Utilization of system-wide urine drug testing to safely confront opioid misuse. (9th November 2022) - Bava, Ejas Palathingal
Abstract: Abuse and addiction of opioids leading to overdose deaths has increased significantly in Michigan since 2014. Moreover, a recent study showed that a majority (92%) of clinicians at Henry Ford Health System (HFHS) had reported prescribing narcotics in a way that was out of their comfort zone. To tackle this menace, we needed to equip our physicians with the appropriate tools to monitor patient compliance. In 2017, our laboratory implemented a reflexive urine drug testing (UDT) strategy called the directed pain panel (DPP). This panel included testing for natural/semi-synthetic /synthetic opiates, benzodiazepines, and cocaine metabolites. In 2019, the DPP was enhanced by adding buprenorphine, fentanyl, and tramadol. It is beneficial to order the DPP as opposed to UDSC (Urine drug screen) because UDSC does not detect the synthetic narcotics methadone, fentanyl, tramadol, and buprenorphine. DPP also has better sensitivity for detection of oxycodone. The primary aim of the current study was to evaluate UDT orders for chronic pain patients and to focus our efforts on improving the lab testing available to our providers to manage patients safely and effectively. Therefore, we evaluated the utilization of our testing strategy by doing a survey among chronic pain physicians in addition to retrospectively analyzing total orders for DPP (chronic pain panel, directed, urine) and UDSC (drug screen, urine) for chronic pain patients at five locations in Michigan over a one-year period (8/2020-8/2021). We collaborated with key providers and accessed their test ordering history to assess compliance with ordering the preferred UDT panel. The DPP represented 68% of all UDTs ordered for this population, however there were still a significant number of UDSC orders (32%). When order location was evaluated, the majority of UDSC orders originated from two locations (80%). When provider ordering patterns were evaluated, most providers (65%) ordered the DPP > 50% of the time. In addition, 70% of all UDSC orders came from just two providers. This data showed that HFHS pain management clinicians favored ordering the DPP, however a small minority of ordering providers may benefit from targeted education regarding the advantages of the DPP. Hence, we educated the physicians who were ordering UDSC. They were willing to modify their practice to order DPP, instead of UDSC. This may pave the way for better patient compliance as well as reduced overdose and abuse of opioids.