Impact of urine drug screening on no shows and dropouts among chronic pain patients: A propensity-matched cohort study

Background: the last 2 decades have seen a substantial increase in both the prescription of opioids for managing chronic pain,and an increase in opioid-related deaths in the us. urine drug screening (uds) is the de facto monitoring tool aimed at detecting and deterring opioid misuse. objective: we study whether administering uds on pain patients influences post-screening behavior of no-shows and dropouts. study design: observational cohort study of electronic medical records. setting: single urban academic pain-clinic. methods: a retrospective cohort comparison of patients receiving uds versus those not receiving uds was conducted on the entire sample as well as in the propensity score-matched samples in which matching was based on age,gender,pain-score,procedure-scheduled,systolic and diastolic blood pressure (bp),pulse,temperature,physician id,year of visit,psychology referral,and opioid prescription in the first visit. in addition,we conducted within-subjects logistic-regression to study no-shows and non-proportional hazards survival modeling to study dropout. results: analyses of 4,448 clinic visits by 723 pain patients indicated that uds exposure in the first visit is associated with increased risk of no-show in the second visit (or = 2.73,p <.0001); no-show rate was 10.24% for those without uds compared to 23.75% for those with a uds. among those tested,the no-show rate was higher for those testing positive for illicit substances (34.57%) than for those testing negative (21.74%). these findings were replicated in 8 different propensity-score matched subsamples aimed at addressing potential nonrandom selection,as well as in within-subject analysis accounting for individual-level no-show propensity. non-proportional hazards survival analysis shows that risk of dropout increased by 100.3% with every additional uds (hr 95% ci: 1.54 to 2.61). limitations: retrospective design,non-randomized sample,single-setting. conclusions: the results indicate that uds is associated with increased no-shows and dropout from clinic subject to limitations of observational studies such as selection bias and confound by unobserved variables. these results serve as a call for additional prospective randomized studies to understand the impact of uds,and where the patients might go when they dropout from the clinic. © 2016,american society of interventional pain physicians. all rights reserved.