Non-compliance among chronic pain sufferers

From Pharmacy News:

A new study has shown high levels of inappropriate drug use in the chronic pain population.

The study, published in Population Health Management , revealed that 75 percent of patients prescribed opioids for chronic pain were unlikely to be taking their medicine in a manner consistent with their prescribed regimen.

Data from more than 900,000 urine toxicology tests conducted on over 500,000 patients prescribed chronic opioid therapy in the US showed 38 percent of patients had no detectable level of their prescribed medication; 27 percent had a drug level higher than expected while 15 percent had a drug level lower than expected.

Patients 35-50 were over 30 percent more likely than patients 12-21 to have no prescribed medication detected in their urine.

Illicit drugs such as cocaine or methamphetamines were detected in the urine of 11 percent of patients and 29 percent had a medication in their system that their doctor was unaware of.

The urine tests showed that only one-quarter of patients were taking their medications as prescribed with no evidence of illicit drug use or misuse of prescribed drugs.

"The high observed rate of non-compliance demonstrates a significant clinical concern and confirms the importance of periodic urine drug screening for the population prescribed long-term opioid therapy," the authors wrote.

Posted: 9/10/2009 3:43:00 PM

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Comments

9/10/2009 4:33:43 PM

Monitoring of patient compliance is extremely important in terms of managing pain medication to optimize comfort and avoid toxicity or drug interactions. This study used an algorithm that estimates normal creatinine corrected urine concentration ranges for patients based on dose, age, gender and weight. This model is based on a patent by Michael Kell filed in the late 1990's but there has been no subsequent validation published of the method. The low rates of compliance in this new study could reflect either remarkably low patient compliance or could reflect limitations of the algorithm. The new study doesnt address that. Estimating dose based on urine concentrations, even creatinine normalized concentrations, is a controversial practice.

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