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Primary care providers' experiences with urine toxicology tests to manage prescription opioid misuse and substance use among chronic noncancer pain patients in safety net health care settings.

ABSTRACT: Guideline recommendations to reduce prescription opioid misuse among patients with chronic noncancer pain include the routine use of urine toxicology tests for high-risk patients. Yet little is known about how the implementation of urine toxicology tests among patients with co-occurring chronic noncancer pain and substance use impacts primary care providers' management of misuse. Clinicians' perspectives on the benefits and challenges of implementing urine toxicology tests in the monitoring of opioid misuse and substance use in safety net health care settings are presented in this paper.Twenty-three primary care providers from 6 safety net health care settings whose patients had a diagnosis of co-occurring chronic noncancer pain and substance use were interviewed. Interviews were transcribed, coded, and analyzed using grounded theory methodology.The benefits of implementing urine toxicology tests for primary care providers included less reliance on intuition to assess for misuse and the ability to identify unknown opioid misuse and/or substance use. The challenges of implementing urine toxicology tests included insufficient education and training about how to interpret and implement tests, and a lack of clarity on how and when to act on tests that indicated misuse and/or substance use.These data suggest that primary care clinicians' lack of education and training to interpret and implement urine toxicology tests may impact their management of patient opioid misuse and/or substance use. Clinicians may benefit from additional education and training about the clinical implementation and use of urine toxicology tests. Additional research is needed on how primary care providers implementation and use of urine toxicology tests impacts chronic noncancer pain management in primary care and safety net health care settings among patients with co-occurring chronic non cancer pain and substance use.

SUBMITTER: Ceasar R

PROVIDER: S-EPMC4823143 | biostudies-literature | 2016 Jan-Mar

REPOSITORIES: biostudies-literature

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Primary care providers' experiences with urine toxicology tests to manage prescription opioid misuse and substance use among chronic noncancer pain patients in safety net health care settings.

Ceasar Rachel R Chang Jamie J Zamora Kara K Hurstak Emily E Kushel Margot M Miaskowski Christine C Knight Kelly K

Substance abuse 20160101 1

<h4>Background</h4>Guideline recommendations to reduce prescription opioid misuse among patients with chronic noncancer pain include the routine use of urine toxicology tests for high-risk patients. Yet little is known about how the implementation of urine toxicology tests among patients with co-occurring chronic noncancer pain and substance use impacts primary care providers' management of misuse. Clinicians' perspectives on the benefits and challenges of implementing urine toxicology tests in ...[more]

PMID: 26682471

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Project description:OBJECTIVE:To examine whether sources of nonmedical use of prescription drugs (NMUPD) involving anxiolytics, opioids, and stimulants were associated with sociodemographic characteristics, NMUPD characteristics (eg, frequency), and other substance use. METHOD:Nationally representative samples of US high school seniors (N = 18,549) were surveyed by self-administered questionnaires (2009-2016). Design-based latent class analysis and Rao-Scott ?2 tests were used to test associations among sociodemographic characteristics, NMUPD characteristics, other substance use behaviors (eg, binge drinking, cigarette smoking, marijuana use), and NMUPD sources. RESULTS:Approximately 11.0% of high school seniors reported past-year NMUPD (n = 1,917). A substantial proportion of nonmedical users obtained the prescription drugs from multiple sources (44.2%). Latent class analysis identified 5 subgroups of NMUPD sources (friend/relative sources, friend/purchased sources, own leftover prescription, multiple sources, and other sources). Nonmedical users who obtained prescription drugs from friend/purchased sources were more likely to be adolescent boys, whereas those who used their own leftover prescriptions were more likely to be adolescent girls. Nonmedical users who obtained prescription drugs from multiple sources were more involved in substance use. In contrast, adolescent nonmedical users who used their own leftover prescriptions were less involved in substance use. CONCLUSION:Growing evidence indicates that different NMUPD sources are associated with different substance use behaviors. All NMUPD sources should be discouraged, because they place individuals, families, and communities at risk. Patients and their families should receive education on how to manage and properly dispose of controlled medications to avoid diversion into the community. Prescribers are encouraged to check prescription monitoring programs and screen adolescents for substance use/misuse when prescribing controlled medications.

Dataset Information

Primary care providers' experiences with urine toxicology tests to manage prescription opioid misuse and substance use among chronic noncancer pain patients in safety net health care settings.

Publications

Primary care providers' experiences with urine toxicology tests to manage prescription opioid misuse and substance use among chronic noncancer pain patients in safety net health care settings.

Similar Datasets

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