• Smita Bakhai, Bright Thilagar, Jessica L Reynolds, and Kenneth E Leonard.
• Medical Director, Internal Medicine Center, Assistant Professor, Department of Internal Medicine, University at Buffalo, The State University of New York, Erie County Medical center, Buffalo, New York.
• J Opioid Manag. 2018 Jan 1; 14 (1): 23-33.

ObjectiveDetermine correlates of opiate misuse based on urine drug test (UDT) among patients on chronic opiate therapy (COT) for chronic noncancer pain.DesignA cross-sectional study.SettingUrban, academic clinic.ParticipantsUDT performed in 206 patients on COT for at least 3 months duration within a one-year period. Patients were classified based on UDT results: (1) Appearance of Opiate Adherence: Positive UDT for prescribed opiate and negative for illicit drugs and nonprescribed control substances; (2) Opiate Misuse; Overt nonadherence: (a) Positive UDT for illicit drugs and/or nonprescribed controlled substances AND positive or negative for prescribed opiates (b) Overdose; (3) Possible opiate nonadherence: Negative for prescribed opiates and negative for illicit and nonprescribed controlled substances.InterventionsNone.Main Outcome MeasuresUDT results, patient demographics, medical history, healthcare adherence, and utilization measures.ResultsOf the 206 records analyzed, 80 (38 percent) had appearance of opiate adherence, 91 (44 percent) had misuse, and 35 (17 percent) had possible opiate nonadherence. Analysis was performed comparing misuse and appearance of opiate adherence groups. In bivariate analyses, history of smoking (OR 3.90, 95% CI 1.69-9.03), substance use (OR 7.02, 95% CI 2.56-19.20), missed medical appointments (OR 2.85, 95% CI 1.44-5.63), and nonadherence to other medications correlated with misuse group (OR 18.86, 95% CI 8.73-40.74). In logistic regression, only substance use history (OR 4.32, 95% CI 1.27-14.64) and nonadherence with nonopiate medications (OR 13.22, 95% CI 5.81-30.10) correlated with misuse.ConclusionsMedication nonadherence and missed appointments for other chronic conditions were significant correlates of opiate misuse.

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