Are Standard Cutoff Concentrations Sufficient for Pain Management Screening? Yes!

Abstract

Pain management is an area of clinical practice and laboratory medicine that is proving to be extremely challenging. Long-term opioid therapy for management of pain involves prescribing potentially addictive substances, with the additional risk of fatal drug–drug interactions if patients are taking nonprescribed medications or illicit drugs. Providers must determine whether the patient is adherent to the prescribed therapeutic regimen while assessing the risk of off-label prescription or illicit drug use, both for patient safety and for their own risk management. Tools such as the Opioid Risk Tool and the revised Screener and Opioid Assessment for Patients with Pain have been used for behavioral-based risk assessment (1, 2), but these tools rely on self-reporting and subjective interpretation of behaviors, all of which can prove unreliable. Prescription monitoring programs are also used to identify patients who are potentially administered controlled substances from multiple providers (i.e., doctor shopping) (3). Against this backdrop, laboratory testing for drugs provides an opportunity for objective assessment of drug exposure that can supplement the behavioral risk assessment for better treatment of patients. However, there is a lack of consensus or guidance on how to approach laboratory testing for pain management. Toxicology testing in both forensic and clinical laboratories has traditionally used concentration-based cutoffs for determining a positive or …