Despite the potential benefits of drug testing (such as monitoring pain medication) to patient care, few primary care practitioners use it. For example, a small study conducted on the medical management of patients with chronic pain in family practices found that only 8 percent of physicians surveyed used drug testing.
Studies show the need for a tool such as SBIRT (Screening, Brief Interventions and Referral to Treatment): Results of the most recent National Survey on Drug Use and Health (NSDUH) show that an estimated 22.1 million people aged 12 or older have a diagnosable alcohol or illicit drug use disorder.
In 2010, according to NSDUH, 8.1 percent of the population aged 12 or older – about 20.5 million people – needed but did not receive substance use treatment at a specialty facility in the past year.
In 2006, excessive drinking cost the United States $223 billion.4 Factoring in public health, public safety, and lost productivity, illicit drug use cost the Nation an estimated $193 billion in 2007.
Data from SAMHSA (substance abuse and mental health services administration) grant programs help demonstrate the impact of SBIRT on patient health through documented:
Reduction in alcohol and drug use 6 months after receiving intervention (41 percent of respondents reported abstinence from drugs and/or alcohol at follow-up, compared to just 16 percent at baseline); Improvement in quality-of-life measures, including employment/education status, housing stability, and 30-day past arrest rates (95 percent of respondents reported no arrests in the past 30 days at follow-up, compared to 88 percent at baseline); and Reduction in risky behaviors, including fewer unprotected sexual encounters (injection drug use decreased from 3.2 percent at baseline to 1.5 percent at follow-up).
72 percent of patients with a positive test result did not have any behavioral indicators considered useful for screening.
The prevalence of opioid dependence may be as high as 26% among patients in primary care receiving opioids for chronic non–cancer-related pain.
Overall, 1 of every 550 patients started on opioid therapy died of opioid-related causes a median of 2.6 years after the first opioid prescription; the proportion was as high as 1 in 32 among patients receiving doses of 200 MME or higher.
→Back pain alone for 2004 and 2005 total healthcare expenditures were estimated at $85 to $100 billion.
Chronic Non Cancer Pain is a leading cause of disability, and can have adverse effects on ability to
work flow, ability to function as well as other quality of life aspects.
→Possible Signs of Inappropriate Opioid Use by Patients:
Patients taking opioids as prescribed for pain management and whose pain is not sufficiently reduced may occasionally display the behaviors listed below. The possibility of psychological dependence is a possibility when a pattern of one or more of these behaviors is observed.
■ Multiple episodes of “lost” or stolen prescriptions
■ Repeatedly running out of medication early
■ Aggressive complaints about the need for additional prescriptions
■ Drug hoarding during periods of reduced symptoms
■ Urgent calls or unscheduled visits
■ Injecting opioids intended for oral use
■ Using the medication to achieve euphoric effects
■ Unapproved use of prescribed opioid to self medicate another problem, such as insomnia
■ Frequently missing appointments unless opioid renewal is expected
■ Unwillingness to try non-opioid treatments
■ Evidence of withdrawal symptoms visible at appointments
■ Concurrent alcohol or illicit drug abuse
■ Sedation, declining activity, sleep disturbances, or irritability unexplained by the pain or other co-occurring conditions
■ Deterioration of functioning at work, with family, or socially because of medication effects
■ Forging prescriptions or obtaining prescriptions from non-medical or multiple medical sources
■ Selling prescription medicines
Info from source
→Initiate more frequent trips to offices, and limit the amount of medication available at one time,
→Random urine drug tests detect the presence of illicit drugs or substances not prescribed for pain management and verify that the patient is taking the prescribed opioid instead of selling it,
→Approximately 18 billion opioid pills were dispensed in 2012, enough to give every American 18 years or older 75 pills
→From 1999 to 2013 the rate for deaths involving both benzodiazepines and prescription opioids rose by 819 percent
→We have way too many prescription drugs lying around. From 2010 to 2014, DEA prescription drug take-back events collected over 4.9 million pounds (2,411 tons) of drugs
→DO perform a thorough medical evaluation and a urine drug screen before initiating chronic opioid therapy.
→DO perform random urine drug screens on patients receiving chronic opioid therapy.
