Medication violations and discontinuation of opioid therapy in a pediatric chronic pain clinic

Introduction To better define the warning signs for possible opioid misuse or abuse that could be incorporated as a work flow screening process, we retrospectively reviewed cases where opioid therapy was discontinued due to suspected opioid misuse, abuse, and diversion in patients seen by the chronic pain service. Materials and methods After Institutional Review Board approval, a retrospective chart review was conducted to identify patients who were seen in the Comprehensive Pain Clinic at Nationwide Children's Hospital and had opioid therapy discontinued during the years 2015-2016 for reasons involving suspected or confirmed opioid misuse. Medical records were reviewed from the time of chronic pain service intake until the time opioid therapy was discontinued. Minor violations (e.g., request for early refills, missing or canceling appointments) and major violations (e.g. negative urine drug screen [UDS] for opioids) were identified. Results The pain clinic team identified 8 patients (2 male/6 female, ages 13-23 years) whose opioid discontinuation was related to documented or suspected opioid misuse. Only 2 patients had opioid misuse explicitly documented as the reason for opioid therapy discontinuation. Five of the 8 patients had minor violations documented, while 3 had major violations. Only 2 patients had repeated medication violations noted, although both patients continued opioid therapy for >1 year after multiple violations became apparent. Discussion and Conclusion While missing or canceling 2 or more appointments was the most commonly documented violation, a discrepancy on a UDS was the reason documented for discontinuation of opioid therapy in both patients overtly involved in opioid misuse.