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This descriptive study of over 900,000 UDTs ordered by physicians to monitor their patients’ appropriate use of opioids found alarmingly high rates of potential problems:
It is important to note that urine samples can fall into multiple categories, and thus patient sample result categories add to greater than 100%. Of the total samples screened, 75% had one or more of these problems. While this rate of problematic tests is considerably higher than that found by Katz and colleagues (46%), Katz did not consider the absence of prescribed opioid in the urine a “problem” test result, whereas a considerable number of patients (38%) fit into this category in the current study.1 These results clearly confirm that physicians and health plans should be vigilant in periodically screening patients who are prescribed long-term opioid therapy.
High rates of likely nonadherence and drug misuse are not surprising given the propensity for misuse, abuse, and diversion associated with these medications.
Vermeire et al reported that up to 50% of patients are nonadherent to their chronic medication regimens, regardless of disease, prognosis, or setting.2
Although the amount of demographic and clinical information available for this analysis was limited, the study confirms previously reported findings that “inappropriate” drug use spans all demographic groups, although to different degrees.
Future multivariate analysis is needed to identify which, if any, of these characteristics appears to drive potentially inappropriate use. This in turn will help guide development of risk stratification models and characteristic-specific screening schedules.