A Prediction Model for Positive Infant Meconium and Urine Drug Tests

2020 ◽  
Author(s):  
Elizabeth A. Simpson ◽  
David A. Skoglund ◽  
Sarah E. Stone ◽  
Ashley K. Sherman
Keyword(s):  
Prediction Model ◽  
Drug Testing ◽  
Clinical Decision Making ◽  
Drugs Of Abuse ◽  
Clinical Decision ◽  
P Value ◽  
Test Characteristics ◽  
Drug Test ◽  
Urine Drug ◽  
Urine Drug Test

Objective This study aimed to determine the factors associated with positive infant drug screen and create a shortened screen and a prediction model. Study Design This is a retrospective cohort study of all infants who were tested for drugs of abuse from May 2012 through May 2014. The primary outcome was positive infant urine or meconium drug test. Multivariable logistic regression was used to identify independent risk factors. A combined screen was created, and test characteristics were analyzed. Results Among the 3,861 live births, a total of 804 infants underwent drug tests. Variables associated with having a positive infant test were (1) positive maternal urine test, (2) substance use during pregnancy, (3) ≤ one prenatal visit, and (4) remote substance abuse; each p-value was less than 0.0001. A model with an indicator for having at least one of these four predictors had a sensitivity of 94% and a specificity of 69%. Application of this screen to our population would have decreased drug testing by 57%. No infants had a positive urine drug test when their mother's urine drug test was negative. Conclusion This simplified screen can guide clinical decision making for determining which infants should undergo drug testing. Infant urine drug tests may not be needed when a maternal drug test result is negative. Key Points

FDA/DEA/PDMP/UDT: Alphabet soup or sensible and integrated risk management?

2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Steven D. Passik, PhD ◽  
Kenneth L. Kirsh, PhD ◽  
Robert K. Twillman, PhD
Keyword(s):  
Risk Management ◽  
Drug Testing ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Management Approach ◽  
Prescription Drug Monitoring Programs ◽  
Integrated Risk ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Liquid Chromatography Tandem Mass

Objective: Both prescription drug monitoring programs (PDMP) and urine drug testing (UDT) are recommended as parts of an ongoing risk management approach for controlled substance prescribing. The authors provide an editorial and commentary to discuss the unique contributions of each to promote better clinical decision making for prescribers.Design: A commentary is employed along with brief discussion comparing four states with an active PDMP in place to three states without an active PDMP as it relates back to findings on UDT in those states from a laboratory conducting liquid chromatography tandem mass spectrometry.Conclusions: The commentary focuses on the place of both tools (UDT and PDMP) in risk management efforts. The argument is made that relying on a PDMP alone would lead to clinical decisions that may miss a great deal of problematic or aberrant behaviors.

Family physicians’ proficiency in urine drug test interpretation

2007 ◽  
Vol 3 (6) ◽  
pp. 333 ◽  
Author(s):  
Gary M. Reisfield, MD ◽  
Fern J. Webb, PhD ◽  
Roger L. Bertholf, PhD ◽  
Paul A. Sloan, MD ◽  
George R. Wilson, MD
Keyword(s):  
Family Medicine ◽  
Drug Testing ◽  
Opioid Therapy ◽  
Physician Education ◽  
Test Interpretation ◽  
Multiple Choice Questions ◽  
Drug Test ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Urine Drug Test

Objective: To determine the proficiency in urine drug test interpretation among family medicine physicians who order these tests to monitor adherence in their patients on chronic opioid therapy.Methods: A seven-question instrument, consisting of six, five-option, single-best-answer multiple choice questions and one yes/no question was administered to 80 family medicine physicians attending a University of Kentucky Family Medicine Review Course. We calculated frequencies and performed χ2 analyses to examine bivariate associations between urine drug test utilization and interpretive knowledge.Results: The instrument was completed by 60/80 (75 percent) of eligible physicians (44 order urine drug testing; 16 do not). None of the physicians who order urine drug testing answered more than five of the seven questions correctly, and only 20 percent answered more than half correctly. Physicians who order urine drug testing performed better than physicians who do not order urine drug testing on only four of the seven questions, although there were no statistically significant differences between the groups on any question.Conclusions: Family medicine physicians who order urine drug testing to monitor their patients on chronic opioid therapy are not proficient in their interpretation. This study highlights the need for improved physician education in this area. It is imperative for physicians to work closely with certified laboratory professionals when ordering and interpreting urine drug tests.

Does the perceived accuracy of urine drug testing impact clinical decision-making?

