Systematic Review: Treatment Agreements and Urine Drug Testing to Reduce Opioid Misuse in Patients With Chronic Pain

  title={Systematic Review: Treatment Agreements and Urine Drug Testing to Reduce Opioid Misuse in Patients With Chronic Pain},
  author={Joanna Starrels and William C. Becker and Daniel P. Alford and Alok Kapoor and Arthur R. Williams and Barbara J. Turner},
  journal={Annals of Internal Medicine},
  pages={712 - 720}
BACKGROUND Experts recommend opioid treatment agreements and urine drug testing to reduce opioid analgesia misuse, but evidence of their effectiveness has not been systematically reviewed. PURPOSE To synthesize studies of the association of treatment agreements and urine drug testing with opioid misuse outcomes in outpatients with chronic noncancer pain. DATA SOURCES MEDLINE, PsycINFO, EMBASE, Cochrane Central Register of Controlled Clinical Trials (January 1966 to June 2009), reference… 
Chronic back pain with possible prescription opioid misuse.
The underlying causes for worrisome behaviors such as urine drug test results that are negative for the prescribed opioid should be fully investigated and subsequent opioid prescriptions should be based on the revised risk and benefit assessment.
  • Mark R Collen
  • Medicine
    Pain practice : the official journal of World Institute of Pain
  • 2011
Until there is evidence that urine drug testing provides greater good than harm, it should be used with caution.
The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain.
Evidence on long-term opioid therapy for chronic pain is very limited but suggests an increased risk of serious harms that appears to be dose-dependent, with several studies showing a dose- dependent association.
Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy.
Impact of Chronic Pain on Treatment Prognosis for Patients with Opioid Use Disorder: A Systematic Review and Meta-analysis
CNCP may increase risk for continued opioid abuse and poor psychiatric functioning and Qualitative synthesis of the findings suggests that major methodological differences in the design and measurement of pain and treatment response outcomes are likely impacting the effect estimates.
Systematic review to determine which validated measurement tools can be used to assess risk of problematic analgesic use in patients with chronic pain
For predicting prescription opioid misuse, the pain medication questionnaire (PMQ) and the screener and opioid assessment for patients with pain (SOAPP) had the best evidence; both developed and validated in five separate studies (four each of acceptable quality).
Clinician Response to Aberrant Urine Drug Test Results of Patients Prescribed Opioid Therapy for Chronic Pain
The majority of clinicians enacted some type of opioid prescribing or other change to reduce risk following an Aberrant UDT, and the action depended on whether the result was an aberrant positive or aberrant negative UDT.
Chronic pain and opioid misuse: a review of reviews
Overall, current systematic reviews have found a lack of high-quality evidence or consistent findings on the prevalence, risk factors, and optimal clinical assessment and treatment approaches related to concurrent chronic pain and substance misuse.
Beneficial opioid management strategies: A review of the evidence for the use of opioid treatment agreements
Weak evidence is shown to support the effectiveness of patient prescriber agreements in the reduction and mitigation of opioid misuse and abuse and further research is needed to determine if these agreements are beneficial as an opioid management strategy.
Do Urine Drug Tests Reveal Substance Misuse Among Patients Prescribed Opioids for Chronic Pain?
Expert adjudication of UDT results identified clinical concern for substance misuse in 37% of patients receiving opioids for chronic pain, and patients aged 18–34 years were more likely to have concerning U DT results.


Does random urine drug testing reduce illicit drug use in chronic pain patients receiving opioids?
This study showed significant reductions in overall illicit drug use with adherence monitoring combined with random urine drug testing, expected to deter use of illicit drugs, and also improve compliance.
Misuse of and dependence on opioids: study of chronic pain patients.
Misuse of and dependence on opioids can be identified and managed successfully in primary care and Physicians should take "universal precautions" that include careful prescribing and ongoing vigilance for signs of misuse.
The use of urine drug testing to monitor patients receiving chronic opioid therapy for persistent pain conditions.
  • T. Tellioglu
  • Medicine, Psychology
    Medicine and health, Rhode Island
  • 2008
Training and education about the benefits and limitations of drug tests are essential to help staff members understand the importance of using test reports appropriately and to help the practitioners' concerns of iatrogenic addiction or relapse of previously addicted patients.
Systematic Review: Opioid Treatment for Chronic Back Pain: Prevalence, Efficacy, and Association with Addiction
Context Patients with low back pain often request pain medication, and many physicians prescribe opioids despite concerns about drug dependence. Contribution Opioid prescribing rates in 11 studies
Behavioral Monitoring and Urine Toxicology Testing in Patients Receiving Long-Term Opioid Therapy
Requiring a report of behavioral issues and urine toxicology screens for patients receiving chronic opioids creates a more comprehensive monitoring system than either alone.
Predictors of opioid misuse in patients with chronic pain: a prospective cohort study
Structured monitoring for opioid misuse can potentially ensure the appropriate use of opioids in chronic pain management and mitigate adverse public health effects of diversion.
Efficacy and safety of opioid agonists in the treatment of neuropathic pain of nonmalignant origin: systematic review and meta-analysis of randomized controlled trials.
Short-term studies provide only equivocal evidence regarding the efficacy of opioids in reducing the intensity of neuropathic pain, and further RCTs are needed to establish their long-term efficacy, safety, and effects on quality of life.
A comparative evaluation of illicit drug use in patients with or without controlled substance abuse in interventional pain management.
A clinically significant use of illicit drugs, particularly marijuana and cocaine in an interventional pain management setting, in patients with or without evidence of concomitant abuse of prescription controlled substances is demonstrated.
Does adherence monitoring reduce controlled substance abuse in chronic pain patients?
Adherence monitoring, including controlled substance agreements and various periodic measures of compliance was associated with a 50% reduction in opioid abuse.
Evaluation of abnormal urine drug screens among patients with chronic non-malignant pain treated with opioids.
Urine drug screens of 89 patients in an interventional pain management practice showed that 55% were not taking the prescribed opioid, whereas 39% were taking opioids which were not prescribed, and 46% of the patients were using illicit drugs.