Legal issues related to drug testing in the clinical laboratory.

1988 ◽  
Vol 34 (3) ◽  
pp. 633-636 ◽  
Author(s):  
R T Chamberlain
Keyword(s):  
Drug Testing ◽  
Clinical Laboratory ◽  
Scientific Evidence ◽  
Legal Issues ◽  
Third Party ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Chain Of Custody ◽  
Urine Drug Test ◽  
The Many

Abstract As has been reported many times by the lay press, urine drug testing may pose some unique challenges. The clinical laboratory interested in industrial drug testing (typically known as employee drug testing) should be aware of the many challenges that may be brought on by the fact that the result may be contested in an adversarial proceeding. This is what makes the urine drug test a forensic test. It may be one piece of evidence or the only piece of evidence used in an adversarial proceeding that may decide on punitive or rehabilitative action against an employee. As a result, unique standards for governmental contract laboratories have been proposed from the National Institute on Drug Abuse, and special proficiency testing and accreditation procedures have been promoted by professional societies. These standards illustrate the sensitive nature of the results. Because the results are subject to adversarial proceedings, all parties concerned in the testing process should be aware of the legal issues surrounding urine drug testing. There are constitutional and statutory issues as well as tort issues such as negligence, defamation, invasion of privacy, battery, infliction of emotional distress, and others. Laboratories should be especially aware of these issues, since they may be brought in as a third-party defendant to a suit or brought in as a participant in gathering the evidence. The laboratory should also be aware of other legal ramifications such as chain of custody, expert testimony, and the acceptability of scientific evidence.

Observation of improved adherence with frequent urine drug testing in patients with pain

2014 ◽  
Vol 10 (2) ◽  
pp. 111 ◽  
Author(s):  
David A. Yee, BS ◽  
Michelle M. Hughes, BA ◽  
Alexander Y. Guo, MS ◽  
Neveen H. Barakat, BS ◽  
Stephanie A. Tse, BS ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Drug Testing ◽  
Patient Adherence ◽  
Parent Drug ◽  
The United States ◽  
Limit Of Quantitation ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Urine Drug Test ◽  
The Relationship

Objective: To determine the relationship between urine drug testing (UDT) frequency and patient adherence for prescribed buprenorphine, carisoprodol, fentanyl, hydrocodone, methadone, morphine, and oxycodone. Setting: Patients with pain routinely seen by private practitioners. Design: A retrospective analysis was conducted on urinary excretion data analyzed by Millennium Laboratories between March 2008 and May 2011.Patient participants: Patients in the United States with chronic pain who underwent routine UDT to confirm adherence for prescribed medications. Interventions: Adherence for the urine drug test was defined as the presence of parent drug and/or metabolite(s) greater than or equal to the lower limit of quantitation. The percent of adherence for prescribed medications was compared to the average percent of the same in subjects with five or more visits.Main outcomes: Correlation analyses were used to determine the relationship between adherence for prescribed medications and number of visits.Results: There were 255,168 specimens submitted for testing from 166,755 individuals. When monitoring with more frequent visits (>=5 visits) adherence was higher by 1 percent for buprenorphine (89 percent vs 88 percent); 8 percent for carisoprodol (77 percent vs 69 percent); 5 percent for fentanyl (95 percent vs 90 percent); 7 percent for hydrocodone (83 percent vs 76 percent); 3 percent for methadone (96 percent vs 93 percent); 5 percent for morphine (92 percent vs 87 percent); and 8 percent for oxycodone (90 percent vs 82 percent).Conclusions: Adherence for prescribed medications is higher with frequent urine monitoring. UDT can be used as tool that may help improve this in patients with chronic pain.

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.

Forensic Testing for Drugs of Abuse

2000 ◽  
Vol 13 (3) ◽  
pp. 226-235 ◽  
Author(s):  
Peter D. Anderson ◽  
Kimmy Naik ◽  
Chenery Kinemond ◽  
Anne ImObersteg
Keyword(s):  
Drug Testing ◽  
Drugs Of Abuse ◽  
Drunk Driving ◽  
Gas Chromatography Mass Spectrometry ◽  
Confirmatory Test ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Chain Of Custody ◽  
Control Procedures ◽  
Forensic Testing

Forensic urine drug testing (FUDT) is a tool of many employers to assess drug use in employees. Collegiate and professional sports test for banned substances. Immunoassays are often the screening test. Gas chromatography/mass spectrometry is the confirmatory test. Numerous foods and medications interfere with test results. Safeguards in FUDT include chain of custody procedures, certification of laboratories and personnel, cutoff values, quality assurance and quality control procedures, and medical review officers. Breath analysis is used in drunk-driving cases. Blood and hair can also be analyzed for substances of abuse. Pharmacists can be an asset in drug testing issues.