2019 ◽  
Vol 41 (1) ◽  
pp. 85-92
Author(s):  
Barry Rosenfeld ◽  
David V. Budescu ◽  
Ying Han ◽  
Melodie Foellmi ◽  
Kenneth L. Kirsh ◽  
...  
Keyword(s):  
Decision Making ◽  
Drug Testing ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Urine Drug Testing ◽  
Urine Drug

A primer on definitive gas and liquid chromatography drug testing: What clinicians need to know

2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Amadeo Pesce, PhD ◽  
Kenneth L. Kirsh, PhD ◽  
Angela Huskey, PharmD, CPE ◽  
Steven D. Passik, PhD ◽  
Catherine A. Hammett-Stabler, PhD
Keyword(s):  
Mass Spectrometry ◽  
Liquid Chromatography ◽  
Drug Testing ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Clinical Tool ◽  
Gas And Liquid Chromatography ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Compare And Contrast

Objective: To describe the differences between mass spectrometry technologies and compare and contrast them with immunoassay techniques of urine drug testing (UDT). Highlight the potential importance of the differences among these technologies for clinicians so as to allow them make decisions in their use in patient care.Methods: Review of mass spectrometry techniques, including gas chromatography, liquid chromatography, and time-of-flight techniques.Results: The potential clinical implications of these technologies stemming from their scope and accuracy are presented.Significance: UDT is an important clinical tool, though there are differences in technology and testing processes with important implications for clinical decision making. It is crucial, therefore, that clinicians have an understanding of the technologies behind the tests they order, so that their interpretation and use of results are based on an understanding of the strengths and weaknesses of the technologies used.

Tapentadol is the least common opioid found in admission urine drug-test results at an intensive outpatient opioid-use disorder treatment program in Ohio: A brief report

2021 ◽  
Vol 17 (1) ◽  
pp. 13-17
Author(s):  
Adam Rzetelny, PhD ◽  
Diana Meske, PhD ◽  
Parag Patel, MD, FACOG, FASAM ◽  
Steven Passik, PhD
Keyword(s):  
Treatment Program ◽  
Opioid Use Disorder ◽  
Common Finding ◽  
Prescription Opioid ◽  
Test Results ◽  
Opioid Use ◽  
Drug Test ◽  
Urine Drug ◽  
Urine Drug Test ◽  
Dispensing Data

Background: Previous data suggest that tapentadol, an atypical opioid with a putative dual mechanism of action, has relatively low rates of abuse. A better understanding of the rates of abuse among different prescription opioids may help clinicians when considering their potential risks and benefits. The results of urine drug tests (UDTs) may provide a unique opportunity to help answer this question.Method: To investigate different rates of prescription-opioid abuse in this retrospective study, we examined urine drug test results from patients seeking treatment at four facilities of an opioid-use-disorder (OUD) treatment program in Ohio. Urine specimens were collected on admission, one from each patient, in the regular course of care. The opioids reviewed in the present study were tapentadol, hydrocodone, oxycodone, hydromorphone, oxymorphone, and tramadol. Drug dispensing data, including morphine-milligram equivalents (MME) dispensed, were examined to adjust for the relative prevalence of each opioid being examined.Results: Data from 4,162 patients were examined. Tapentadol was the least common finding in UDT results in this cohort and remained so after adjusting for drug availability. The percentage of specimens positive for a given opioid ranged from 0.12 percent (tapentadol) to 7.04 percent (oxycodone). The availability and MME adjustments resulted in a change of rank order, with tapentadol remaining the lowest but tramadol replacing oxycodone as the prescription opioid with the highest rate of abuse.Conclusions: In this sample of UDT results from patients seeking treatment at an OUD program in Ohio, tapentadol was the least frequent finding among the opioids examined, and this remained true when adjusting for dispensing data. Factors potentially contributing to this difference may include pharmacological properties unique to tapentadol. Several important limitations notwithstanding, these findings are consistent with previous real-world evidence and warrant an ongoing line of inquiry. 

Buprenorphine not detected on urine drug screening in supervised treatment

2021 ◽  
Vol 17 (7) ◽  
pp. 69-76
Author(s):  
Nazila Jamshidi, MBBS, FRACP, FAChAM, BPharm (hons), PhD ◽  
Akshay Athavale, MBBS, FRACP, BPharm (hons), MMed ◽  
Bridin Murnion, MBChB, FRACP, FFPMANZCA, FAChAM
Keyword(s):  
Cytochrome P450 ◽  
Child Protection ◽  
Drug Testing ◽  
Addiction Treatment ◽  
Clinical Decision ◽  
Gas Chromatography Mass Spectrometry ◽  
Cytochrome P450 3A4 ◽  
Opioid Agonist ◽  
Detection Rates ◽  
Urine Drug

