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Observation of improved adherence with frequent urine drug testing in patients with pain

David A. Yee, BS, Michelle M. Hughes, BA, Alexander Y. Guo, MS, Neveen H. Barakat, BS, Stephanie A. Tse, BS, Joseph D. Ma, PharmD, Brookie M. Best, PharmD, MAS, Rabia S. Atayee, PharmD, BCPS


Objective: To determine the relationship between urine drug testing (UDT) frequency and patient adherence for prescribed buprenorphine, carisoprodol, fentanyl, hydrocodone, methadone, morphine, and oxycodone.

Setting: Patients with pain routinely seen by private practitioners. Design: A retrospective analysis was conducted on urinary excretion data analyzed by Millennium Laboratories between March 2008 and May 2011.

Patient participants: Patients in the United States with chronic pain who underwent routine UDT to confirm adherence for prescribed medications. Interventions: Adherence for the urine drug test was defined as the presence of parent drug and/or metabolite(s) greater than or equal to the lower limit of quantitation. The percent of adherence for prescribed medications was compared to the average percent of the same in subjects with five or more visits.

Main outcomes: Correlation analyses were used to determine the relationship between adherence for prescribed medications and number of visits.

Results: There were 255,168 specimens submitted for testing from 166,755 individuals. When monitoring with more frequent visits (>=5 visits) adherence was higher by 1 percent for buprenorphine (89 percent vs 88 percent); 8 percent for carisoprodol (77 percent vs 69 percent); 5 percent for fentanyl (95 percent vs 90 percent); 7 percent for hydrocodone (83 percent vs 76 percent); 3 percent for methadone (96 percent vs 93 percent); 5 percent for morphine (92 percent vs 87 percent); and 8 percent for oxycodone (90 percent vs 82 percent).

Conclusions: Adherence for prescribed medications is higher with frequent urine monitoring. UDT can be used as tool that may help improve this in patients with chronic pain.


urine drug testing, adherence, compliance, pain medications, pain management

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De Geest S, Sabate E: Adherence to long-term therapies: Evidence for action. Eur J Cardiovasc Nurs. 2003; 35(3): 207.

Dunbar-Jacob J, Mortimer-Stephens MK: Treatment adherence in chronic disease. J Clin Epidemiol. 2001; 54(Suppl 1): S57-S60.

American Pharmacists Association: Enhancing patient adherence: Proceedings of the pinnacle roundtable discussion. Pharm Today Highlights Newslett. 2004; 7(4): 1-12.

Broekmans S, Dobbels F, Milisen K, et al.: Medication adherence in patients with chronic non-malignant pain: Is there a problem? Eur J Pain. 2009; 13(2): 115-123.

Balkrishnan R: The importance of medication adherence in improving chronic-disease related outcomes: What we know and what we need to further know. Med Care. 2005; 43(6): 517-520.

Simpson SH, Eurich DT, Majumdar SR, et al.: A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006; 333(7557): 15.

Sokol MC, McGuigan KA, Verbrugge RR, et al.: Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005; 43(6): 521-530.

Cramer JA: A systematic review of adherence with medications for diabetes. Diabetes Care. 2004; 27(5): 1218-1224.

Delamater AM: Improving patient adherence. Clin Diabetes. 2006; 24(2): 71-77.

Grant R, Adams AS, Trinacty CM, et al.: Relationship between patient medication adherence and subsequent clinical inertia in type 2 diabetes glycemic management. Diabetes Care. 2007; 30(4): 807-812.

American Society of Anesthesiology Task Force on Chronic Pain Management and American Society of Regional Anesthesia and Pain Medicine: Practice guidelines for chronic pain management. Anesthesiology. 2010; 112(4): 810-833.

Broekmans S, Dobbels F, Milisen K, et al.: Determinants of medication underuse and medication overuse in patients with chronic non-malignant pain: A multicenter study. Int J Nurs Stud. 2010; 47(11): 1408-1417.

Broekmans S, Dobbels F, Milisen K, et al.: Pharmacologic pain treatment in a multidisciplinary pain center: Do patients adhere to the prescription of the physician? Clin J Pain. 2010; 26(2): 81-86.

