Opioid Urine Tests Scare Away People in Chronic Pain

Urine drug screening (UDS) has become a standard routine for monitoring people who take opioids and root out opioid abuse.  The problem is that these drug screenings are scaring legitimate pain sufferers away from future treatment, a new study shows.

The study, published in Pain Physician, found that drug screenings increase the chance that patients taking opioids will not return for additional treatment. Nearly one quarter (23%) who received a urine drug screening during their first visit to a physician did not return for follow-up care.  Not surprisingly, the no-show rate for those who tested positive for illegal drugs was highest – 34%.  The no-show rate for those who tested negative was a stunning 21%.  For those who did not receive a urine drug screening on their first visit, the no-show rate was only 10%.

According to the authors, “These findings were replicated in eight different propensity-score matched subsamples aimed at addressing potential nonrandom selection, as well as in within-subject analysis accounting for individual-level no-show propensity.”

The study was done by researchers at the University of Houston and the University of Texas Medical Branch at Galveston.  They conducted an observational cohort study of 4,448 clinic visits by 723 people who suffer with pain.

“Urine drug screening is a mainstay in informing physicians about potential aberrant behaviors on the part of patients on opioid medications. While there is considerable research on the value of UDS to the physician, there is little research on how it influences patient behavior,” the authors wrote.

“Taken together the findings support the view that UDS may, in effect, be deterring people who are at high risk for abuse (as indicated by a positive test for illicit substances) from further engagement with the clinic.”

The authors believe their study is a first step in better understanding the relationship between urine drug screening and its impact on changing patients’ behavior. They note that additional research is needed to drill down to an even clearer understanding of how monitoring opioid use affects the behavior of those being considered for opioid therapy.

The study can be found here:  Krishnamurthy, P., PhD, Ranganathan, G., MD, Williams, C., MD, & Doulatram, G., MD. (n.d.). Impact of urine drug screening on no shows and dropouts among chronic pain patients: A propensity-matched cohort study. Pain Physician, 19(2), 89-100.

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