Urine Drug Testing in Patients Prescribed Long-Term Opioid Therapy: Associations with Patient and Prescriber Factors

Context: National guidelines recommend that patients with chronic non-cancer pain prescribed long-term opioid therapy (LTOT) undergo periodic urine drug testing (UDT), yet little evidence supports the utility of this approach. Given wide variation in test utilization and interpretation, it is important to understand factors associated UDT. Objective: To identify patient prescriber UDT primary care LTOT. Study Design Analysis: One-year retrospective cohort study LTOT by clinicians. Data extracted from health system electronic medical record. Negative binomial regression examined number tests received, logistic estimated propensity order testing. Analyses were adjusted for provider characteristics accounted clustering within prescribers. Setting: Primary network Northern California. Population: Adult (N=5,690) (>3 prescriptions) their providers. Outcome Measures: Any total during year. Results: A 2,256 (39.6%) had completed at least once. More was identifying as Black (vs white) race [adjusted incidence rate ratio (aIRR) = 1.2, 95% CI 1.0-1.4] receipt more prescriptions [aIRR 1.1, 1.1-1.1]. Asian tested less 0.7, 0.5-1.0]. Prescriber significantly included female male) sex 1.3, 1.0-1.5] Internal Medicine Family Medicine) specialty, 1.6, 1.3-1.9]. Provider also significant [rho=0.21, 0.16-0.26]. Conclusions: relatively infrequent race, which not an opioid-related risk factor. Additionally, there provider-driven The findings are concerning, given uncertain clinical such potentially high consequences decision-making, signal need strategies address potential biases use