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

Parthasarathy Krishnamurthy, Govindaraj Ranganathan, Courtney Williams, Gulshan Doulatram

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)89-100
Number of pages12
JournalPain physician
Issue number2
StatePublished - Feb 2016


  • Adherence
  • Chronic pain
  • Dropout
  • No-show
  • Opioid monitoring
  • Propensity-score matching
  • UDS
  • Urine-drug screening

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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