Balancing Compassion and Caution: Urine Drug Testing and Opioid
Misuse in Cancer Pain Treatment
Neha Bhupathiraju, MS21; Serena J. Kim B.A.2; Saba Javed, MD3; Dhanalakshmi Koyyalagunta, MD3
1Texas Tech University Paul L. Foster School of Medicine, El Paso; 2Baylor College of Medicine, Houston; 3University of Texas MD Anderson Cancer Center
Department of Pain Management, Houston

 

Background
Cancer Patients

Methods

Advanced, Metastatic and
Terminal Cancer Patients

UDT

Appropriate

Inappropriate

Pacients whd
reported

44.5%

30.6%

POPULATION
500 adult patients (218 years)
consults from January 2024-June
2025 with quantitative UDTs

Brief Pain Inventory

O (least) - 10 (worst)
Least Pain

Average Pain Right now

Personal Pain Goal

Worst Pain

Pain

Depression
Shortness of
Breath
Sleep

How often have you
attended an AA or NA

problem?

How often have your
medications been lost or
stolen?

ten have others
expressed concern over
your use of medication?

Opioid Based Treatment Indications:
Cancer Related Pain (direct cancer or treatment related)
Non-cancer Related
Palliative Indications

occunati

Non-Medical Opioid Use in 19% of cancer patients
within 8 wks of initial consultation 10

Pain management agreements + consent for ur
consent for urine drug testing (UDT), are a
recommended strategy for patients at higher risk of misuse, helping to set expectations
and facilitate consistent monitoring.
UDT has revealed abnormal results in 15-34% (1) of patients in oncology settings, with
s revealed abhormal results in 15-347e (T) of patients in oneology st
some clinics reporting noncompliance rates as high as 54% (2).
Risk stratificationtes
tification tools such as SOAPP-14, CAGE-AID, and ESAS are often used
alongside UDTs and are essential components of opioid stewardship in cancer care.

Objectives

Analyze the incidence of abnormal UDT in patients seen in a
Cancer Pain Clinic

Demographics
age, gender, race, primary language,
employ
employment status, occupation,
insurance status, socioeconomic status

(13)

Have you ever felt you
should cut down on your
drinking or drug use?

Have you ever felt bad or
or drug use

Fatigue
Anxiety
Appetite

Financial Distress

CAGE-AID
22 potential misuse

O = No. 1= Yes
you ever been annoyed
Have you eve been annoy
by people criticizing your
drinking or drug use?

Have you ever had a dr
used drugs first thing in the
guilty about your drinking morning to steady your nerves
or get rid of a hangover (eye
or get rid of
opener)?

ESAS

0 (best/none) - 10 (worst)
Nausea
Drowsiness
Felling of Well
Being
Spiritual Pain

mood swings?

after you wake up?

SOAPP-14
27 high risk

0 - Never, 1 - Seldom, 2 - Sometimes, 3 = Often, 4 = Very Often

How often have any of
your family members
How often do you have How often do you smoke
a cigarette within an hour including parents and
grandparents had a
problem with alcohol or
drugs?

Discussion and Conclusions

Results support utility of integrating risk
screening tools and UDT into routine
opioid monitoring practices.

asked to give urine
screen for substance
abuse?

How aften, in your
lifetime have you had
legal problems or been
arrested?

How often have you been
How often have you
used illegal drugs in the
past 5 years?

How often have any of How often have others
your close friends had suggested that you have
a problem with alcobol
a problem with alcohol a drug or alcohol
or drugs?

How often have you
taken medication othe
than the way that it
was prescribed?

How often have you
felt a craving for
nedication?

...

We acknowledge limitations of relying solely on
self-report instruments and hope that this study
supports universal and broader UDT application
over selective screening

These results aim to highlight the importance of
integrating:
Objective monitoring (e.g., UDT)
Psychosocial assessment
Individualized opioid safety strategies

Analysis and Results

Approprate UDT

ESAS

..

SOAPP.14 score

SOAPP-14

Higher SOAPP-14 > Inappropriate UDTs
5.31 vs. 3.33: p < 0.0001
Significant items: Mood Swings (p = 0.012)
m Others (p = 0.0037), Illegal Drug Use
(p < 0.001), Legal Problems/Arrests (p < 0.001)

..**

Correlate abnormal UDT with SOAPP-14, CAGE-Aid scores, and
symptom burden.

profiems

AA/NA meeting
Misused medicatior

Mond swinas

Smoke after waking
amity alcoholidrug probien
Friends atcotoltrug probiem
Othees suggested probiem

ymptoR

Treated for aicuhol/drug probiem

Craving mesication

Meds lost/stolen
Others cuncarned about med

Urine screees
Hegsl drug use

Legai probiems/arres

415 (83%) classified
as having Appropriate
UDT and 85 (17%)
classified as having
inappropriate UDT

Mean

Depression

Anxiety

Mowsiness
Drowsiness
Shortness of Breath

Fe Appetite

Feeling of Well Being

Spiritual Pain
Financial Distress

Appropriate UDT
Inappropriate UDT

Higher ESAS>
Inappropriate UDTs
42.78 vs. 38.26; p =
0.0149
Significant domains
Anxiety (p < 0.001),
Depression (p =
0.0272), Financial
Distress (p = 0.003),
Spiritual Pain (p =
0.0085)

Further research is needed to:
Develop oncology-specific risk models
Explore longitudinal NMOU trends
Compare universal vs. risk-based UDT
approaches
Investigate barriers to UDT implementation in
cancer care

References and Poster

Occupation

Ethnicity

Identify descriptive data among patients at high risk for opioid
misuse and abuse as identified by abnormal urine drug screens.

0309

Occupation

No Reported

Retired White Collar

White Collar
Retired Blue Collar

Blue Collar

Appropriate
Inappropriate
Inap
(Ilicit Substance)
Inappropriate
(Not Prescribed)

Inappropriate UDTs were associated with significantly higher worst
pain scores over the past week
8.15 vs. 7.75 (p = 0.0138).

thnicity

Unknown

Not Hispanic
or Latino

Appropriate
Inappropriat
gstance
(Illicit Substance)
Inappropriate
(Not Prescribed)

CAGE-Aid > No statistically significant differences between
groups

Hispanic or Latinc

150