Urine Drug Screens to Monitor Opioid Use for Managing Chronic Pain,JAMA

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Urine Drug Screens to Monitor Opioid Use for Managing Chronic Pain
JAMA ( IF 63.1 ) Pub Date : 2017-09-19 , DOI: 10.1001/jama.2017.10593
Shannon Haymond ₁ , Geeta Nagpal ₂ , Heather Heiman ₃

Affiliation

A 53-year-old woman presented for a prescription refill of hydrocodone/acetaminophen 10 mg/325 mg. She had chronic low back pain and partial paralysis from a thoracic spinal cord infarction, secondary to aortic dissection from prior cocaine use. Taking 2 to 3 tablets of hydrocodone/acetaminophen daily improved her back pain from 5 to 2 on a 10-point scale. She reported no recent illicit substance or drug use and stated her last dose of hydrocodone was that day. The patient had not achieved pain control with prior nonopioid pharmacologic pain management, including duloxetine and gabapentin. Although past cocaine use was a risk factor for opioid misuse, a trial of hydrocodone was initiated, after discussion of risks and benefits, with a plan for careful monitoring. The state prescription drug monitoring program showed no other prescribers of controlled substances. A urine immunoassay drug screen was ordered to evaluate for medication misuse and illicit use (Table).

中文翻译：

尿液药物筛查以监测阿片类药物用于控制慢性疼痛

一名 53 岁女性因处方补充氢可酮/对乙酰氨基酚 10 毫克/325 毫克而就诊。她患有慢性腰痛和胸脊髓梗塞导致的部分瘫痪，继发于先前使用可卡因导致的主动脉夹层。每天服用 2 至 3 片氢可酮/对乙酰氨基酚可将她的背痛从 5 分改善到 2 分（10 分制）。她报告说最近没有使用非法物质或药物，并说她最后一次服用氢可酮是在那天。该患者之前使用非阿片类药物疼痛管理（包括度洛西汀和加巴喷丁）未能实现疼痛控制。尽管过去的可卡因使用是阿片类药物滥用的风险因素，但在讨论了风险和收益后，开始了氢可酮试验，并制定了仔细监测的计划。国家处方药监测计划显示没有其他受管制药物的处方者。要求进行尿液免疫分析药物筛查以评估药物滥用和非法使用（表）。

更新日期：2017-09-19

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