Anesth Analg 2003;97:1097-1102
© 2003 International Anesthesia Research Society
PAIN MEDICINE
Behavioral Monitoring and Urine Toxicology Testing in Patients Receiving Long-Term Opioid Therapy
Nathaniel P. Katz, MD*,
Summer Sherburne, BA*,
Michael Beach, MD PhD , ,
Robert J. Rose, MD,
Janet Vielguth, RN,
Joyce Bradley, RN , and
Gilbert J. Fanciullo, MD MS
*Pain Trials Center, Brigham and Women’s Hospital, Boston, Massachusetts;
Departments of Anesthesiology and
Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and
Pain Management Center, Brigham and Women’s Hospital, Boston, Massachusetts
Address correspondence to Gilbert J. Fanciullo, MD, MS, Pain Management Center, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH 03756. Address e-mail to Gilbert.J.Fanciullo{at}Hitchcock.org Reprints will not be available from the authors.
No study has examined the role of urine toxicology in addition to behavioral monitoring in patients receiving opioid therapy for chronic pain. All patients maintained on chronic opioid therapy by the two senior authors at two university pain management centers were monitored for 3 yr with urine toxicology testing and for behaviors suggestive of inappropriate medication use. We retrospectively extracted demographic information, aberrant drug-taking behaviors, and urine toxicology information from the medical record. For 122 patients maintained on chronic opioid therapy, 43% (n = 53) had a "problem" (either positive urine toxicology or one or more aberrant drug-taking behaviors). Of patients with no behavioral issues, 21% (n = 26) had a positive urine screen for either an illicit drug or a nonprescribed controlled medication. Of patients with a negative urine screen, 14% (n = 17) had one or more behavioral issues. Monitoring both urine toxicology and behavioral issues captured more patients with inappropriate drug-taking behavior than either alone. Requiring a report of behavioral issues and urine toxicology screens for patients receiving chronic opioids creates a more comprehensive monitoring system than either alone.
IMPLICATIONS: Monitoring both urine toxicology and aberrant behavior in chronic-pain patients treated with opioids identified more problem patients than by monitoring either alone. The authors recommend routine urine testing on all patients prescribed opioids for noncancer pain and as a required element in all opioid analgesic studies.
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