Recommendations for Urine Drug Monitoring as a Component of Opioid Therapy in the Treatment of Chronic Pain

Authors


  • Conflicts of Interest: Development of these recommendations was supported by Ameritox, Inc. through an unrestricted grant to the Jefferson School of Population Health. All authors received a usual and customary honorarium in compensation for their time and travel expenses. Dr. Peppin has received honoraria, consulting fees, or grant/research support from Aiko Technology, Ameritox, Inc., Depomed Pharmaceuticals, Ely Lilly Pharmaceuticals, Grünenthal Pharmaceuticals, Salix Pharmaceuticals, and Zogenix Pharmaceuticals. Dr. Passik has received honoraria, consulting fees, or grant/research support from Ameritox, Inc., Cephalon, Inc., Covidien, Endo Pharmaceuticals, Janssen Pharmaceuticals, Millennium Pharmaceuticals, Pfizer, Inc., Pharmacofore, Inc., Purdue Pharmaceuticals, and Quest Labs. Dr. Couto has received grant/research support from Ameritox, Inc. Dr. Fine has received honoraria, consulting fees, or grant/research support from Ameritox, Inc., Cephalon, Inc., Johnson & Johnson, and Purdue Pharmaceuticals. Dr. Christo has received honoraria, consulting fees, or grant/research support from Actavis, Ameritox, Inc., Chattem, and Medtronic. Dr. Argoff has received honoraria, consulting fees, or grant/research support from Ameritox Inc., Millenium Laboratories, and Quest Diagnostics. Dr. Aronoff has received honoraria, consulting fees, or grant/research support from Ameritox, Inc., Horizon Pharmaceuticals, King Pharmaceuticals, Nektar Therapeutics, Pfizer Pharmaceuticals, QRX Pharmaceuticals, The Selva Group. Dr. Bennett has no potential conflicts to disclose, other than his employment. Dr. Cheatle has received honoraria, consulting fees, or grant/research support from Ameritox, Inc. Dr. Slevin has received honoraria, consulting fees, or grant/research support from Cephalon, Inc. Mr. Goldfarb has no potential conflicts to disclose, other than his employment.

Joseph E. Couto, PharmD, MBA, School of Population Health, Thomas Jefferson University, 1015 Walnut Street, Suite 115, Philadelphia, PA 19107, USA. Tel: 215-955-1708; 401-954-3934; Fax: 215-923-7583; E-mail: josephecouto@gmail.com.

Abstract

Objective.  Several prominent guidelines recommend that patients on long-term opioid therapy have periodic urine drug monitoring (UDM) for appropriate use; however, none address the specific questions of which patients to test, which substances to test for, how often to test, and how to act on the results.

Design.  In the absence of adequate scientific evidence in the literature, a panel of experts in the field of pain and addiction medicine was convened to develop consensus UDM recommendations. The panel met three times between March 2010 and April 2011, and reviewed several drafts of the recommendations document between meetings.

Results.  The group was able to achieve consensus on a set of UDM recommendations addressing test selection, test frequency, interpretation of results, and how to handle discrepancies based on specific results.

Conclusion.  While the participating panel members recognize that there currently is a limited evidence base to support the expert panel's recommendations, primary care providers and pain specialists are largely acting today based on anecdote, intuition, and individual experience. The recommendations are meant to begin to provide a framework for standardizing practices for UDM in the treatment of chronic pain, and to serve as a catalyst to advance research that quantifies the effects of UDM on opioid therapy management and patient outcomes.

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