Status of drugs-of-abuse testing in urine under blind conditions: an AACC study.

1989 ◽  
Vol 35 (5) ◽  
pp. 891-894 ◽  
Author(s):  
C S Frings ◽  
D J Battaglia ◽  
R M White
Keyword(s):  
Quality Assurance ◽  
Drug Testing ◽  
Drugs Of Abuse ◽  
The United States ◽  
Accuracy Rate ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Chain Of Custody ◽  
A Chain ◽  
Positive Results

Abstract We report results of a blind study designed to determine the accuracy of drugs-of-abuse testing in urine as done in 31 laboratories across the United States. The drugs studied were amphetamines, cannabinoids, cocaine, opiates, and phencyclidine. These laboratories confirmed all positive drug results with a different analytical method. Ten urine samples were sent to each laboratory, which resulted in 1486 trials. There were no false-positive results. The overall accuracy rate was 97%. Our study demonstrates that urine drug testing can be accurate when performed by qualified staff, using up-to-date screening and confirmation methods, appropriate quality-assurance measures, and a chain of custody.

scholarly journals Physician Renewal of Chronically Prescribed Controlled Substances Based on Urine Drug Test Results

2019 ◽  
Vol 10 ◽  
pp. 215013271988363
Author(s):  
Fatima Hosain ◽  
Josephine Lee ◽  
Ashar Ata ◽  
Ravneet K. Bhullar ◽  
Andrew K. Chang
Keyword(s):  
Drug Testing ◽  
Illicit Drugs ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Test Results ◽  
Controlled Substances ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Urine Drug Test ◽  
Physician Prescribing

Objective: The effect of specific urine drug testing (UDT) results on physician prescribing habits has not been well described. The primary objective was to report renewal rates of chronically prescribed controlled substances based on types of inconsistent UDT results. Methods: We conducted a retrospective chart review over a 5-month period comparing prescription renewals rates for patients with consistent versus inconsistent UDTs. Inconsistent UDTs were defined by prescribed drug not detected or the presence of heroin, cocaine, nonprescribed opioids, nonprescribed benzodiazepines, or marijuana. Results: Of the 474 UDTs reviewed, 214 (45.1%) were inconsistent. The most common findings among inconsistent UDTs, including overlapping results, were prescribed drug not detected (26.8%) and the presence of marijuana (20.7%), nonprescribed opioids (9.9%), and nonprescribed benzodiazepines (6.1%). In contrast, cocaine (5.5%) and heroin (0.4%) were less likely to be found on UDTs for this population. The relative risk (RR) of prescription renewal was 0.64 (95% CI 0.57-0.71) for inconsistent UDTs versus consistent UDTs. Within the inconsistent UDTs, the renewal rates when marijuana (79.6%) or nonprescribed opioids or benzodiazepines (63.6%) were present were much higher than when heroin or cocaine were present (0.0%; P < .001). Patients whose prescribed controlled substance was not detected had a 55.8% renewal rate. Conclusions: Prescription renewal rates were high when patient UDTs contained nonprescribed marijuana, opioids, and benzodiazepines, or when the prescribed drug was not detected. Prescription renewal rates were low when illicit drugs, such as heroin and cocaine, were detected.

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

Analytical and technical aspects of testing for drug abuse: confirmatory procedures.

1988 ◽  
Vol 34 (3) ◽  
pp. 471-473 ◽  
Author(s):  
M A Peat
Keyword(s):  
Drug Testing ◽  
Analytical Procedure ◽  
Gas Chromatography Mass Spectrometry ◽  
Technical Aspects ◽  
Governmental Agencies ◽  
Accuracy And Precision ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Chemical Technique ◽  
Layer Chromatography

Abstract Many laboratories are now performing urine drug testing for employers, governmental agencies, and other institutions. It is now recognized that presumptive positive screening results have to be confirmed by an analytical procedure based on a different chemical technique with greater than or equal sensitivity to the screening test. Thin-layer chromatography has been widely used for this; however, it is relatively insensitive for certain drugs, and it cannot satisfy the accuracy and precision requirements needed to determine threshold concentrations reliably. Gas chromatography-mass spectrometry is able to satisfy these threshold requirements and has become the method of choice for confirming initial immunoassay results.

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