Open AccessIllicit Drug Use in the Pain Patient Population Decreases with Continued Drug Testing
Author(s) -
Amadeo Pesce,
Cameron West,
M. Rosenthal,
Charles Mikel,
Robert West,
Bridgit Crews,
Perla Almazan,
Sergey Latyshev,
Paul S. Horn
Publication year - 2011
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2011/14/189
Subject(s) - medicine , drug , mdma , heroin , illicit drug , population , ecstasy , opioid , substance abuse detection , codeine , methamphetamine , pharmacology , emergency medicine , morphine , psychiatry , environmental health , receptor
Background: A major concern of physicians treating pain patients with chronic opioidtherapy and similar drugs is determining whether the patients are also using illicit drugs.This is commonly determined by urine drug testing (UDT). However, there are few studieson whether or not monitoring patients by this technique decreases illicit drug use.Objective: To determine if the presence of illicit drugs decreases over a number ofphysician visits where UDT was performed.Method: The method involved a retrospective study of tests for the illicit drugsmarijuana, cocaine, methamphetamine, ecstacy (MDMA) phencyclidine (PCP) and theheroin metabolite, 6-acetylmorphine as confirmed by Liquid Chromatography-TandemMass Spectrometry (LC-MS/MS). A database of 150,000 patient visits was examined forthe presence of any of these 6 drugs.Results: A total of 87,000 patients were initially tested. The number of patients whowere repeatedly tested decreased over time. The percentage of patients positive for anyof these illicit drugs decreased from 23% to 9% after 14 visits where UDT was performed.When graphed there was a trend to decreasing use. The Spearman correlation = -0.88,P < 0.0001. The major illicit drug was marijuana. When this was removed from theanalysis, there was an even greater correlation with decreased illicit drug use. Spearmancorrelation = -0.92 (P < 0.0001) using a weighted correlation.Limitation: Patients continuing to use illicit drugs might be dismissed from practicesthus biasing the study towards illicit drug avoidance.Conclusion: Continued UDT might decrease illicit drug use among pain patients.Key words: Pain patients, UDT, urine drug testing, LC-MS/MS, illicit drugs, decreasedrug use