Urine Drug Testing in Pain Medicine

Abstract

The recent Institute of Medicine report declared that greater than 100 million Americans have chronic pain with an associated cost of up to $635 billion each year due to medical treatment and lost productivity.[1,2] The explosion in opioid prescribing since the 1990s has resulted in opioids being the most frequently prescribed medication in the United States.[3–5] Manchikanti et al.'s study revealed a 149% increase in retail opioid sales and a 402% increase in average sales of opioids per person in the United States from 1997 to 2007 [6]. Looking at 1999–2012, the National Center for Health Statistics found that among patients aged 20 or older prescription opioid use increased from 5% to 6.9% until 2006 and then stayed at 6.9% until 2012.7 However, the percentage of patients using an opioid stronger than morphine dramatically increased from 17% to 37% over the same period.[7] Among the top 25 dispensed prescriptions in the United States, hydrocodone, tramadol, and oxycodone accounted for 1, 21, and 22 dispensed prescriptions, respectively. 5 Opioids represent one of many therapeutic options for treating chronic nonmalignant pain (CNMP), but their widespread use has resulted in a concomitant increase in misuse, abuse, addiction, overdose, and diversion. While there is evidence of the short-term benefit of opioids for treating pain based on randomized trials lasting less than 3 months, there are few studies reporting outcomes at 12 months or longer [8,9].