Describing Prescription Opioid Adherence among Individuals with Chronic Pain using Urine Drug Testing
Describing Prescription Opioid Adherence among Individuals with Chronic Pain using Urine Drug Testing
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DOI：
10.1016/j.pmn.2014.04.001
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发表时间：
2015-02-01
影响因子：
1.7
通讯作者：
Chang, Yu-Ping
中科院分区：
文献类型：
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作者：
Matteliano, Deborah;Chang, Yu-Ping
对处方阿片类药物使用的依从性监测是处方阿片类药物治疗慢性疼痛的个人的临床必要性。尿液药物检测（UDT）为处方阿片类药物依从性提供了客观证据，正如国家指南所建议的那样，这是依从性监测的一部分。本研究的目的是使用UDT结果描述慢性疼痛患者的处方阿片类药物依从性，并检查人口统计学特征与其处方阿片类药物治疗方案依从性之间的相关性。我们使用了一个回顾性的图表审查120例连续患者在城市疼痛管理诊所。收集的数据包括UDT结果、疼痛水平和人口统计学特征。数据分析采用描述性统计和相关性统计。约54%的人出现不遵守其规定的阿片类药物治疗方案，定义为不存在或不适当的处方控制药物，存在额外的非处方控制物质，存在非法物质或尿样中存在掺假物。在参与者中，23%没有一种或多种处方控制药物，12.5%存在一种或多种其他阿片类药物。大麻是使用的主要非法物质（24.2%），其次是可卡因（11.7%）。患者的年龄、疼痛程度、性别、种族和损伤补偿与UDT结果无关。UDT结果可能有助于教育和指导患者正确使用受控药物。来自UDT的结果是高度上下文和容易被误解，需要随着时间的推移与各种临床指标进行比较，然后再决定是否有慢性疼痛患者遵守规定的阿片类药物治疗方案。(C)美国疼痛管理护理学会（American Society for Pain Management Nursing）
Adherence monitoring for prescription opioid use is a clinical imperative for individuals prescribed opioids for chronic pain. Urine drug testing (UDT) provides objective evidence for prescription opioid adherence, as recommended by national guidelines to be part of adherence monitoring. The aim of this study was to describe prescription opioid adherence using UDT results in chronic pain patients and to examine the association between demographic characteristics and adherence to their prescribed opiate regimens. We used a retrospective chart review of 120 consecutive patients at an urban pain management clinic. Data collected included UDT results, pain level, and demographic characteristics. Descriptive and correlational statistics were used for data analysis. About 54% of the individuals appeared nonadherent to their prescribed opiate regimen as defined by absence or inappropriate level of prescribed controlled medication, presence of additional nonprescribed controlled substance( s), presence of illicit substance(s), or presence of adulterant in the urine sample. Of the participants, 23% had absence of one or more of their prescribed controlled medications and 12.5% had presence of one or more other opioids. Marijuana was the main illicit substance used (24.2%), followed by cocaine (11.7%). Patients' age, pain level, sex, ethnicity, and injury compensation were not associated with UDT results. UDT results could be useful to educate and guide patients on the proper use of controlled medications. Results from UDT are highly contextual and easily misinterpreted, requiring comparison with a variety of clinical indicators over time before deciding if there is adherence to a prescribed opiate regimen for individuals with chronic pain. (C) 2015 by the American Society for Pain Management Nursing