Clinical Drug Monitoring in Primary Care
Brought to you by Quest Diagnostics and Practical Pain Management

Why to Monitor Drug Use

Why Every Physician Needs to Integrate Clinical Drug Monitoring into their Practice
with Jeff Gudin, MD

There are many misperceptions among the healthcare community regarding the need to perform drug monitoring of patients. Some clinicians may think drug monitoring is optional; others may assume only pain specialists treating high-risk patients need to be monitored. However, over the past few years, drug monitoring has not only gained support throughout the healthcare profession but has also been added to regulatory guidelines from the US Centers for Disease Control and Prevention (CDC) and accepted by several medical boards (see Additional Resources for details).

In the pain management setting, clinicians use laboratory-based drug monitoring for most patients. While primary care physicians (PCPs) may rely on patient self-reporting, monitoring for use of prescribed and non-prescribed drugs, as well as illicit substances, is becoming more important than ever as 52% of patient drug monitoring test results have shown to be inconsistent with the medications prescribed.

Furthermore, the National Center for Health Statistics and CDC reported that between 1999 and 2017, more than 72,000 Americans died from drug-related overdoses, of which approximately 49,000 involved opioids and just over 19,000 involved pain-relieving opioids, and among individuals age 25 to 64, national statistics show that drug overdose caused more deaths than motor vehicle traffic crashes. Through the integration of drug monitoring into the primary care setting, a clinician can demonstrate his/her commitment to addressing these widespread public health concerns by helping to identify and reduce substance use disorders, diversion, or drug misuse. In day-to-day practice, drug monitoring can be used as a critical tool to help obtain objective data about patients’ drug use, promote compliance of safe use of controlled substance, and meet certain regulatory expectations.

Overall, clinical drug monitoring and testing can help PCPs to:

  • Obtain objective data to analyze patients’ adherence to their treatment plans
  • Manage patients’ prescription drug use; for instance, to
    • obtain a baseline prior to initiating controlled medication
    • monitor to ensure compliance with prescribed drug(s)
    • identify use of non-prescribed drugs or illicit substances
  • Help identify harmful drug interactions, misuse, abuse
  • Advocate for their patients
  • Meet certain new regulatory expectations
  • Protect their practice.

It is important for PCPs to communicate not only with their laboratories and toxicologists to ensure proper interpretation of test results, but also to communicate with their patients—upfront and throughout the process. Both subjects are addressed on the following pages.

Key Takeaways
  • Clinicians should use urine drug testing for patients before prescribing opioid therapy and consider urine drug testing for those patients at least annually to assess for prescribed medications as well as for other controlled prescription drugs and illicit substances.
  • Clinical drug monitoring is now a standard of care when managing patients with long-term opioid therapy.
  • Clinicians who prescribe opioid analgesics should develop skill sets in pain assessment and management, as well as in mitigation of drug misuse and abuse.

 

Next, Who to Monitor

 

Last updated on: February 27, 2019
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