scholarly journals Demand for Interpretation of a Urine Drug Testing Panel Reflects the Changing Landscape of Clinical Needs; Opportunities for the Laboratory to Provide Added Clinical Value

2020 ◽  
Vol 5 (5) ◽  
pp. 858-868
Author(s):  
Yifei K Yang ◽  
Kamisha L Johnson-Davis ◽  
Brian N Kelly ◽  
Gwendolyn A McMillin
Keyword(s):  
Drug Testing ◽  
Patient Adherence ◽  
Direct Detection ◽  
Traditional Approach ◽  
Clinical Value ◽  
Medication Information ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Test Ordering ◽  
Result Interpretation

Abstract Background The direct detection of drugs and metabolites in urine using a targeted panel offers sensitive and specific detection in comparison to the traditional approach to urine drug testing (screen with reflex of samples with positive results to confirmation testing). The purpose of this study was to evaluate changes in clinical demand for the laboratory to provide interpretation of patient adherence and abstinence, based on reconciling laboratory results and individual patient medication information provided by the clinician. The shifts in toxicology testing likely reflect the inherent complexity of the data and associated interpretation. Methods Retrospective testing results associated with a targeted urine drug panel and its related interpretation were collected from our laboratory. We examined the associated testing volume and positivity rates of each reported analyte over 5 consecutive years (2015–2019). Requests from clinicians for consultation regarding this test and use of interpretive comments for the most recent year (2019), as well as access to publicly available educational resources over two years (2018–2019) were collected. Results The changes in test ordering patterns demonstrate shifting of clinical demands for toxicology testing, by increased adoption of a targeted panel for which laboratory-based interpretation is provided. Positivity rates reflect national shifts in controlled substance prescriptions. Several consultative services were accessed by clinicians suggesting interest and need. Conclusion The value of clinical urine drug testing is improved by providing laboratory-based result interpretation and consultative services.

Specimen validity testing in urine drug monitoring of medications and illicit drugs: Clinical implications

2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Kenneth L. Kirsh, PhD ◽  
Paul J. Christo, MD, MBA ◽  
Howard Heit, MD ◽  
Katherine Steffel, PharmD ◽  
Steven D. Passik, PhD
Keyword(s):  
Drug Testing ◽  
Illicit Drugs ◽  
Patient Adherence ◽  
Adherence Behavior ◽  
Medical Problems ◽  
Clinical Role ◽  
Validity Testing ◽  
Therapeutic Decisions ◽  
Urine Drug Testing ◽  
Urine Drug

Objective: To discuss the importance of specimen validity testing (SVT) in urine drug testing (UDT) and the clinical role it plays in identifying efforts to subvert the UDT process.Methods: A discussion of the clinical impact of SVT is presented.Results: A discussion of pH, specific gravity, creatinine, and oxidation for monitoring the adulteration of UDT samples is presented along with the clinical significance of such tests.Significance: SVT has a significant place in healthcare efforts to measure patient adherence, behavior, and honesty in communication with clinicians. SVT is typically ordered by treating clinicians who use the results to make therapeutic decisions regarding specific medical problems of their patient, including those related to medication and illicit drug use. In the absence of SVT, a healthcare provider may fail to identify a patient's adulteration of their urine sample in an attempt at deceiving the provider. Moreover, the presence of some underlying medical conditions may obfuscate the UDT results.

scholarly journals Lower Cutoffs for LC-MS/MS Urine Drug Testing Indicates Better Patient Compliance

2017 ◽  
Vol 7 (20;7) ◽  
pp. E1107-E1113
Author(s):  
Kevin Krock
Keyword(s):  
Health Care Providers ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Patient Adherence ◽  
False Negative ◽  
Test Results ◽  
Care Providers ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Cutoff Levels

