Prevalence of THC-Positive Urine Drug Screens in Patients Receiving Chronic Opioid Therapy: A Retrospective Review.

Abstract

Purpose of study: This retrospective review aimed to evaluate the prevalence of tetrahydrocannabinol (THC)-positive urine drug screens (UDS) in patients undergoing chronic opioid therapy (COT) for chronic pain at a single academic institution. With a growing national trend toward cannabis legalization and increased public access to marijuana for medical and recreational purposes, understanding the intersection between THC use and opioid prescribing practices is essential. The presence of THC on UDS has clinical, legal, and ethical implications, especially in regions where cannabis remains illegal. This study sought to quantify the prevalence of THC positivity in patients receiving COT for chronic pain.

Findings: A total of 244 UDS results were reviewed from January 1, 2024, to December 31, 2024. Among these, 24 patients (9.8%) tested positive for THC. Documentation and clinical responses to positive results varied, with some providers documenting patient counseling, while others did not acknowledge the result in the medical record. In a small subset of cases, positive THC findings contributed to changes in opioid therapy, including tapering or discontinuation.

Conclusion: THC-positive UDS results are relatively common among patients receiving chronic opioid therapy, highlighting the increasing prevalence of cannabis use in this population. These findings align with prior literature and reinforce the need for individualized, non-punitive approaches to care. Routine screening, consistent documentation, and open communication about cannabis use are essential components of effective opioid risk stratification, safe prescribing practices, and informed treatment planning. These considerations are critical in regions where recreational marijuana remains illegal, which may further influence provider decision-making regarding ongoing opioid therapy.