Urine drug testing of chronic pain patients: Licit and illicit drug patterns

Edward J. Cone, Yale H. Caplan, David L. Black, Timothy Robert, Frank Moser

Research output: Contribution to journalArticlepeer-review

73 Scopus citations


Chronic pain patients are frequently maintained on one or more powerful opioid medications in combination with other psychoactive medications. Urine tests provide objective information regarding patient compliance status. Little information is available on testing this unique population. The goal of this study was to characterize drug disposition patterns in urine specimens collected from a large population of pain patients. Confirmation data for 10,922 positive specimens were collated into 11 drug Classes. The number of drug/metabolites tested (#) and number of confirmed positive specimens were as follows: amphetamines (7), 160; barbiturates (5), 308; benzodiazepines (6), 2397; cannabinoids (1), 967; carisoprodol (2), 611; cocaine (1), 310; fentanyl (1), 458; meperidine (2), 58; methadone (2), 1209; opiates (7), 8996; and propoxyphene (2), 385. Subdivision into 19 distinct drug Groups allowed characterization of drug use patterns. Of the 10,922 positive specimens, 15,859 results were reported as positive in various drug Classes, and 27,197 drug/metabolites were measured by gas chromatography-mass spectrometry. The frequency of illicit drug use (cannabis, cocaine, ecstasy) was 10.8%. Being the first study of this type, these data present a large array of information on licit and illicit drug use, drug detection frequencies, drug/metabolite patterns, and multi-drug use combinations in pain patients.

Original languageEnglish (US)
Pages (from-to)530-543
Number of pages14
JournalJournal of analytical toxicology
Issue number8
StatePublished - Oct 2008
Externally publishedYes

ASJC Scopus subject areas

  • Analytical Chemistry
  • Environmental Chemistry
  • Toxicology
  • Health, Toxicology and Mutagenesis
  • Chemical Health and Safety


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