This year’s World Congress of Anaesthesiologists (WCA) in Hong Kong (28 Aug – 2 Sept) shows that regular urine testing of patients prescribed painkilling opioid drugs can keep them compliant with the therapy, improve compliance in those failing, and also highlight any illicit drug they might be taking so that appropriate support can be offered. The study is conducted by Dr N. Nick Knezevic and colleagues at the Department of Anaesthesiology, Advocate Illinois Masonic Medical Center in Chicago, IL, USA.
The purpose of this study was to accurately assess the compliance of chronic opioid-consuming patients in an outpatient setting and evaluate if repeated urine drug testing (UDT) could improve compliance and overall pain control in these chronic patients.
After the ethics committee approval was obtained, a retrospective analysis of data for 500 patients was conducted. The researchers included patients who were aged 18 years and older who were treated with opioid analgesic medication for chronic pain more than 3 months. Patients were randomly chosen and asked to provide urine toxicology specimens during their regular clinic visits without prior notification. The specimens were sent to an external laboratory for quantitative testing by using liquid chromatography-tandem mass spectrometry.
A total of 386 (77.2%) of patients were compliant with prescribed medication and did not use any illicit drugs or unlisted medications. A further 50 were positive for at least one opioid medication that were not prescribed in the clinic; 5 (1%) patients tested negative for prescribed opioids and thus have not being following their prescribed therapy regimen; and 60 (12%) patients were positive for illicit drugs, (8.6%-marijuana, 3.2%-cocaine or 0.2%-heroin). Repeated urine testing, followed after re-education and disclosure, showed 49 of the 77 patients (63.6%) that had urine toxicology testing repeated had improved compliance.
Dr Knezevic says: “Our results showed that repeated urine drug testing can improve compliance of patients on opioid medication and can improve overall pain management. We believe urine drug testing should be used as an important adjunctive tool to help guide with various medical decisions, potentially increasing future quality of care.”
He adds: “Based on our experience, we believe that patients should undergo regular urine testing if prescribed opioid medications for pain relief. However, the remaining question