Urine Drug Testing Among Long-term Opioid Prescribed Patients: Disparities and Opportunities

Area of Science:

• Pain Management and Addiction Medicine
• Health Services Research
• Pharmacology

Background:

• Opioid prescribing practices exhibit considerable variability in quantity and risk mitigation strategies (RMS).
• Urine drug tests (UDT) are commonly employed as an RMS for patients on opioid therapy.
• Standardized recommendations for UDT implementation are currently lacking.

Purpose of the Study:

• To investigate disparities in opioid prescribing and UDT utilization among patients with multiple opioid prescriptions.
• To analyze variations in opioid dosage (MME) and RMS based on patient demographics and clinical factors.

Main Methods:

• Retrospective analysis of a national outpatient database.
• Inclusion criteria: long-term adult opioid prescriptions (≥3 prescriptions over ≥120 days).
• Variables analyzed: demographics, abuse history, morphine milligram equivalents (MME), UDT frequency.

Main Results:

• Hispanic patients received lower daily MME compared to non-Hispanics.
• American Indian/Alaskan Native and White patients had the highest rates of high-dose opioid prescriptions (≥50 MME/day).
• UDT rates varied significantly by race, with American Indian/Alaska Native and Black patients undergoing testing more frequently than White patients. Higher MME, opioid use disorder, and tobacco use were associated with increased UDT likelihood.

Conclusions:

• Significant variations exist in opioid prescribing quantity and UDT utilization across different racial groups.
• White patients were prescribed higher opioid quantities but received fewer UDTs compared to other racial populations.
• There is a critical need for standardized opioid prescribing practices and equitable implementation of risk mitigation strategies, including UDT.