Presented at the 2013 AAPM Annual Meeting « Back

Urine Drug Testing and Pain Management: The Role of Patient Characteristics in Physician Decision-Making

Arthur W. Wood, MD, arthurwood@gmail.com¹, Michelle Roach, MD¹, Edward Michna, MD JD², Ajay D. Wasan, MD MSc², (1) Brigham and Women's Hospital, Boston, Massachusetts, (2) Brigham and Women's Hospital, Chestnut Hill, Massachusetts

Introduction: The frequency of urine drug testing (UDT) in the outpatient pain management setting varies with practitioner. This study aims to determine what patient characteristics are associated with a physician’s decision to obtain UDT at an initial clinic evaluation. Methods: Initial encounters of 200 opioid-taking subjects presenting to a pain management clinic were retrospectively reviewed with IRB approval. Subjects were divided into two groups: those who received UDT at the initial or second encounter and those who did not. Various subject characteristics were recorded including sex, age, single versus multiple opioid formulation usage, history of psychiatric diagnosis such as major depression, and history of illicit substance use. Results: Of the 200 subjects, 120 received UDT at the initial or second encounter (S group) while 80 did not (NS group). Subjects in the S group were significantly younger (P<.005) and had greater prevalence of both psychiatric diagnoses (P<0.005) and illicit substance use (P<.001). Sex and single versus multiple opioid formulation usage were not associated with subject group. Conclusions: In this study, age, psychiatric comorbidity, and history of illicit substance use were associated with a pain management physician’s decision to obtain UDT on a new opioid-taking clinic patient. Such physician decision making processes may undermine the ability to institute "universal precautions" across clinic populations. Further investigation is needed to delineate the relationship between patient characteristics and physician decision-making with respect to drug testing.

Funding: None