Gary M. Reisfield, MD; Noni A. Graham, MPH; Mark S. Gold, MD
Potential Conflicts of Interest: None disclosed.
Reisfield G., Graham N., Gold M.; Urine Drug Testing Is Still an Invaluable Resource for Primary Care. Ann Intern Med. 2010;153:420. doi: 10.7326/0003-4819-153-6-201009210-00018
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Published: Ann Intern Med. 2010;153(6):420.
TO THE EDITOR:
We commend Starrels and colleagues (1) for their excellent systematic review and wholeheartedly agree that more rigorous studies are needed to determine the roles of treatment agreements and urine drug testing (UDT) to reduce misuse of prescription opioids. The authors could have emphasized, however, that in addition to reducing opioid misuse, for which they found weak supportive evidence, UDT plays an invaluable role in detecting abuse of and addiction to prescribed opioids, illicit drugs, and nonprescribed controlled substances, as well as diversion of prescribed opioids. The abuse of prescription opioids in the United States has reached epidemic proportions. Heit and Gourlay (2), in their accompanying editorial, point out that the number of new nonmedical users of prescription opioids has equaled or exceeded the number of new users of marijuana in recent years. The provenance of the opioids and the consequences of their use were left unstated. As prescriptions for opioid analgesics have increased dramatically in recent years, there have been parallel increases in emergency department mentions, hospitalizations, and deaths related to these medications. In fact, rates of poisoning mortality involving opioid analgesics have been exponentially higher than those involving heroin and cocaine (3). It should be sobering to all clinicians that most of the opioids destined for nonmedical use in the United States originate from valid physician prescriptions (4). Reducing misuse of prescription opioids remains a vexing problem and depends on multiple patient, physician, and system factors. However, the utility of UDT in the detection of opioid-related problems is unequivocally supported by data, such as the seminal study by Katz and colleagues (5), which shows that UDT is perhaps the most important surveillance technique for detecting illicit drug use in long-term opioid analgesic therapy.
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