Do Urine Drug Tests Reveal Substance Misuse Among Patients Prescribed Opioids for Chronic Pain?
Do Urine Drug Tests Reveal Substance Misuse Among Patients Prescribed Opioids for Chronic Pain?
复制标题
尿液药物测试是否表明服用阿片类药物治疗慢性疼痛的患者存在药物滥用？
DOI：
10.1007/s11606-021-07095-8
复制
发表时间：
2022
影响因子：
5.7
通讯作者：
Liebschutz,JaneM
中科院分区：
文献类型：
--
作者：
Larochelle,MarcR;Cruz,Ricardo;Kosakowski,Sarah;Gourlay,DougL;Alford,DanielP;Xuan,Ziming;Krebs,ErinE;Yan,Shapei;Lasser,KarenE;Samet,JeffreyH;Liebschutz,JaneM
背景尿药物试验(UDT)是治疗慢性疼痛的阿片类药物患者推荐的风险缓解策略，但UDT支持物质滥用鉴定的证据有限。目的确定UDT结果在慢性疼痛阿片类药物处方患者中的普及率，包括药物滥用。设计回顾队列研究。研究对象638名接受阿片类药物治疗的慢性疼痛患者，在一年的一年期间，每个样本检查多达8种物质。主要措施是判定UDT结果提示物质滥用或转移的临床担忧与不相关、不确定或无关。在638名患者中，48%为女性，49%为55岁以上。在干预年中，患者的UDT中位数为3个。我们发现37%的≥-1患者存在不稳定型糖尿病，另有35%(222/638)的患者存在≥-1不确定的不稳定型糖尿病。我们发现24%(156/638)的患者由于未检测到处方物质而导致UDT，23%(147/638)的患者检测到非处方物质。与65岁以上的患者相比，18-34岁的患者更有可能担心UDT的结果，调整后的优势比(AOR)为4.8(95%可信区间[CI]1.9-12.5)。有精神健康诊断的患者(AOR 1.6[95%CI 1.1~2.3])和药物使用诊断(AOR 2.3[95%CI 1.5~3.7])的患者更有可能有UDT结果的担忧。结论对UDT结果的专家判断发现37%的阿片类药物治疗慢性疼痛患者存在药物滥用的临床担忧。需要进一步的研究来确定UDT是否会影响临床实践或与患者相关的结果。
BackgroundUrine drug testing (UDT) is a recommended risk mitigation strategy for patients prescribed opioids for chronic pain, but evidence that UDT supports identification of substance misuse is limited.ObjectiveIdentify the prevalence of UDT results that may identify substance misuse, including diversion, among patients prescribed opioids for chronic pain.DesignRetrospective cohort study.SubjectsPatients (n=638) receiving opioids for chronic pain who had one or more UDTs, examining up to eight substances per sample, during a one 1-year period.Main MeasuresExperts adjudicated the clinical concern that UDT results suggest substance misuse or diversion as not concerning, uncertain, or concerning.Key ResultsOf 638 patients, 48% were female and 49% were over age 55 years. Patients had a median of three UDTs during the intervention year. We identified 37% of patients (235/638) with ≥1 concerning UDT and a further 35% (222/638) having ≥1 uncertain UDT. We found concerning UDTs due to non-detection of a prescribed substance in 24% (156/638) of patients and detection of a non-prescribed substance in 23% (147/638). Compared to patients over 65 years, those aged 18–34 years were more likely to have concerning UDT results with an adjusted odds ratio (AOR) of 4.8 (95% confidence interval [CI] 1.9–12.5). Patients with mental health diagnoses (AOR 1.6 [95% CI 1.1–2.3]) and substance use diagnoses (AOR 2.3 [95% CI 1.5–3.7]) were more likely to have a concerning UDT result.ConclusionsExpert adjudication of UDT results identified clinical concern for substance misuse in 37% of patients receiving opioids for chronic pain. Further research is needed to determine if UDTs impact clinical practice or patient-related outcomes.
登录
查看更多内容
影响因子：
1.7
作者：
Matteliano, Deborah;Chang, Yu-Ping
通讯作者：
Chang, Yu-Ping
DOI：
10.1093/pm/pnx285
发表时间：
2018-01-01
期刊：
Pain medicine (Malden, Mass.)
影响因子：
--
作者：
Argoff CE;Alford DP;Fudin J;Adler JA;Bair MJ;Dart RC;Gandolfi R;McCarberg BH;Stanos SP;Gudin JA;Polomano RC;Webster LR
通讯作者：
Webster LR
影响因子：
5.7
作者：
Chua, Isaac;Petrides, Athena K.;Melanson, Stacy E. F.
通讯作者：
Melanson, Stacy E. F.
社区设计中心（CDC）
DOI：
--
发表时间：
--
期刊：
影响因子：
--
作者：
通讯作者：
--
DOI：
10.1097/01.naj.0000530238.99144.e8
发表时间：
2018-03
期刊：
The American journal of nursing
影响因子：
--
作者：
Guy GP Jr;Shults RA
通讯作者：
Shults RA