Urine Tests Increase Consistencies in Injured Workers

Urine drug testing alongside clinical monitoring and oversight can reduce the use and expenses of high-risk medications such as opioids, according to study results presented in September at AAPM by Helios.

Researchers from Helios studied 335 injured workers aged an average of 49 years enrolled in the Drug Testing and Monitoring (DTM) service between March and May 2013. The categories measured included total medications, opioid analgesics, all controlled substances, and benzodiazepines. The researchers evaluated the patients in 90-day intervals (-90 days, 0 days, and +90 days), using baseline as the initial inconsistent test. Utilization was determined by supply of medication.

Most notably, the researchers determined more injured workers were filling their prescriptions at multiple pharmacies and/or had prescriptions for opioids written by multiple prescribers. These patients had a urine drug test result consistent with their current medication regimen.

Similarly, more workers’ — who had received a prescription for a cannabinol, stimulant, and/or those that were receiving a therapy of long-acting opioid pain relievers in lieu of any short-acting analgesic – test results returned inconsistencies with their current medication regimens.

The investigators found 67.2 percent of the urine drug tests were inconsistent. The researchers attribute this to potentially aberrant behavior, such as prescribed medications not found in the urine, non-prescribed medications detected in the urine, and/or other illicit substances found. Of the inconsistencies, 66.6 percent of urine tests had at least one non-prescribed medication, 46.8 percent did not show prescribed medications, and 14.9 percent had illegal substances such as marijuana, cocaine, methamphetamine, and heroin.

The researchers also successful 75 percent of the time in identifying injured workers who had inconsistent test results; prescribers were only accurate 51.3 percent of the time.

The changes in utilization and costs were also assessed during the 90 day period. All medication use and spend showed reductions: opioids showed 34.2 percent and 26.5 percent reductions in utilization and spend, respectively; benzodiazepines showed 44.4 percent and 47.7 percent reductions in utilization and spend, respectively; and all other controlled substances showed 35.8 percent and 37.3 percent decrease in utilization and spend, respectively. Over the 90 day period, average morphine equivalency dose per day was reduced from 145 mg to 100 mg, and 30 percent of the test group were completely weaned off opioid substances.

“By providing prescribers with additional information regarding unexpected drug test results, our drug testing and monitoring service has successfully reduced workers’ compensation payer spend on controlled substances and other medications,” Matthew Foster, PharmD, clinical pharmacy manager for Helios, said in a press release. “It also resulted in decreased therapeutic risks associated with chronic pain treatment for injured workers.”