Clinical Urine Drug Testing During Opioid Therapy: A Case-Based Approach to Patient Monitoring
Release Date: January 1, 2010
Expiration Date: January 31, 2011
NEEDS STATEMENT
Each year, chronic pain affects more than 50 million Americans. Chronic pain is debilitating and often becomes the defining factor in a patient's life. Opioids are the most potent and effective class of analgesics available for the treatment of chronic pain. Complicating the effective use of opioids is the risk for misuse, abuse, and drug diversion, as confirmed by a 4.5% prevalence for nonmedical use of prescription opioids. While most patients on long-term opioid therapy will not develop opioid-use disorders and will not divert their prescription medications to others, the emergence of aberrant drug-related behaviors and the ability to detect such behaviors remain a significant concern for physicians. Yet, it is critical for clinicians to ensure that the benefits of a particular opioid analgesic outweigh its potential risks.
According to the recent recommendations from the American Pain Society and American Academy of Pain Medicine, implementing a risk management strategy with opioid therapy will allow the physician to take the patient's history and physical examination into account when administering opioids, while frequently monitoring outcomes using strategies such as urine drug testing (UDT). Given the complexities associated with drug screening, physicians need to have an understanding of how to interpret test results. This activity provides pain-treating physicians with up-to-date information and practical case examples to illustrate the implementation and utility of UDT and monitoring in patients with chronic noncancer pain (CNCP) who are receiving long-term opioid therapy.
ACCREDITATION STATEMENT
Physician: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of AKH Inc. and Applied Clinical Education. AKH Inc. is accredited by the ACCME to provide continuing medical education for physicians. AKH Inc. designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
LEARNING OBJECTIVES
After completing this activity, participants should be better able to:
- Summarize the American Pain Society/American Academy of Pain Medicine guideline recommendations for the use of urine drug testing (UDT) in patients with CNCP who are receiving long-term opioid therapy.
- Describe the 2-step urine screen process (immunoassay and gas chromatography/mass spectrometry) and other UDT methodologies that aid in opioid risk management.
- Implement a routine urine-screening program as part of a comprehensive risk management strategy for patients receiving opioid therapy for CNCP.
- Determine appropriate next steps in a treatment plan while considering result interpretation and limitations of UDT.
- Educate patients on the importance of adherence to their opioid treatment plan and the implications of irregular UDT results.
TARGET AUDIENCE
This activity is intended for physicians prescribing opioid therapy to patients with noncancer chronic pain.
CONFLICT OF INTEREST STATEMENT
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The faculty must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflict of interest is resolved by AKH Inc. prior to certification of the activity. AKH planners and reviewers have no relevant financial relationships to disclose.
DISCLOSURE OF UNLABELED USE
This educational activity contains discussion of published and/or investigational uses of opioids for the treatment of chronic pain. Some uses of these agents have not been approved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
ESTIMATED TIME OF COMPLETION
This activity should take approximately 1 hour to complete.
METHOD OF PARTICIPATION
There are no fees for participating in and receiving credit for this activity. The participant should, in order, read the objectives and monograph, answer the multiple-choice online post-test and complete the evaluation form. The evaluation form provides each participant with the opportunity to comment on the quality of the instructional process, the perception of enhanced professional effectiveness, the perception of commercial bias, and his/her views on future educational needs. A score of at least 70% is required to successfully complete this activity. One retake is allowed. Credit is available through January 31, 2011.
FACULTY
Bill McCarberg, MD
Founder of the Chronic Pain Management Program
Kaiser Permanente
Adjunct Assistant Clinical Professor
University of California, San Diego
San Diego, California
Lynn Webster, MD
Medical Director
Lifetree Clinical Research and Pain Clinic
Salt Lake City, Utah
REVIEWER
Gary H. Wimbish, PhD
President
Forensics Toxicology Consultants
Milford, Texas
MEDICAL WRITER
Oren Traub, MD, PhD
FINANCIAL DISCLOSURE
Dr. McCarberg is on the speaker's bureau for Cephalon, Endo Pharmaceuticals, Forest Pharmaceuticals, Lilly, Merck, Ortho-McNeil, Pfizer, Inc., and Purdue.
Dr. Webster has received research grants from Arcion, Advanced Bionic, Cephalon, CoMentis, Forest, Hisamitsu, Hoffman LaRoche, King Pharmaceutical, Medtronic, Merck, Myriad, Nektar, NeurogesX, Pfizer, Inc., Wyeth, and XenoPort. He is a consultant for Ameritox, Cephalon, King Pharmaceuticals, and Medtronic. He also is on the advisory board of Ameritox, King Pharmaceuticals, Nektar, Nervo, Neuromed, and Purdue.
Dr. Wimbish has no relevant financial relationships to disclose.
Dr. Traub has no relevant financial relationships to disclose.
DISCLAIMER
This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc., the author(s) and the publisher specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through reader's misunderstanding of the content.
SOFTWARE REQUIREMENTS
PC
Microsoft Windows 2000 SE or above.
Internet Explorer (v5.5 or greater), or Firefox
Adobe Acrobat Reader*
MAC
MAC OS 10.2.8
Safari
Adobe Acrobat Reader*
Internet Explorer is not supported on the Macintosh.
* Required to view printable (PDF) version of the lesson.
Jointly sponsored by AKH Inc. and Applied Clinical Education.
Supported by educational grants from AIT Laboratories and Endo Pharmaceuticals.
Copyright © 2010 AKH Inc. and Applied Clinical Education.
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