Introduction: Urine drug screens (UDS) assist in clinical planning and assessment of adherence in opioid agonist treatment (OAT). Urine drug screens may also be used in criminal justice and child protection settings. Buprenorphine (BPN) UDS testing is complex. Immunoassay often does not detect BPN and gas chromatography-mass spectrometry (GC-MS) is needed. A limited understanding of testing can negatively influence UDS interpretation and clinical decision making.Objectives: The primary aim was to determine detection rates of BPN in UDS in participants on BPN or buprenorphine/naloxone (BNX) treatment. The secondary aim was to identify if comorbidities, sex, co-prescribed medications, or dosing site and observation were associated with BPN detection.Setting: Public outpatient clinic in a specialist addiction treatment service.Design/participants: In this retrospective observational study, records of clients on supervised BPN/BNX treatment between September 2017 and 2018 were reviewed.Measures: Data extracted included UDS results, age, sex, indication for BPN, frequency of observed doses, dose of BPN, dosing site, co-morbid medical conditions, and medications.Results: One hundred and sixty-one medical records were reviewed. Ninety-seven (60 percent) underwent screening urine immunoassay. Of these 97, 51 (53 percent) had further GC-MS testing for BPN of which 22 (43 percent) did not detect BPN despite directly observed OAT. Co-prescription of medications known to interact with cytochrome P450 3A4 was associated with nondetection of BPN (p 0.05). No significant association between median dose, dosing site, and observed dosing and BPN detection was identified.Conclusion: Urine drug testing for BPN is complex. Failure to detect BPN does not betoken nonadherence to treatment and is associated with co-prescription of drugs interacting with cytochrome P450 3A4.

scholarly journals Establishment and Preclinical Application of Conditional Reprogramming Culture System for Laryngeal and Hypopharyngeal Carcinoma

2021 ◽  
Author(s):  
Yanbo DONG ◽  
Jian WANG ◽  
Wei JI ◽  
Mengzhu ZHENG ◽  
Peng WANG ◽  
...  
Keyword(s):  
Anticancer Drugs ◽  
Drug Testing ◽  
Clinical Decision Making ◽  
Cell Model ◽  
Clinical Decision ◽  
Culture Technique ◽  
Hypopharyngeal Carcinoma ◽  
Molecular Characteristics ◽  
Drug Responses

Abstract Purpose Management of laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) remains highly challenging due to their anatomic location and highly variable therapeutic responses. We aim to establish a new in vitro model for LHSCC based on conditional reprogramming (CR), a novel cell-culture technique, and investigate its potential value on personalized cancer therapies. Methods Primary LHSCC cells were isolated from tumor specimens and cultured under CR conditions. The characteristics and malignant potential of cells were evaluated by histological staining, whole-exome sequencing and heterotransplantation. The responses of CR tumor cells to anticancer drugs and radiotherapy were tested using cell proliferation assay. CR cells could form xenografts and organoids, which were used for drug testing respectively. Clinical responses for certain patients were also compared with in vitro responses. Results A panel of 28 human LHSCC CR cells were established from 50 tumor tissues. They retain tumorigenic potential upon xenotransplantation and recapitulate molecular characteristics of LHSCC. Differential responses to anticancer drugs and radiotherapy were detected in vitro. CR cells can be transformed to xenograft and organoid, shared comparable drug responses. The clinical drug responses were consistent with in vitro drug responses. Conclusions The patient-derived CR cell model could promisingly be utilized in clinical decision-making and assist in the selection of personalized therapies for LHSCC.

Interpretation and Utility of Drug of Abuse Immunoassays: Lessons From Laboratory Drug Testing Surveys

2010 ◽  
Vol 134 (5) ◽  
pp. 735-739 ◽  
Author(s):  
Stacy E. F. Melanson ◽  
Leland Baskin ◽  
Barbarajean Magnani ◽  
Tai C. Kwong ◽  
Annabel Dizon ◽  
...  
Keyword(s):  
Drug Testing ◽  
Drugs Of Abuse ◽  
False Negative ◽  
Cross Reactivity ◽  
Treatment Programs ◽  
Drug Of Abuse ◽  
Negative Results ◽  
Urine Drug ◽  
Clinically Significant ◽  
Pain Services

Abstract Context.—To assist with patient diagnosis and management, physicians from pain services, drug treatment programs, and the emergency department frequently request that urine be tested for drugs of abuse. However, urine immunoassays for drugs of abuse have limitations. Objective.—To use data from the College of American Pathologists Proficiency Testing Surveys to determine and summarize the characteristics, performance, and limitations of urine immunoassays for drugs of abuse. Design.—Six years of urine drug testing proficiency surveys were reviewed. Results.—Lysergic acid diethylamide and methaqualone are infrequently prescribed or abused and, therefore, testing may be unnecessary. However, implementation of more specific testing for methylenedioxymethamphetamine and oxycodone may be warranted. Each drug of abuse immunoassay exhibits a different cross-reactivity profile. Depending on the cross-reactivity profile, patients with clinically insignificant concentrations of drugs may have false-positive results, and patients with clinically significant concentrations of drugs may have false-negative results. Conclusions.—Laboratory directors should be aware of the characteristics of their laboratories' assays and should communicate these characteristics to physicians so that qualitative results can be interpreted more accurately. Furthermore, manufacturer's claims should be interpreted with caution and should be verified in each organization's patient population, if possible.

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