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Psych Congress  

Urine Drug Monitoring in Patients on Prescribed Antipsychotic Medications

Mancia Ko, PharmD, MBA
Tom Smith, MD
Ingenuity Health, a service of Ameritox LLC, Baltimore, MD

This poster was presented at the 29th Annual U.S. Psychiatric & Mental Health Congress, held October 21-24, 2016, in San Antonio, Texas.

Background: Maintenance of antipsychotic drugs (APD) are critical in the management of patients with serious mental illness in preventing relapse; however, up to 69% of seriously mentally ill patients are not adherent to their prescription regimen.

Objective: To assess the incidence of potential non-adherence among patients prescribed APD and to identify use of illicit substances and/or non-prescribed medications in these patients.

Methods: Between 2013 and 2016, 62,342 urine samples were obtained from patients prescribed APD.  Samples were classified as APD positive (a positive LC/MS/MS result for APD parent and/or metabolite) or APD negative (negative LC/MS/MS).  Samples were also classified as positive or negative for: non-prescribed opiates, synthetic opioids or benzodiazepines, cocaine and THC.  Logistic regression analyses were used to calculate odds ratios and 95% CIs.

Results: The study population was 49.2% male with a mean age of 41.6 ± 14.2 years. UDM was positive for APD in 75.3% of samples and negative in 24.7%, and varied widely by specific APD.  APD negative individuals were more likely than APD positive to have a non-prescribed opiate/synthetic opioid found (14.5% vs. 11.2%) as well as a non-prescribed benzodiazepine (7.3% vs. 5.7%).  They also were more likely to have THC found (20.7% vs. 17.1%), or cocaine found (5.7% vs. 3.5%).  A non-prescribed APD was found in 6.7% of samples.

Conclusions:  These data suggest that UDM in patients who are prescribed APD can be of value in both monitoring adherence to APD therapy, and in identifying use of inappropriate prescription and non-prescription substances. 

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