Impact of Patient Prescriber Agreement on Aberrant Urine Drug Tests Among Patients Receiving Opioids for Cancer Pain

• Published in: Journal of pain and symptom management Vol. 70; no. 4; pp. e236 - e243
• Main Authors: Arthur, Joseph A., Pacheco, Soraira, Paulino, Rex A.D., Manuel, Christopher, Qiao, Wei, Hui, David
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2025
• Subjects: Adult; Aged; Analgesics, Opioid - therapeutic use; Analgesics, Opioid - urine; Anesthesia; Cancer pain; Cancer Pain - drug therapy; Cancer Pain - urine; Female; Humans; Male; Middle Aged; Nonmedical; Opioid-Related Disorders - prevention & control; Opioid-Related Disorders - urine; Opioids; Pain Medicine; Patient prescriber agreement; Retrospective Studies; Substance Abuse Detection; Urine drug test; Cancer pain; Nonmedical; Urine drug test; Opioids; Patient prescriber agreement
• ISSN: 0885-3924; 1873-6513; 1873-6513
• DOI: 10.1016/j.jpainsymman.2025.07.002

Best practices recommend the use of patient prescriber agreement (PPA) to improve patient adherence and reduce nonmedical opioid use (NMOU) during opioid therapy but evidence for this is lacking. No study has examined its efficacy among patients with cancer. We examined the impact of PPA completion on aberrant urine drug test (UDT), an NMOU indicator, within 3 and 6 months post-PPA completion. Demographic and clinical information of consecutive patients receiving opioids for cancer pain who completed a PPA were retrospectively reviewed and compared with those without a PPA. Univariable and multivariable regression models were used to determine factors associated with aberrant UDT. 126/236 (53%) and 150/236 (64%) of eligible patients had UDT results within 3 and 6 months respectively; among these patients, 92/126 (73%) and 107/150 (71%) signed a PPA. PPA completion was associated with significantly lower rates of an aberrant UDT within 3 months (OR 0.28, 95% CI: 0.09, 0.76; P = 0.02). Higher baseline pain expression (OR 1.22, 95% CI: 1.04, 1.46; P = 0.02), higher Morphine Equivalent Daily Dose (OR 1.07, 95% CI: 1.02, 1.14; P = 0.02), and history of illicit drug use (OR8.39, 95% CI: 3.31, 23.57; P < 0.001) were associated with aberrant UDT within 3 months post-PPA completion and remained significant at 6 months. Patients who signed a PPA had significantly lower rates of aberrant UDT within the following 3 months compared to patients who did not. The findings suggest that PPA may decrease NMOU behaviors, highlighting its potential as a risk mitigation strategy.