→The number one cause of death in 17 U.S. states is prescription drug abuse, surpassing motor vehicle accidents. (Source: Centers for Disease Control and Prevention)
→A total of 59% of respondents rated their medical school preparation and 36% rated their residency preparation as “fair” or “poor”; only 17% reported being “confident” or “very confident” in assessing patients with CNCP; and 30% used negative or derogatory terms (eg, manipulative, irritable, needy) to describe patients with CNCP.
1 Adams, N. J., Plane, M. B., Fleming, M. F., Mundt, M. P., Saunders, L.A., & Stauffacher, E. A. (2001). Opioids and the treatment of chronic pain in a primary care sample. Journal of Pain and Symptom Management, 22(3), 791−796.
2 Substance Abuse and Mental Health Services Administration, 2011. Results from the 2010 National Survey on Drug Use and Health: Volume 1. Summary of National Findings. DHHS Publication No. SMA 10-4856.
3 Substance Abuse and Mental Health Services Administration, 2011. Results from the 2010 National Survey on Drug Use and Health: Volume 1. Summary of National Findings. DHHS Publication No. SMA 10-4856.
4 National Drug Intelligence Center (2011). The Economic Impact of Illicit Drug Use on American Society. United States Department of Justice. Retrieved from http://www.justice.gov/ndic/
5 Unpublished data from SAMHSA's Services Accountability Improvement System, July 2012.
6 Katz, N. P., Sherburne, S., Beach, M., Rose, R. J., Vielguth, J., Bradley, J., et al. (2003). Behavioral monitoring and urine toxicology testing in patients receiving long-term opioid therapy. Anesthesia and Analgesia, 97(4), 1097−1102. Kintz
7 CDC guideline for prescribing opioids for chronic pain — United States, 2016. MMWR Recomm Rep 2016;65(RR-1):1-49
8 Kaplovitch E, Gomes T, Camacho X, Dhalla IA, Mamdani MM, Juurlink DN. Sex differences in dose escalation and overdose death during chronic opioid therapy: a population-based cohort study. PLoS One 2015;10:e0134550-e0134550
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12 Breivik 2005; Coluzzi and Pappagallo 2005; Lussier and Pappagllo 2004; Primm et al. 2004; Savage 2002; Schneider 2005; Weaver and Schnoll 2002.
13 Coluzzi, F., and Pappagallo, M. Opioid therapy for chronic noncancer pain: Practice guidelines for initiation and maintenance of therapy. Minerva Anestesiologica 71(7–8):425–433, 2005.
14 Jones, E.M., Knutson, D., and Haines, D. Common problems in patients recovering from chemical dependency. American Family Physician 68(10):1971–1978, 2003.
15 Passik, S.D., and Kirsh, K.L. Managing pain in patients with aberrant drug-taking behaviors. Journal of Supportive Oncology 3(1):83–86, 2005.
16 Weaver, M.F., and Schnoll, S.H. Opioid treatment of chronic pain in patients with addiction. Journal of Pain & Palliative Care Pharmacotherapy 16(3):5–26, 2002.
17 IMS Health. 2012. National Prescription Audit.
18 Friedan, T. 2014. Oral presentation at Preventing Prescription Drug Overdose: New Challenges, New Opportunities. National RX Drug Abuse Summit, Operation Unite. Atlanta GA.
19 2015. Underlying Cause of Death on CDC Wide-ranging Online data for Epidemiology for Research. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics.
20 Drug Enforcement Administration. 2014. Final Press Release on Disposal: DEA and Partners collect 309 Tons of Pills on Ninth Prescription Drug Take-Back Day. http://www.dea.gov/divisions/hq/2014/hq110514.shtml.
21 Physicians For Responsible Prescribing. “Cautious, Evidence-Based Opioid Prescribing.” Comp. Wed accessed August 2016. www.responsibleopioidprescribing.org.
23 Center For Disease Control and Prevention
24 Yanni, Leanne M., Jessica L. Mckinney-Ketchum, Sarah B. Harrington, Christine Huynh, Bs Saad Amin, Robin Matsuyama, Patrick Coyne, Betty A. Johnson, Mark Fagan, and Linda Garufi-Clark. "Preparation, Confidence, and Attitudes About Chronic Noncancer Pain in Graduate Medical Education." Journal of Graduate Medical Education 2.2 (2010): 260-68. Web.