{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:58:38Z","timestamp":1790297918732,"version":"4.1.0"},"reference-count":18,"publisher":"Open Medical Publishing","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Background<\/jats:title>\n Urine drug screening (UDS) is commonly incorporated into the monitoring of patients receiving chronic opioid therapy for noncancer pain. Detection of an illicit substance such as cocaine creates a challenging clinical situation because continuation of full \u00b5-opioid agonist therapy may carry increased risk, while abrupt or reflexive discontinuation may also have unintended consequences. There is limited literature describing how clinicians modify chronic opioid therapy following cocaine-positive UDS results.<\/jats:p>\n <\/jats:sec>\n \n Case Series<\/jats:title>\n We describe four patients receiving chronic opioid therapy who were found to have cocaine-positive UDS results. Two patients receiving hydrocodone\/acetaminophen were gradually weaned from opioid therapy and opioids were subsequently discontinued. A third patient receiving hydrocodone\/acetaminophen was transitioned to buprenorphine\/naloxone 2 mg twice daily as an alternative to continued full agonist opioid therapy. A fourth patient with a history of substance misuse and prior spine surgery was offered transition to buprenorphine\/naloxone but declined and elected not to continue care with the practice.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Cocaine-positive UDS results may substantially alter chronic opioid prescribing. Management may include increased monitoring, gradual discontinuation of full agonist opioids, or consideration of buprenorphine-based therapy in appropriately selected patients. These cases emphasize the importance of individualized risk assessment rather than a uniform response to an unexpected UDS result.<\/jats:p>\n <\/jats:sec>","DOI":"10.52965\/001c.171215","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:58:33Z","timestamp":1790294313000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinical Responses to Cocaine-Positive Urine Drug Screens in Patients Receiving Chronic Opioid Therapy: A Four-Patient Case Series"],"prefix":"10.52965","volume":"18","author":[{"given":"Jamal","family":"Hasoon","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03gds6c39","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of Texas Health Science Center at Houston","department":["Department of Anesthesiology, Critical Care and Pain Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Chuan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00hj54h04","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of Texas at Austin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Viswanath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Urits","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"30777","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"issue":"9","key":"ref1","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1001\/jama.2013.522","article-title":"Chronic back pain with possible prescription opioid misuse","volume":"309","author":"D. 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