Couto JE, Romney MC, Leider HL, et al.: High rates of inappropriate drug use in the chronic pain population. Popul Health Manag. 2009; 12(4): 185-190.

Chou R, Fanciullo G, Fine PG, et al.: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10(2): 113-130.

West R, Pesce A, West C, et al.: Observations of medication compliance by measurement of urinary drug concentrations in a pain management population. J Opioid Manag. 2010; 6(4): 253-257.

Osterberg L, Blaschke T: Adherence to medication. N Engl J Med. 2005; 353(5): 487-497.

Christo PJ, Manchikanti L, Xiulu R, et al.: Urine drug testing in chronic pain. Pain Physician. 2011; 14(2): 123-143.

Toombs JD: Commonsense opioid-risk management in chronic noncancer pain: A clinician’s perspective. Pain-Topics. org. 2007. Available at Accessed November 4, 2013.

American Pain Society and American Academy of Pain Medicine: Guideline for the use of chronic opioid therapy in chronic noncancer pain: Evidence review. 2009. Available at Accessed November 4, 2013.

Jaffee WB, Truco E, Levy S, et al.: Is this urine really negative? A systematic review of tampering methods in urine drug screening and testing. J Subst Abuse Treat. 2007; 31(1): 33-42.

Nafziger AN, Bertino JS: Utility and application of urine drug testing in chronic pain management with opioids. Clin J Pain. 2009; 25(1): 73-79.

Mikel C, Almazan P, West R, et al.: LC-MS/MS extends the range of drug analysis in pain patients. Ther Drug Monit. 2009; 31: 746-748.

Pesce A, Rosenthal R, West C, et al.: An evaluation of the diagnostic accuracy of liquid chromatography-tandem mass spectrometry versus immunoassay drug testing in pain patients. Pain Physician. 2010; 13: 273-281.

Heit HA, Gourlay DL: Urine drug testing in pain medicine. J Pain Symptom Manage. 2004; 27(3): 260-267.

Peppin JF, Passik SD, Cuoto JE, et al.: Recommendations for urine drug monitoring as a component of opioid therapy in the treatment of chronic pain. Pain Med. 2012; 13(7): 886-896.

Owen GT, Burton AW, Schade CM, et al.: Urine drug testing: Current recommendations and best practices. Pain Physician. 2012; 15(3 Suppl): ES119-ES133.

Eap CB, Buclin T, Baumann P: Interindividual variability of the clinical pharmacokinetics of methadone: Implications for the treatment of opioid dependence. Clin Pharmacokinet. 2002; 41: 1153-1193.

Berndt S, Maier C, Schutz HW: Polymedication and medication compliance in patients with chronic non-malignant pain. Pain. 1993; 52(3): 331-339.

Manchikanti L, Manchukonda R, Pampati V, et al.: Evaluation of abuse of prescription and illicit drugs in chronic pain patients receiving short-acting (hydrocodone) or long-acting (methadone) opioids. Pain Physician. 2005; 8(3): 257-261.

Ives TJ, Chelminski PR, Hammett-Stabler CA, et al.: Predictors of opioid misuse in patients with chronic pain: A prospective cohort study. BMC Health Serv Res. 2006; 6: 46.

Lewis ET, Combs A, Trafton JA: Reasons for under-use of prescribed opioid medications by patients in pain. Pain Med. 2010; 11(6): 861-871.

Nicklas LB, Dunbar M, Wild M: Adherence to pharmacological treatment of non-malignant chronic pain: The role of illness perceptions and medication beliefs. Psychol Health. 2009; 25(5): 601-615.

Lanier RK, Umbricht A, Harrison JA, et al.: Evaluation of a transdermal buprenorphine formulation in opioid detoxification. Addiction. 2007; 102(10): 1648-1656.

Laffer L, Murphy R, Winegarden W, et al.: An economic analysis of the costs and benefits associated with regular urine drug testing for chronic pain patients in the United States. 2011. Available at Accessed October 24, 2013.

McCarberg BH: Chronic pain: Reducing costs through early implementation of adherence testing and recognition of opioid misuse. Postgrad Med. 2011; 123(6): 132-139.



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