1. 2006;9;123-129Does Random Urine Drug Testing Reduce Illicit Drug Use In Chronic Pain Patients Receiving Opioids?
   A Prospective Evaluation
   Laxmaiah Manchikanti, MD, Rajeev Manchukonda, BDS, Vidyasagar Pampati, MSc, Kim S. Damron, RN, Doris E. Brandon, CST, Kim A. Cash, RT, and Carla D. McManus, RN, BSN.

Background: Prescription drug abuse and illicit drug use are common in chronic pain patients. Adherence monitoring with screening tests, and urine drug testing, periodic monitoring with prescription monitoring programs, has become a common practice in recent years. Random drug testing for appropriate use of opioids and use of illicit drugs is often used in pain management practices. Thus, it is expected that random urine drug testing will deter use of illicit drugs, and also improve compliance.

Objectives: To study the prevalence of illicit drug use in patients receiving opioids for chronic pain management and to compare the results of illicit drug use with the results from a previous study.

Design: A prospective, consecutive study.

Setting : Interventional pain management practice setting in the United States.

Methods: A total of 500 consecutive patients on opioids, considered to be receiving stable doses of opioids supplemental to their interventional techniques, were studied by random drug testing. Testing was performed by rapid drug screen. Results were considered positive if one or more of the monitored illicit drugs including cocaine, marijuana (THC), methamphetamine or amphetamines were present.

Results: Illicit drug use was evident in 80 patients, or 16%, with marijuana in 11%, cocaine in 5%, and methamphetamine and/or amphetamines in 2%. When compared with previous data, the overall illicit drug use was significantly less. Illicit drug use in elderly patients was absent.

Conclusion: The prevalence of illicit drug abuse in patients with chronic pain receiving opioids continues to be a common occurence. This study showed significant reductions in overall illicit drug use with adherence monitoring combined with random urine drug testing.

Key Words: Chronic pain, controlled substances, illicit drug use, substance abuse, opioids, urine drug testing.