Effectiveness of Opioid-Treatment Agreements and Urine Testing in Reducing Opioid Misuse among Patients with Chronic Noncancer Pain
Chronic noncancer pain is one of the most common reasons patients visit physicians. Despite a paucity of data demonstrating effectiveness, opioid therapy is frequently prescribed. To offset potential risks associated with opioid prescribing, consensus guidelines suggest the use of risk-reduction strategies including opioid-treatment agreements (OTAs) and urine drug testing (UDT). This systematic review assessed the effectiveness of OTAs and UDT in reducing opioid misuse in outpatients prescribed opioids for chronic noncancer pain.
- Eleven of 102 eligible studies met inclusion criteria (6 in pain clinics and 5 in primary care): 3 evaluated OTAs alone, 1 evaluated UDT alone, and 7 evaluated both.
- All studies were observational and of poor-to-fair quality based on multiple assessment criteria.
- In the 4 studies with a comparison group, there was a 7–23% absolute-risk reduction in opioid misuse; however, the multicomponent interventions described were not representative of common clinical practice.