Helping you stay current in drug monitoring

Getting Started with Clinical Drug Monitoring

If you are prescribing medications for patients with chronic pain or substance use disorder (SUD), a clinical drug monitoring program should be part of your routine practice. Without it, you are basically “flying blind” and may putting your patients at increased risk. With it, you have the objective information you need to keep your patients safe throughout their treatment.

Data from the annual Quest Diagnostic’s® Health TrendsTM report show that when drug tested, more than half of patients misuse their medications.1 In 2018, 17% of samples tested did not contain any prescribed drugs or other tested drugs, while 10% did not show the prescribed drugs, but did reveal at least 1 nonprescribed or illicit drugs. At the same time, 24% of all samples combined the prescribed drug or drugs with a nonprescribed or illicit drug.

While many physicians feel inappropriately confident they can recognize the signs of prescription drug misuse based solely on interacting with their patient; although 95% of physicians surveyed in the Quest Health Trends™ report were confident in their ability to discuss the risks of misuse with their patients, only 55% said that they actually had those difficult conversations with their patients who were prescribed controlled medications.

When you have a clinical drug monitoring report from Quest, you have the important, objective information you need to begin a conversation with the patient.

Key considerations in establishing your clinical drug monitoring include2:

  • Determining which individuals to monitor (most commonly, patients receiving opioids for chronic pain)
  • Evaluating patient risk factors using validated tools, such as the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) or the Opioid Risk Tool (ORT)
  • Reviewing your patient’s prescribing history in the state Prescription Drug Monitoring Program (PDMP)

With each patient, the protocol should include:

  • Discussing the risks and benefits of therapy (informed consent)
  • Reviewing patient responsibilities and creating a written treatment agreement
  • Conducting baseline testing
  • Conducting periodic, risk-based drug monitoring

The choice of which drugs to test will depend on your patient’s history, patterns of use in your community, the treatment plan, and the prescription the patient is receiving. Common drug classes include:

  • Alcohol Metabolites
  • Amphetamines
  • Barbiturates
  • Benzodiazepines
  • Buprenorphine
  • Cocaine
  • Fentanyl
  • Heroin
  • Marijuana
  • Methadone
  • Opiates
  • Oxycodone

According to guidelines from the Centers for Disease Control and Prevention, “When prescribing opioids for chronic pain, clinicians should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.” 3 The actual frequency may vary; if a patient is at high risk for drug misuse, more intensive monitoring may be appropriate, based on clinician determination.

1. Health Trends™ Drug Misuse in America 2019: Physician Perspectives and Diagnostic Insights on the Evolving Drug Crisis. Quest Diagnostics 2019.

2. Adler JA and Jackson WC. Implementing a prescription drug monitoring protocol to ensure responsible opioid prescribing. Pain Medicine News. September 2018. https://www.painmedicinenews.com/Monographs-and-Whitepapers/Article/09-18/Implementing-a-Prescription-Drug-Monitoring-Protocol-to-Ensure-Responsible-Opioid-Prescribing/52549

3. Quality improvement and care coordination: Implementing the CDC guideline for prescribing opioids for chronic pain. 2018. National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Atlanta, GA. Accessed November 21, 2020. https://www.cdc.gov/drugoverdose/pdf/prescribing/CDC-DUIP-QualityImprovementAndCareCoordination-508.pdf