Rational Urine Drug Monitoring in Patients Receiving Opioids for Chronic Pain: Consensus Recommendations.
Rational Urine Drug Monitoring in Patients Receiving Opioids for Chronic Pain: Consensus Recommendations.
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DOI：
10.1093/pm/pnx285
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发表时间：
2018-01-01
期刊：
影响因子：
--
通讯作者：
Webster LR
中科院分区：
文献类型：
--
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
制定阿片类药物处方慢性疼痛患者尿液药物监测（UDM）的共识建议。一个由在疼痛、物质使用障碍和初级保健方面具有专业知识的临床医生组成的跨学科小组进行了虚拟会议，以审查相关文献和现有指南，并在达成共识建议之前分享他们在UDM方面的临床经验。强制性的（例如，基于色谱法的）检测由于其准确性而被推荐为最适合UDM的临床检测;然而，机构或付款人政策可能要求最初使用推定检测（即，免疫测定）。UDM分析物质的合理选择涉及每个患者特定的考虑因素，并与非法药物的可用性有关。适当的阿片类药物风险分层基于患者病史（特别是精神疾病或阿片类药物或物质使用障碍史）、处方药监测项目数据、经验证的风险评估工具的结果和既往UDM。对于大多数因慢性疼痛而处方阿片类药物的患者，建议在基线时进行尿液药物监测，低风险患者至少每年一次，中度风险患者每年两次或更多次，高风险患者每年三次或更多次。根据临床判断，应根据需要进行额外的UDM。尽管UDM在预防阿片类药物使用障碍、过量和转移方面的疗效证据有限，但专家组建议将UDM作为慢性疼痛患者处方阿片类药物的持续综合风险监测的一部分。
To develop consensus recommendations on urine drug monitoring (UDM) in patients with chronic pain who are prescribed opioids. An interdisciplinary group of clinicians with expertise in pain, substance use disorders, and primary care conducted virtual meetings to review relevant literature and existing guidelines and share their clinical experience in UDM before reaching consensus recommendations. Definitive (e.g., chromatography-based) testing is recommended as most clinically appropriate for UDM because of its accuracy; however, institutional or payer policies may require initial use of presumptive testing (i.e., immunoassay). The rational choice of substances to analyze for UDM involves considerations that are specific to each patient and related to illicit drug availability. Appropriate opioid risk stratification is based on patient history (especially psychiatric conditions or history of opioid or substance use disorder), prescription drug monitoring program data, results from validated risk assessment tools, and previous UDM. Urine drug monitoring is suggested to be performed at baseline for most patients prescribed opioids for chronic pain and at least annually for those at low risk, two or more times per year for those at moderate risk, and three or more times per year for those at high risk. Additional UDM should be performed as needed on the basis of clinical judgment. Although evidence on the efficacy of UDM in preventing opioid use disorder, overdose, and diversion is limited, UDM is recommended by the panel as part of ongoing comprehensive risk monitoring in patients prescribed opioids for chronic pain.
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DOI：
10.1016/j.jpain.2008.10.008
发表时间：
2009-02
期刊：
The journal of pain
影响因子：
--
作者：
Chou R;Fanciullo GJ;Fine PG;Adler JA;Ballantyne JC;Davies P;Donovan MI;Fishbain DA;Foley KM;Fudin J;Gilson AM;Kelter A;Mauskop A;O'Connor PG;Passik SD;Pasternak GW;Portenoy RK;Rich BA;Roberts RG;Todd KH;Miaskowski C;American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
通讯作者：
American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
影响因子：
2.6
作者：
Benzon, Honorio T.;Kendall, Mark C.;Avram, Michael J.
通讯作者：
Avram, Michael J.
影响因子：
3.5
作者：
Bauer, Scott R.;Hitchner, Lily;Steiger, Scott
通讯作者：
Steiger, Scott
影响因子：
2.7
作者：
Casale, John F.;Mallette, Jennifer R.;Guest, Elizabeth M.
通讯作者：
Guest, Elizabeth M.
影响因子：
4
作者：
Belgrade, Miles J.;Schamber, Cassandra D.;Lindgren, Bruce R.
通讯作者：
Lindgren, Bruce R.