Background: Urine drug testing is used by health care providers to determine a patient’s compliance to their prescribed regimen and to detect non-prescribed medications and illicit drugs. However, the cutoff levels used by clinical labs are often arbitrarily set and may not reflect the urine drug concentrations of compliant patients. Objectives: Our aim was to test the hypothesis that commonly used cutoffs for many prescribed and illicit drugs were set too high, and methods using these cutoffs may yield a considerable number of false-negative results. The goals of this study were to outline the way to analyze patient results and estimate a more appropriate cutoff, develop and validate a high sensitivity analytical method capable of quantitating drugs and metabolites at lower than the commonly used cutoffs, and determine the number of true positive results that would have been missed when using the common cutoffs. Study Design: This was a retrospective study of urine specimens submitted for urine drug testing as part of the monitoring of prescription drug compliance described in chronic opioid therapy treatment guidelines. Setting: The study was set in a clinical toxicology laboratory, using specimens submitted for routine analysis by health care providers in the normal course of business. Methods: Lognormal distributions of test results were generated and fitted with a trendline to estimate the required cutoff level necessary to capture the normal distributions of each drug for the patient population study. A validated laboratory derived liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis capable of achieving the required cutoff levels was developed for each drug and/or metabolite. Results: The study shows that a lognormal distribution of patient urine test results fitted with a trendline is appropriate for estimating the required cutoff levels needed to assess medication adherence. The study showed a wide variation in the false-negative rate, ranging from 1.5% to 94.3% across a range of prescribed and illicit drugs. Limitations: The patient specimens were largely sourced from patients in either a long-term pain management program or in treatment for substance use disorder in the US. These specimens may not be representative of patients in other types of treatment or in countries with different approaches to these issues. Conclusions: The high-sensitivity method reduces false-negative results which could negatively impact patient care. Clinicians using less sensitive methods for detecting and quantifying drugs and metabolites in urine should exercise caution in assessing patient adherence using and changing the treatment plan based on those results. Key words: Urine drug testing, patient adherence, clinical toxicology, immunoassay, LC-MS, definitive drug testing, REMS, negative test results, false negative

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.

Approach to the Patient with an Abnormal Drug Screen

2017 ◽  
Author(s):  
Magdalena Anitescu ◽  
Jeffrey Hopcian ◽  
John Henry Harrison
Keyword(s):  
Drug Testing ◽  
Patient Adherence ◽  
Drug Screen ◽  
Urine Drug Screen ◽  
Medication Regimen ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Treatment Plans ◽  
Proper Interpretation ◽  
Test Result

Urine drug testing has become widely used in clinical practice as a measure to monitor patient adherence to treatment plans and assess the efficacy of the treatment prescribed. In many circumstances, the clinician is challenged with an abnormal urine drug screen either for a new patient or for a patient presumed to be compliant with the medication regimen; proper interpretation of the test result and a detailed history and physical examination during the visit are necessary to identify the cause of the abnormality and properly care for the patient.

scholarly journals Increased frequency of urine drug testing in chronic opioid therapy: rationale for strategies for enhancing patient adherence and safety

2019 ◽  
Vol Volume 12 ◽  
pp. 2239-2246 ◽  
Author(s):  
David J DiBenedetto ◽  
Kelly M Wawrzyniak ◽  
Michael E Schatman ◽  
Hannah Shapiro ◽  
Ronald J Kulich
Keyword(s):  
Drug Testing ◽  
Patient Adherence ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Urine Drug Testing ◽  
Urine Drug

Approach to the Patient with an Abnormal Drug Screen

2017 ◽  
Author(s):  
Magdalena Anitescu ◽  
Jeffrey Hopcian ◽  
John Henry Harrison
Keyword(s):  
Drug Testing ◽  
Patient Adherence ◽  
Drug Screen ◽  
Urine Drug Screen ◽  
Medication Regimen ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Treatment Plans ◽  
Proper Interpretation ◽  
Test Result

Urine drug testing has become widely used in clinical practice as a measure to monitor patient adherence to treatment plans and assess the efficacy of the treatment prescribed. In many circumstances, the clinician is challenged with an abnormal urine drug screen either for a new patient or for a patient presumed to be compliant with the medication regimen; proper interpretation of the test result and a detailed history and physical examination during the visit are necessary to identify the cause of the abnormality and properly care for the patient.

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.

Sign in / Sign up

Export Citation Format

Share Document