Utility of the Pain Medication Questionnaire to Predict Aberrant Urine Drug Tests: Results From a Longitudinal Cohort Study

• Published in: Psychological services 2021-08, Vol.18 (3), p.319-327
• Main Authors: Morasco, Benjamin J., Iacocca, Megan O., Lovejoy, Travis I., Dobscha, Steven K., Deyo, Richard A., Cavese, Julie A., Hyde, Stephanie, Yarborough, Bobbi Jo H.
• Format: Article
• Language: English
• Subjects: Alcohol use; Cohort analysis; Drug Abuse; Drug dosages; Drug testing; Drug Therapy; Drug Usage Screening; Drugs; Female; Human; Male; Medical screening; Narcotics; Opiates; Opioids; Pain; Pain Measurement; Prescription Drugs; Quality of life; Questionnaires; Risk assessment; Screening Tests; Self report; Test Construction; Urine; Urine tests
• ISSN: 1541-1559; 1939-148X
• DOI: 10.1037/ser0000471

Identifying patients at risk of misusing prescription opioids is a priority. Standardized risk measures exist, but prior research has been limited in an assessment of their utility by a reliance on cross-sectional or retrospective analyses. In this study, the Pain Medication Questionnaire (PMQ), a standardized self-report measure of risk for prescription opioid misuse, was used to predict aberrant urine drug test (UDT) results over the subsequent 24 months. At baseline, participants who were prescribed long-term opioid therapy completed self-report measures assessing pain, function, and quality of life; this also included the PMQ. Medical record data were abstracted for 24 months postbaseline to collect results of UDTs administered during clinical care. Among participants, 12.9% had a UDT result that was positive for a nonprescribed or illicit substance, 18.9% had an aberrant negative UDT result, 3.6% had aberrant positive and negative UDT results, and the remaining 64.6% had expected UDT results. Average PMQ score at baseline did not significantly differ based on participants' type of UDT result over 24 months of follow-up. Participant variables that were significantly associated with a subsequent aberrant positive UDT were higher prescription opioid dose and hazardous alcohol use; those associated with an aberrant negative UDT were lower prescription opioid dose and hazardous alcohol use; no variable was associated with combined positive and negative UDT results. In conclusion, total PMQ score was not predictive of aberrant positive or negative UDT results. More work is needed to identify optimal strategies of screening for risk of aberrant UDT results. Impact Statement We conducted a 2-year study to examine if a specific self-report measure, the Pain Medication Questionnaire, predicted if patients with chronic pain would have aberrant urine drug test results. The analyses found that the Pain Medication Questionnaire was not associated with urine drug test results, although other factors were predictive. The study findings do not support the Pain Medication Questionnaire as a one-time, stand-alone measure of predicting urine drug test results.