, George M Jeha4, Alan David Kaye4,5, Paul J Christo6. 1. VA San Diego Healthcare System, UC San Diego School of Medicine, La Jolla, CA, USA. kvchakravarthy@ucsd.edu. 2. Department of Anesthesiology, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA. kvchakravarthy@ucsd.edu. 3. Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, 550 North Broadway, Suite 301, Baltimore, MD, 21205, USA. 4. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA. 5. Departments of Anesthesiology and Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA, USA. 6. Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, 550 North Broadway, Suite 301, Baltimore, MD, 21205, USA. pchristo@jhmi.edu.
Abstract
PURPOSE OF REVIEW: Therapeutic use, misuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain remain a major concern for physicians, the government, payers, and patients. The challenge remains finding effective diagnostic tools that can be clinically validated to eliminate or substantially reduce the abuse of controlled prescription drugs, while still assuring the proper treatment of those patients in pain. Urine drug testing still remains an important means of adherence monitoring, but questions arise as to its relevance and effectiveness. This review examines the role of UDT, determines its utility in current clinical practice, and investigates its relevance in current chronic pain management. RECENT FINDINGS: A review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature was searched from year 2000 to present examining the relevance and role of UDT in monitoring chronic opioid therapy along with reliability and accuracy, appropriate use, overuse, misuse, and abuse. There are only a limited number of reviews and investigations on UDT, despite the fact that clinicians who prescribe controlled medications for chronic states commonly are expected to utilize UDT. Therefore, despite highly prevalent use, there is a limited publication base from which to draw in this present study. Regardless of experience or training background, physicians and healthcare providers can much more adequately assess opioid therapy with the aid of UDT, which often requires confirmatory testing by a laboratory for clinical and therapeutic prescribing decisions. It has become a strongly recommended aspect of pain care with controlled substances locally, regionally, and nationally. Incorporating UDT for all patients in whom chronic opioid therapy is undertaken is consistent with state and national guidelines and best practice strategies. Practice standards vary as to the frequency of UDT locally, regionally, and nationally, however.
PURPOSE OF REVIEW: Therapeutic use, misuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain remain a major concern for physicians, the government, payers, and patients. The challenge remains finding effective diagnostic tools that can be clinically validated to eliminate or substantially reduce the abuse of controlled prescription drugs, while still assuring the proper treatment of those patients in pain. Urine drug testing still remains an important means of adherence monitoring, but questions arise as to its relevance and effectiveness. This review examines the role of UDT, determines its utility in current clinical practice, and investigates its relevance in current chronic pain management. RECENT FINDINGS: A review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature was searched from year 2000 to present examining the relevance and role of UDT in monitoring chronic opioid therapy along with reliability and accuracy, appropriate use, overuse, misuse, and abuse. There are only a limited number of reviews and investigations on UDT, despite the fact that clinicians who prescribe controlled medications for chronic states commonly are expected to utilize UDT. Therefore, despite highly prevalent use, there is a limited publication base from which to draw in this present study. Regardless of experience or training background, physicians and healthcare providers can much more adequately assess opioid therapy with the aid of UDT, which often requires confirmatory testing by a laboratory for clinical and therapeutic prescribing decisions. It has become a strongly recommended aspect of pain care with controlled substances locally, regionally, and nationally. Incorporating UDT for all patients in whom chronic opioid therapy is undertaken is consistent with state and national guidelines and best practice strategies. Practice standards vary as to the frequency of UDT locally, regionally, and nationally, however.
Entities:
Keywords:
Abuse; Adherence monitoring; Benzodiazepines; Chromatography; Compliance monitoring; Controlled substances; Diversion; False negatives; False positives; Illicit drugs; Immunoassay; Opioids; Prescription drug monitoring programs; Substance use disorder; Urine drug testing
Authors: John F Peppin; Steven D Passik; Joseph E Couto; Perry G Fine; Paul J Christo; Charles Argoff; Gerald M Aronoff; Daniel Bennett; Martin D Cheatle; Kieran A Slevin; Neil I Goldfarb Journal: Pain Med Date: 2012-06-13 Impact factor: 3.750
Authors: Roger Chou; Gilbert J Fanciullo; Perry G Fine; Jeremy A Adler; Jane C Ballantyne; Pamela Davies; Marilee I Donovan; David A Fishbain; Kathy M Foley; Jeffrey Fudin; Aaron M Gilson; Alexander Kelter; Alexander Mauskop; Patrick G O'Connor; Steven D Passik; Gavril W Pasternak; Russell K Portenoy; Ben A Rich; Richard G Roberts; Knox H Todd; Christine Miaskowski Journal: J Pain Date: 2009-02 Impact factor: 5.820
Authors: Joseph V Pergolizzi; Peter Magnusson; Paul J Christo; Jo Ann LeQuang; Frank Breve; Kailyn Mitchell; Giustino Varrassi Journal: Front Pain Res (Lausanne) Date: 2021-11-16