Urine Drug Testing in Pain Medicine

Abstract

Rehan Haider

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].

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