P01 - The Frequency of Urine Drug Screening for Opioid Monitoring

Background: The use of opioid medications has the potential to provide relief of chronic, severe non-cancer pain. However, there is a significant risk of abuse and misuse. Urine drug screening is used to monitor patients on chronic opioid therapy for compliance and to detect illicit drug use. Although the literature supports the use of urine drug screening, there is little evidence to identify the testing frequency.

Methods: A quality improvement project was performed to assess the previously implemented protocol for urine drug screening frequency. A retrospective chart review was performed utilizing the pain clinic’s electronic health record over a predefined, 24-month period. Data was gathered on 311 patients over the age of 18 who met the inclusion criteria. Descriptive statistics was performed on the demographic variables, including age, gender, smoking status, diagnosis, marital status, and prescribed medication.

Results: Chi-square analysis found a statistically significant main effect between the four independent groups and the rates of positive drug screens, p = 0.002. Statistically significant differences were not detected between the once-per-year group and the twice-per-year group, p = 0.96, nor between the three-times-per-year group and the once-per-year group, p = 0.82. There was a significant difference between the four- times-per-year group and the once-per-year group, p = 0.014.

Conclusion: Participants that had four drug screens over the year were 3.05 times more likely (95% CI 1.26 – 7.40) to have a positive drug screen over the course of a year versus those that received just one drug screen a year. The findings support the clinic’s policy of performing urine drug testing four times a year to monitor opioid therapy compliance. It is recommended that a nurse be assigned to oversee the coordination of the monitoring process and that urine drug screen results are reviewed and the appropriate intervention is completed.