The utility of universal urinary drug screening in chronic pain management

Figures & data

Table 1. Demographics of patients with CNCP for group with toxicology available vs. group without (n = 664).

	Toxicology available (n = 438)	Toxicology not available (n = 226)
Mean age (years)	50.19	56.19
% 80 + (n = 37)	2.05	12.39
% 60–79 (n = 165)	23.29	27.88
% 40–59 (n = 328)	52.05	44.25
% 20–39 (n = 118)	19.63	14.16
% 0–19 (n = 16)	2.97	1.33
% Male	42.92	36.73
% Female	57.08	63.27

CNCP = Chronic non-cancer pain.

Table 2. Number of drugs testing positive on UDS.^a

Number of drugs on UDS		% Toxicology available (n = 438)
0	171	39.04
1	148	33.79
2	73	16.67
3	31	7.08
4	12	2.74
5 or more	3	0.68
2 or more opioids	45
2 or more BDZ	13

^aDrug metabolites were not counted if the parent drug was present.

UDS = urinary drug screening; BDZ = benzodiazepines.

Table 3. Positive UDS results in respective drug classes.

Drug	Positive UDS result	% of toxicology available with positive UDS result (n = 438)
Amphetamine	4	0.91
Benzodiazepine	90	20.55
Barbiturate	1	0.23
Cannabinoid	106	24.20
Cocaine	6	1.37
Opioid	186	42.47
Phencyclidine	0	0

UDS = urinary drug screening.

Table 4. Unexpected UDS results in respective drug classes for general pain specialists.^a

Drug	Unexpected positive on UDS	Unexpected negative on UDS	Total number of unexpected UDS results	% of unexpected UDS results (n = 69) classified as unexpected for drug	% of UDS results (n = 414) classified as unexpected for drug
Amphetamine	0	1	1	1.45	0.24
Barbiturate	1	1	2	2.90	0.48
Benzodiazepine	12	5	16	23.19	3.86
Cannabinoid	14	1	15	21.74	3.62
Cocaine	5	0	5	7.25	1.21
Opioid	27	15	41	59.42	9.90
Phencyclidine	0	0	0	0	0
Total	59	23	69		16.67

^aIn the opioid drug class, there was one UDS result that had an opioid test unexpectedly positive and a different opioid test unexpectedly negative. Though this result had both an unexpected positive and negative, it still only counts as one patient having an unexpected UDS result. Therefore, the sum of unexpected positives and negatives in the opioid drug class does not equal the total number of unexpected opioid UDS results. This was also the case for the benzodiazepine drug class. There were 13 unexpected UDS results with two drugs that were unexpected. Therefore, the total number of unexpected UDS results does not equal the total number of unexpectedly positive and negative drugs on UDS.

UDS = urinary drug screening.

Table 5. Unexpected UDS results for individual opioid/metabolite(s) for general pain specialists.

Opioid/metabolite	Unexpected positive on UDS	Unexpected negative on UDS	Unexpected positive or negative on UDS	% of unexpected opioid and metabolite counts on UDS (n = 54) contributed by opioid/metabolite
Codeine	17	4	21	38.89
Hydrocodone	1	0	1	1.85
Hydromorphone	5	5	10	18.52
Methadone	2	0	2	3.70
Morphine	10	3	13	24.07
Oxycodone	2	5	7	12.96
Total	37	17	54	100

UDS = urinary drug screening.