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Improvement of pain physicians’ practices of opioid management: Population-based urinary excretion data

Amadeo Pesce, PhD, DABCC, Bridgit Crews, PhD, Sergey Latyshev, MS, Charles Mikel, PhD, Perla Almazan, CLS, MT (ASCP), Robert West, MS, Murray Rosenthal, DO, FAPA, Cameron West, PhD

Abstract


Background: Physicians treating patients for chronic pain have limited means of determining whether a person is taking their medications as prescribed and are not taking extra medication. Complicating patient treatment regimens is the fact that pain physicians’ prescribing practices may come under scrutiny by the Drug Enforcement Agency and other licensing agencies. If questioned, doctors can be hard-pressed to substantiate that their particular practices meet the established standard of care. It would be helpful to establish that their patients adhere to medications when compared with other practices. Previous studies show that urinary excretion data transformed by mathematical models can produce a reliable range of expected values for pain medications and may be useful to help resolve the aforementioned issues.
Purpose of the study: To provide comparative urinary excretion information data on three commonly prescribed opioid medications (morphine, hydrocodone, and oxycodone).
Methods: This retrospective study involved quantitative analysis of 300,000 urine specimens for three test drugs using previously described methods. The results were analyzed as percent frequency distributions and logarithmic functions.
Results: The authors established a creatinine-normalized range of urinary concentration values for each drug. Results for two practices were compared with the meta-findings, providing quantitative evidence of overall standard of care prescription practice by that physician.
Conclusions: Expected urinary drug excretion values for morphine, hydrocodone, and oxycodone can potentially benefit pain physicians by showing that they are within the expected standard of care, helping to establish patient compliance, and identifying patients whose metabolism of these drugs may put them at risk.


Keywords


urinary drug excretion, population data, physician practice, hydrocodone, morphine, oxycodone

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References


Federation of State Medical Boards of the United States, Inc.: Model policy for the use of controlled substances for the treatment of pain; May 2004. Available at http://www.fsmb.org/pdf/2004_grpol_Controlled_Substances.pdf. Accessed May 25, 2010.

Trescot AM, Helm S, Hansen H, et al.: Opioids in the management of chronic non-cancer pain: An update of American Society of the Interventional Pain Physicians’ (ASIPP) Guidelines. Pain Physician. 2008; 11(2 Suppl): S5-S62.

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

Kuehn B: Efforts aim to curb opioid deaths, injuries. JAMA. 2009; 301(12): 1213-1215.

Reidenberg MM, Willis O: Prosection of physicians for prescribing opiates to patients. Clin Pharmacol Ther. 2007; 81: 903-906.

Pesce A, West C, West R, et al.: Reference intervals: A novel approach to detecting drug abuse in a pain patient population. J Opioid Manag. 2010; 6: 341-350.

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.

West R, Pesce A, West C, et al.: Comparison of clonazepam compliance by measurement of urinary concentration by immunoassay and LC-MS/MS in a pain management population. Pain Physician. 2010; 13: 71-78.

Pesce A, West C, West R, et al.: Marijuana correlates with use of other illicit drugs in a pain patient population. Pain Physician. 2010; 13: 283-287.

Belpaire FM, Wijnant P, Temmerman A, et al.: The oxidative metabolism of metoprolol in human liver microsomes: Inhibition by the selective serotonin reuptake inhibitors. Eur J Clin Pharmacol. 1998; 54: 261-264.

Hiemke C, Härtter S: Pharmacokinetics of selective serotonin reuptake inhibitors. Pharmacol Ther. 2000; 85: 11-28.

Fishbain DA, Fishbain D, Lewis J, et al.: Genetic testing for enzymes of drug metabolism: Does it have clinical utility for pain medicine at the present time? A review. Pain Med. 2004; 5: 81-93.

Rosemary J, Adithan C: The pharmacogenetics of CYP2C9 and CYP2C19: Ethnic variation and clinical significance. Curr Clin Pharmacol. 2007; 2: 93-109.

Sistonena J, Fusellib S, Paloa JU, et al.: Pharmacogenetic variation at CYP2C9, CYP2C19, and CYP2D6 at global and microgeographic scales. Pharmacogenet Genomics. 2009; 19: 170-179.




DOI: https://doi.org/10.5055/jom.2010.0084

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