TY - JOUR
KW - Ambulatory Care Facilities/utilization
KW - Drug Evaluation, Preclinical/methods
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Neoplasms/urine
KW - Opioid pain management
KW - Outpatient palliative care
KW - Retrospective Studies
KW - Risk Assessment
KW - Risk Stratification
KW - Substance Abuse Detection/methods
KW - Substance-Related Disorders/urine
KW - Universal precautions
KW - urine drug screen
AU - S. Rauenzahn
AU - A. Sima
AU - B. Cassel
AU - D. Noreika
AU - T. H. Gomez
AU - L. Ryan
AU - C. E. Wolf
AU - L. Legakis
AU - E. Del Fabbro
A1 - 
AB - PURPOSE: Professional organizations provide no guidelines regarding assessment and management of opioid abuse risk in cancer. Universal precautions (UP) developed for non-cancer pain, include assessments for aberrant behavior, screening questionnaires, and urine drug screens (UDS). The role of UDS for identifying opioid abuse risk in cancer is uncertain. Our aim is to characterize inappropriate UDS, and identify a potential role for UDS in therapeutic decision-making. METHODS: An observational retrospective chart review of 232 consecutive supportive care clinic patients were seen during the study. Twenty-eight of the two hundred thirty-two did not meet inclusion criteria. One hundred fifty of the two hundred four had active cancer, while 54 had no evidence of active disease. Clinicians ordered UDS based on their clinical judgment of patients' substance misuse risk. Edmonton symptom assessment scores, history of substance abuse, alcohol use, tobacco use, aberrant behavior, and morphine equivalent daily dose (MEDD) were obtained. RESULTS: Pain scores and MEDD were higher (p = 0.021; p < 0.001) in the UDS group vs non-UDS. Forty percent of the patients (n = 82/204) had at least one UDS and 70% (60/82) had an inappropriate result. Thirty-nine percent (32) were inappropriately negative, showing no prescribed opioids. Forty-nine of the eighty-two were positive for non-prescribed opioids, benzodiazepine, or illicit substance. Eleven of the forty-nine had only cannabis metabolites in their urine. There were no significant differences between appropriate and inappropriate UDS groups regarding pain scores, MEDD or referral to psychology, psychiatry, or substance abuse specialists. CONCLUSIONS: UDS on the 82 oncology patients at high risk for substance misuse were frequently positive (46%) for non-prescribed opioids, benzodiazepines or potent illicit drugs such as heroin or cocaine, and 39% had inappropriately negative UDS, raising concerns for diversion.
BT - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
C5 - Opioids & Substance Use
CP - 6
CY - Germany
DO - 10.1007/s00520-017-3575-1
IS - 6
JF - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
N2 - PURPOSE: Professional organizations provide no guidelines regarding assessment and management of opioid abuse risk in cancer. Universal precautions (UP) developed for non-cancer pain, include assessments for aberrant behavior, screening questionnaires, and urine drug screens (UDS). The role of UDS for identifying opioid abuse risk in cancer is uncertain. Our aim is to characterize inappropriate UDS, and identify a potential role for UDS in therapeutic decision-making. METHODS: An observational retrospective chart review of 232 consecutive supportive care clinic patients were seen during the study. Twenty-eight of the two hundred thirty-two did not meet inclusion criteria. One hundred fifty of the two hundred four had active cancer, while 54 had no evidence of active disease. Clinicians ordered UDS based on their clinical judgment of patients' substance misuse risk. Edmonton symptom assessment scores, history of substance abuse, alcohol use, tobacco use, aberrant behavior, and morphine equivalent daily dose (MEDD) were obtained. RESULTS: Pain scores and MEDD were higher (p = 0.021; p < 0.001) in the UDS group vs non-UDS. Forty percent of the patients (n = 82/204) had at least one UDS and 70% (60/82) had an inappropriate result. Thirty-nine percent (32) were inappropriately negative, showing no prescribed opioids. Forty-nine of the eighty-two were positive for non-prescribed opioids, benzodiazepine, or illicit substance. Eleven of the forty-nine had only cannabis metabolites in their urine. There were no significant differences between appropriate and inappropriate UDS groups regarding pain scores, MEDD or referral to psychology, psychiatry, or substance abuse specialists. CONCLUSIONS: UDS on the 82 oncology patients at high risk for substance misuse were frequently positive (46%) for non-prescribed opioids, benzodiazepines or potent illicit drugs such as heroin or cocaine, and 39% had inappropriately negative UDS, raising concerns for diversion.
PP - Germany
PY - 2017
SN - 1433-7339; 0941-4355
SP - 1859
EP - 1864
EP - 
T1 - Urine drug screen findings among ambulatory oncology patients in a supportive care clinic
T2 - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
TI - Urine drug screen findings among ambulatory oncology patients in a supportive care clinic
U1 - Opioids & Substance Use
U2 - 28120116
U3 - 10.1007/s00520-017-3575-1
VL - 25
VO - 1433-7339; 0941-4355
Y1 - 2017
ER -