"Part of the policy": A qualitative study of PCP attitudes toward urine drug testing for chronic opioid prescriptions.

OBJECTIVE

Guidelines for safer chronic opioid prescribing recommend regular urine drug testing (UDT); however, evidence on the best use of this testing is less clear, and wide variation exists in practice. Our objective in this qualitative study was to assess provider attitudes, barriers, and facilitators to ordering and interpreting UDT for patients prescribed chronic opioids.

DESIGN, SETTING, AND SUBJECTS: Qualitative study among family and internal medicine physicians working at several clinics within a large community and academic health system.

METHODS

Semistructured interviews were analyzed with qualitative thematic analysis.

RESULTS

Themes were (1) perceived medical benefit outweighs concerns, (2) UDT requirement has a push-pull relationship with professional autonomy, (3) standardization of UDT as key to reduce bias, (4) systematic process eases confusion, and (5) desire for training for "gray areas."

DISCUSSION: A key facilitator was also a key barrier: Guideline-required urine drug tests as the requirement both reduced conflict between primary care physicians (PCPs) and patients around ordering urine drug tests and reduced professional autonomy and shared decision-making. Education on ordering and interpreting urine drug tests was endorsed as important to facilitate use.

CONCLUSIONS

PCPs generally view urine drug tests favorably but have mixed attitudes toward urine drug test mandates and desire comprehensive education on urine drug test management.