Observations of medication compliance by measurement of urinary drug concentrations in a pain management population

Authors

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

DOI:

https://doi.org/10.5055/jom.2010.0023

Keywords:

pain patients, medication compliance, opioids, carisoprodol

Abstract

Background: One of the major concerns of physicians treating pain patients with opioids is to determine whether the patients are compliant, and this is commonly determined by urine drug testing. There is limited information on which drugs these patients are most compliant with. There is also limited information as to how compliance is defined in terms of cutoffs.
Objective: To compare reported patient medication use with the presence of the drug in the patients’ urine with defined cutoffs.
Method: A retrospective study of the medications listed by the physicians’ offices and the confirmed drug test findings. A Millennium Laboratories database of 20,457 patient results was examined for the presence of the listed medications and was matched for the presence of the drugs above the analytical cutoffs.
Results: For oxycodone and hydrocodone, the authors observed 23 and 24 percent noncompliance, respectively. For carisoprodol, they observed 33 percent noncompliance. For morphine, they observed 14 percent noncompliance. For methadone, they observed 9 percent noncompliance.
Conclusions: Noncompliance is prevalent in this patient population and varies with the prescribed drug.

Author Biographies

Robert West, MS

Co-Laboratory Director, Millennium Laboratories, San Diego, California.

Amadeo Pesce, PhD, DABCC

Co-Laboratory Director, Millennium Laboratories, San Diego, California.

Cameron West, PhD

Executive Vice President, Millennium Laboratories, San Diego, California.

Bridgit Crews, PhD

Director Analytical Development, Millennium Laboratories, San Diego, California.

Charles Mikel, PhD

Chief Scientist, Millennium Laboratories, San Diego, California.

Murray Rosenthal, DO, FAPA

Medical Director, Millennium Laboratories, San Diego, California.

Perla Almazan, CLS, MT (ASCP)

Associate Director, Millennium Laboratories, San Diego, California.

Sergey Latyshev, MS

Staff Scientist, Millennium Laboratories, San Diego, California.

References

Vermeire E, Hearnshaw H, Van Royen P, et al.: Patient adherence to treatment: Three decades of research. A comprehensive review. J Clin Pharm Ther. 2001; 26: 331-342.

Fischer MA, Stedman MR, Lii J, et al.: Primary medication non-adherence: Analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010; 25(4): 284-290.

Kennedy J, Tuleu I, Mackay K: Unfilled prescriptions of medicare beneficiaries: Prevalence, reasons, and types of medicines prescribed. J Manag Care Pharm. 2008; 14(6): 553-560.

Manchikanti L, Damron KS, McManus CD, et al.: Patterns of illicit drug use and opioid abuse in patients with chronic pain at initial evaluation: A prospective, observational study. Pain Physician. 2004; 7(4): 431-437.

Tellioglu T: The use of urine drug testing to monitor patients receiving chronic opioid therapy for persistent pain conditions. Med Health R I. 2008; 91(9): 279-280, 282.

Chou R: 2009 Clinical Guidelines from the American Pain Society and the American Academy of Pain Medicine on the use of chronic opioid therapy in chronic noncancer pain: What are the key messages for clinical practice? Pol Arch Med Wewn. 2009; 119(7-8): 469-477.

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

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

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.

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.

Mohsin S, Yang Y, Zumwalt M: Quantitative Analysis of Opiates in Urine Using RRHT LC/MS/MS. Agilent Application. Agilent Technologies, Inc., Santa Clara CA.

Agilent Corp.: Target Compound Identification and Quantitation Procedure. Agilent Technologies, Inc. [MSD ChemStation Data Analysis] Last Reviewed: March 20, 2002.

Crews B, Mikel C, Latyshev S, et al.: 6-Acetylmorphine detected in the absence of morphine in pain management patients. Ther Drug Monit. 2009; 31: 749-752.

Cole JM, Best BM, Pesce AJ: Variability of transdermal fentanyl metabolism and excretion in pain patients. J Opioid Manag. 2010; 6(1): 29-39.

Evans M, Kriger S, Gunn J, et al.: Effective monitoring of opiates in chronic pain patients. Pract Pain Manag. 2009: 9: 32-33.

Published

01/29/2018

How to Cite

West, MS, R., A. Pesce, PhD, DABCC, C. West, PhD, B. Crews, PhD, C. Mikel, PhD, M. Rosenthal, DO, FAPA, P. Almazan, CLS, MT (ASCP), and S. Latyshev, MS. “Observations of Medication Compliance by Measurement of Urinary Drug Concentrations in a Pain Management Population”. Journal of Opioid Management, vol. 6, no. 4, Jan. 2018, pp. 253-7, doi:10.5055/jom.2010.0023.

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Section

Articles