Response to Urine Drug Testing in a Family Residency Practice.
Response to Urine Drug Testing in a Family Residency Practice.
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家庭住院医师实践中对尿液药物检测的反应。
DOI：
10.1097/adm.0000000000000283
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发表时间：
2017
影响因子：
5.5
通讯作者：
Maynard,Charles
中科院分区：
文献类型：
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作者：
McDonell,MichaelG;West,ImaraI;Ries,RichardK;Donovan,DennisM;Bumgardner,Kristin;Dunn,Chris;Atkins,DavidC;Roy-Byrne,Peter;Maynard,Charles
致编辑：我们阅读了Woodall等人提交的信件，对我们的论文“床旁尿液药物检测在治疗药物使用障碍的初级保健患者中的效用”（McDonell等人，2016年）。在我们的论文中，我们得出结论，尿液药物检测（UDT）可用于改善接受物质使用障碍护理的初级保健患者的药物使用评估。我们观察到，40%的初级保健样本至少有1个阳性UDT，尽管否认使用相应的自我报告，并发现27%的受访者否认阿片类药物使用，尽管相应的阿片类药物阳性UDT。Woodall等人（2017）提供了记录UDT在初级保健中用于相关但单独目的的数据，以筛选和监测在家庭医学诊所治疗的慢性疼痛患者中处方的阿片类药物、苯二氮卓类药物和安非他明。根据UDT的评估，他们观察到药物不依从率很高。具体而言，40%的处方阿片类药物或苯二氮卓类药物的UDT表明最近没有使用这些药物。此外，20%的UDT对非供应商处方的药物呈阳性。他们将大多数不一致的结果归因于患者报告不准确。Woodall等人（2017）还观察到由于实施UDT而改善护理的指标。提供者变得更舒适地与患者讨论UDT结果，并在使用随机UDT时开具受控药物。此外，作者描述了他们如何更熟悉UDT的优点和缺点，从而更适当地使用UDT。我们的国家面临着阿片类药物滥用的流行，许多美国人患有慢性疼痛。当与自我报告结合使用时，UDT是治疗慢性疼痛患者时评估药物依从性和非处方药物使用的重要工具。然而，最近的一项研究发现，接受长期阿片类药物治疗的人中只有8%接受了UDT（Benzon et al.，2013年）。等努力
To the Editor: We read the letter submitted by Woodall et al. commenting on our paper,‘‘Utility of Point of Care Urine Drug Tests in the Treatment of Primary Care Patients with Drug Use Disorders’’with great interest (McDonell et al., 2016). In our paper, we conclude that urine drug tests (UDTs) can be used to improve the assessment of drug use in primary care patients receiving care for substance use disorders. We observed that 40% of a primary care sample had at least 1 positive UDT, despite denying use on a corresponding self-report, and found that 27% of respondents denied opioid drug use, despite a corresponding opioid-positive UDT. Woodall et al.(2017) present data documenting the utility of UDTs in primary care for a related but separate purpose, to screen for and monitor prescribed opioid, benzodiazepines, and amphetamines in chronic pain patients treated in a family medicine clinic. They observed high rates of medication nonadherence, as assessed by UDTs. Specifically, 40% of those prescribed opioids or benzodiazepines had UDTs that indicated no recent use of these medications. Additionally, 20% of UDTs were positive for drugs not prescribed by providers. They attribute the majority of these discordant results to inaccurate patient report. Woodall et al.(2017) also observed metrics of improved care as a result of implementing UDTs. Providers became more comfortable discussing UDT results with their patients, and prescribing controlled substances when random UDTs were being used. Additionally, the authors describe how they became more familiar with the strengths and weaknesses of UDTs, leading to more appropriate use of UDTs.Our nation is faced with an epidemic of opioid misuse, and many Americans suffer from chronic pain. When used in combination with selfreport, UDTs are an important tool for assessing medication adherence and nonprescribed drug use when treating chronic pain patients. Yet, a recent study found only 8% of those receiving long-term opioid therapy received a UDT (Benzon et al., 2013). Efforts such