Research exposes downside of drug screening for pain patients


Doctors who treat patients suffering from chronic pain risk deterring those patients through urine screening, according to research from the University of Houston and the University of Texas Medical Branch.

Monitoring patients through urine drug screenings, part of the standard protocol to ensure patient safety, is associated with an increase in the odds that the patients won't return for future treatment.

The study, published in the February edition of Pain Physician, deals with an issue drawing increasing public attention. President Barack Obama earlier this month called for $1.1 billion in new federal money to combat problems linked to prescription drug abuse and heroin, including more treatment for people addicted to painkilling opioids such as OxyContin and hydrocodone.

That will require monitoring of patients treated with those drugs, but the study found monitoring may have some unintended consequences; 23.75 percent of chronic pain patients who were given a urine drug screening test on their first visit failed to show up for their next appointment. That compares to just more than 10 percent of patients who were not screened. The trend applied even to patients whose drug screening indicated they had followed clinic rules.

"It is a balancing act," said Partha Krishnamurthy, a marketing professor and director of the Institute for Health Care Marketing at UH's Bauer College of Business. "On one hand, concerns about patient safety and public health necessitate the monitoring of patients on opioid medications. On the other hand, aggressive monitoring may interfere with the therapeutic alliance."

Krishnamurthy was lead author for the study, titled Impact of Urine Drug Screening on No Shows and Dropouts among Chronic Pain Patients, along with co-authors Govindaraj Ranganathan, Courtney Williams and Gulshan Doulatram, all UTMB physicians who are board certified in pain management.

Drug screenings offer clues to patient behavior but also signal the patient that the doctor is watching.

"When you give a signal to the patient, it is likely to affect their decision making," Krishnamurthy said. 

University of Houston, University of Texas Medical Branch, Partha Krishnamurthy, US