Presented at the 2013 AAPM Annual Meeting « Back

An Analysis of the Association Between Marijuana Use and Potential Nonadherence in Patients Prescribed Hydrocodone

Michael K. DeGeorge, PharmD, michael.degeorge@ameritox.com¹, Eric Dawson, PharmD², Patricia Woster, PharmD¹, Lisa Burke, PhD MBA RN¹, Mancia M. Ko, PharmD, MBA³, Kathryn Bronstein, PhD RN¹, (1) Ameritox, Baltimore, Maryland, (2) Ameritox, Fairhope, Alabama, (3) Ameritox, Evergreen, Colorado

Introduction: Marijuana use, particularly in teens and young adults, has been found to be associated with abuse of prescription opioids and other drugs.1,2,3 Despite this, there are varying views on the clinical relevance of a positive marijuana (THC) finding in pain patients. Therefore, we sought to investigate the relationship of marijuana use and potential nonadherence. Methods: A retrospective review was conducted utilizing a database of over 100,000 urine drug samples in patients prescribed hydrocodone. Data from an existing database was analyzed by researchers as de-identified, so IRB approval wasn’t obtained. Results were separated into three categories for analysis based on presence of illicit(s): THC only, cocaine only (a comparator because cocaine is typically considered a serious finding by clinicians), and no illicit found. Results were analyzed to determine the rates of having no hydrocodone detected and having nonprescribed medication detected. Results: The frequency of hydrocodone not being detected was 36% in the THC only group, 59% in cocaine only, and 27% of the no illicit group. Samples which contained any nonprescribed medication were 28% for both the THC and cocaine groups, but only 22% in the no illicit group. Conclusions: These data suggest that marijuana use is associated with potential nonadherence. In the case of finding a nonprescribed medication, the association is equal to that of cocaine. Clinicians should carefully consider these data when deciding whether to test for THC when utilizing urine drug monitoring for patients on chronic opioid therapy. References: 1) Fiellin L, et al. (2012). Previous Use of Alcohol, Cigarettes, and Marijuana and Subsequent Abuse of Prescription Opioids in Young Adults. Journal of Adolescent Health, published online August 21st, 2012 2) Lynskey MT, Heath AC, Bucholz KK, et al. Escalation of drug use in early onset cannabis users vs co-twin controls. JAMA 2003;289:427–33. 3) The DEA Position on Marijuana, January 2011 (http://www.justice.gov/dea/docs/marijuana_position_2011.pdf) Accessed September 11th, 2012.

Funding: None