The use of chronic opioid therapy for the treatment of chronic pain has increased dramatically inrecent years. With the increase in the use of opioids, there has been a concomitant rise inprescription opioid misuse and abuse. Clinical practice guidelines for the treatment of chronicpain recommend screening for prescription opioid misuse with urine drug testing (UDT) for allpatients prior to initiating opioid therapy and regularly during treatment. If patients have aberrantUDT results appropriate follow-up should ensue. However, less than 25% of patients who areprescribed chronic opioid therapy receive UDT and no empirical data are available about howproviders alter clinical treatment following an aberrant UDT. The proposed research study willemploy mixed research methods to study UDTs and methods for managing patients who abuseprescription opioids.
The specific aims of this proposal are: (1) in a national sample of patients,estimate the incidence of UDT and identify variables associated with the use of UDT, (2)conduct qualitative interviews with clinicians to explore perceptions of barriers to UDT andmethods for managing patients with aberrant UDT results, and (3) describe current clinicalpractice following an aberrant UDT result. These results will inform the development of a largerimplementation study designed to increase the use of UDTs and assist providers in managingpatients who have aberrant UDT results. The long-term goal of this research is to ensure thesafe use and reduce preventable harm from prescription opioid medications.

Public Health Relevance

Clinical practice guidelines for patients prescribed chronic opioid therapy recommend screening for prescription opioid misuse and abuse with urine drug tests;however, this recommendation is underutilized. This research will identify factors which predict the use of urine drug tests among patients prescribed chronic opioid therapy, generate data from clinicians on barriers to urine drug testing and methods for managing patients with aberrant urine drug test results, and document changes in medical treatment for patients who have aberrant urine drug test results. Findings from the proposed study will be used to form an implementation study designed to increase the use of urine drug tests and reduce prescription opioid abuse.

National Institute of Health (NIH)
Food and Drug Administration (FDA)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZFD1-SRC (99))
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Oregon Health and Science University
Schools of Medicine
United States
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Morasco, Benjamin J; Peters, Dawn; Krebs, Erin E et al. (2016) Predictors of urine drug testing for patients with chronic pain: Results from a national cohort of U.S. veterans. Subst Abus 37:82-7
Morasco, Benjamin J; Krebs, Erin E; Cavanagh, Renee et al. (2015) Treatment changes following aberrant urine drug test results for patients prescribed chronic opioid therapy. J Opioid Manag 11:45-51
Morasco, Benjamin J; O'Hearn, Daniel; Turk, Dennis C et al. (2014) Associations between prescription opioid use and sleep impairment among veterans with chronic pain. Pain Med 15:1902-10