Presented at the 2012 AAPM Annual Meeting « Back

Developing Recommendations for Urine Drug Monitoring for Patients on Long-Term Opioid Therapy

Joseph E. Couto, PharmD MBA, joseph.couto@jefferson.edu¹, John F. Peppin, DO FACP², Perry G. Fine, MD³, Steven D. Passik, PhD⁴, Neil I. Goldfarb, BA ABD⁵, (1) Thomas Jefferson School of Population Health, Philadelphia, Pennsylvania, (2) The Pain Treatment Center of the Bluegrass, Lexington, Kentucky, (3) University of Utah, Salt Lake City, Utah, (4) Vanderbilt University Medical Center, Nashville, Tennessee, (5) Greater Philadelphia Business Coalition on Health, Philadelphia, Pennsylvania

Introduction: Several prominent guidelines recommend that patients on long-term opioid therapy have periodic urine drug monitoring (UDM) for appropriate use, however, none address the specific questions of which patients to test, which substances to test for, how often to test, and how to act on the results. Materials and Methods: A panel of experts in the field of pain and addiction medicine was convened to develop consensus urine drug monitoring (UDM) recommendations based upon a thorough review of exigent literature on the subject and their own clinical practice perspectives. It was concluded that in the absence of a substantial literature or evidence of predictive outcomes, recommendations would be developed over three in-person meetings and intervening draft revisions. Results: The group was able to achieve consensus on a set of UDM recommendations addressing test selection, test frequency, interpretation of results, and how to handle discrepancies based on specific results. These recommendations were sent to pain professional societies for critical review and feedback. Conclusion: While the participating panel members recognize that there currently is a limited evidence base to support the expert panel’s recommendations, primary care physicians and pain specialists do not have a structure to guide practice. The recommendations are meant to begin to provide a framework for standardizing practices for UDM testing in the treatment of chronic pain, and to serve as a catalyst to advance research that quantifies the effects of UDM as a risk management tool for opioid therapy management and associated patient outcomes.

Funding: Financial support was provided in the form of an unrestricted grant from Ameritox, Inc.