2047. Result of Urine Toxicology in VA Patients Treated In a Pain Clinic
Ariel M Baria, MSN-NP, VA Greater Los Angeles Healthcare System and University of California, U Ghazi, VA Greater Los Angeles Healthcare System and University of California, Q Pham, VA Greater Los Angeles Healthcare System and University of California, R Kumar, VA Greater Los Angeles Healthcare System and University of California, F Davis, VA Greater Los Angeles Healthcare System and University of California, B Schieffer, VA Greater Los Angeles Healthcare System, W Vanvort, VA Greater Los Angeles Healthcare System, E Dinovo, VA Greater Los Angeles Healthcare System, B Naliboff, University of California

Objectives: Study describes results of urine toxicology in a VA patient population treated in a Chronic Pain Program.

Methods: The VAGLAHS Outpatient Pain Program (OPMP) utilizes a standard Drug of Abuse (DOA) immunoassay and Biorad High Performance Liquid Chromatography (HPLC) Remedi-HS. These tests are used to monitor for medication compliance. 52 samples were reviewed. Both DOA and HPLC results were correlated with each patient’s opiate medication profile.

Results: Of the total DOA urine toxicology, 44 % was found negative for opiates despite patient prescribed opioid medication. Of the 44% negative urine toxicology, 13% was prescribed long acting opiates, 86% was prescribed short-acting opiates. Of 86% found negative urine toxicology and prescribed short-acting opiates, 80% were prescribed an oxycodone derivative. Of the total DOA urine toxicology, 51% completed confirmatory testing HPLC. Of the total HPLC result, 74% confirmed correct opiate prescribed, while 26% found a different type of opiates. DOA findings: 0% were positive for amphetamines, 5% positive for non-prescribed benzodiazepines, 13% positive for cannabinoids, and 3% positive for cocaine.

Conclusions: The findings illustrate the importance of close monitoring of patients on long-term opioid therapy. The findings also suggest the sensitivity of DOA in detecting opiate medication. A high percentage of patients on oxycodone tested false negative for opiates according to the DOA screening. A more sensitive test such as HPLC may be used as an alternative measurement.

Impact: Further studies shoud be conducted to fully understand the role of urine toxicology screening in monitoring opioid compliance.