Drug Monitoring: One Approach to Decreasing Addiction

McMillin, medical director of Pharmacogenetics, oversees pain management tests at ARUP
November 15, 2017

Dr. Gwen McMillin, left, is medical director of Toxicology and Pharmacogenetics at ARUP and a professor of pathology at the University of Utah School of Medicine.


Each week, Lily takes the S53 bus to her doctor’s office on Clove Road in Staten Island, New York. Six months ago, after a work injury stressed nerve endings, she was prescribed with an opioid pain reliever. While she takes the course of medication, Lily is tested each week to make sure her blood contains only prescribed substances. Others in her family have a history of drug addiction, so her physician assigned testing with the hope of protecting her from drug misuse. Her screenings also take into account her psychiatrist’s prescription of Adderall, which helps Lily focus at work.

Naturally, she is not alone in experiencing chronic and sharp pain. A 2012 analysis by the National Institutes of Health (NIH) found that an estimated 25.3 million adults (11.2 percent) experience chronic pain—that means they had pain every day for the preceding three months. Nearly 40 million adults (17.6 percent) experience severe levels of pain, according to the analysis. What’s more, every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids, according to the Centers for Disease Control (CDC) website.

In pain management, it isn’t unusual for a patient to be taking many different types of drugs at once. In addition to monitoring with urine drug tests to assure adherence to therapy and minimize drug misuse, it’s important to try to consider the risk of drug-drug interactions and whether a drug is likely to contribute to an adverse reaction.

Gwen McMillin, PhD, a medical director of two labs at ARUP.

The types of testing Lily undergoes—drug monitoring and pain-management monitoring—are approaches to preventing further pain and addiction on the part of patients. Ideally, monitoring can help patients taper off medications in a prescribed time period and control their usage of a medication. Clinicians also sometimes order pharmacogenetics testing to learn whether a patient will correctly metabolize a medication based on their DNA so that negative or ineffective reactions don’t occur.  

“In pain management, it isn’t unusual for a patient to be taking many different types of drugs at once,” notes Gwen McMillin, PhD, medical director of Toxicology and Pharmacogenetics at ARUP Laboratories, referring in particular to chronic pain, psychiatric, and elderly patients. “In addition to monitoring with urine drug tests to assure adherence to therapy and minimize drug misuse, it’s important to try to consider the risk of drug-drug interactions and whether a drug is likely to contribute to an adverse reaction.”

Drug monitoring programs are one of the current weapons against addiction. Working out universal practices for pain management and helping to encourage them with pain monitoring “can reduce the risk for abuse and misuse associated with chronic pain medications, especially opioids,” said a 2011 study published by American Health and Drug Benefits.

ARUP has several panels and individual tests for pain and drug monitoring.

Catherine Arnold, Science Communications Writer

 

Related blog:

Advancing Precision Medicine Through Pharmacogenetics: Updated Test Prevents Adverse Drug Reactions

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