Drug Testing and Other Tools for Patient Monitoring (DRAFT)

2018 ◽  
Author(s):  
Louis E. Baxter
Keyword(s):  
Drug Use ◽  
Drug Testing ◽  
Patient Monitoring ◽  
Self Report ◽  
Test Methodology ◽  
Breath Testing ◽  
Yield Information ◽  
Urine Drug ◽  
Addiction Risk ◽  
Urine Testing

Chapter 12 describes patient monitoring in the setting of addiction or addiction risk, and pain management, to include drug testing. The advantages, disadvantages, and types of available testing for drug use are described, with a discussion of their limitations. Body fluids and tissues for sampling include hair, blood, saliva, sweat, and urine; all yield information regarding drug use within unique limitations and at different levels of convenience. The test methodology imposes a need to know respective sensitivities and specificities, particularly in a forensic setting. Breath testing (alcohol) is not within the scope of this chapter. Recommended frequencies of urine testing are addressed. The utility of other forms of monitoring (self-report, collateral sources, PDMP) is assessed in the final section. Two tables are provided, (1) urine drug detection times, and (2) sources of false positive tests in urine immunoassay studies. Supplemental information sources are cited in a text box.

Trends in drug use from urine drug testing of addiction treatment clients

2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Kenneth L. Kirsh, PhD ◽  
Howard A. Heit, MD ◽  
Angela Huskey, PharmD, CPE ◽  
Jennifer Strickland, PharmD, BCPS ◽  
Kathleen Egan City, MA, BSN, RN ◽  
...  
Keyword(s):  
Drug Use ◽  
Drug Testing ◽  
Addiction Treatment ◽  
National Laboratory ◽  
Prescription Medication ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Liquid Chromatography Tandem Mass ◽  
Testing Company ◽  
National Trends

Objective: Urine drug testing (UDT) can play an important role in the care of patients in recovery from addiction, and it has become necessary for providers and programs to utilize specific, accurate testing beyond what immunoassay (IA) provides.Design: A database of addiction treatment and recovery programs was sampled to demonstrate national trends in drug abuse and to explore potential clinical implications of differing results due to the type of testing utilized.Setting: Deidentified data was selected from a national laboratory testing company that had undergone liquid chromatography tandem mass spectrometry (LCMS/MS).Patients/Participants: A total of 4,299 samples were selected for study.Interventions: Descriptive statistics of the trends are presented. Results: In total, 48.5 percent (n = 2,082) of the samples were deemed in full agreement between the practice reports and the results of LC-MS/MS testing. The remaining 51.5 percent of samples fell into one of seven categories of unexpected results, with the most frequent being detection of an unreported prescription medication (n = 1,097).Conclusions: Results of UDT demonstrate that more than half of samples yield unexpected results from specimens collected in addiction treatment. When comparing results of IA and LC-MS/MS, it is important to consider the limits of IA in the detection of drug use by these patients.

scholarly journals Current drug use and lack of HIV virologic suppression: point-of-care urine drug screen versus self-report

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Han-Zhu Qian ◽  
Valerie J Mitchell ◽  
Sally Bebawy ◽  
Holly Cassell ◽  
Gina Perez ◽  
...  
Keyword(s):  
Drug Use ◽  
Point Of Care ◽  
Self Report ◽  
Drug Screen ◽  
Virologic Suppression ◽  
Urine Drug Screen ◽  
Current Drug ◽  
Urine Drug

Under-reporting of drug use among individuals with schizophrenia: prevalence and predictors

2013 ◽  
Vol 44 (1) ◽  
pp. 61-69 ◽  
Author(s):  
A. L. Bahorik ◽  
C. E. Newhill ◽  
C. C. Queen ◽  
S. M. Eack
Keyword(s):  
Drug Use ◽  
Justice System ◽  
Regression Models ◽  
Drug Testing ◽  
Illicit Drug ◽  
Significant Proportion ◽  
Neurocognitive Deficits ◽  
Logistic Regression Models ◽  
Methamphetamine Use ◽  
Urine Drug

BackgroundIllicit drug use is common in individuals with schizophrenia, and it has been suspected that many individuals under-report their use of substances, leading to significant barriers to treatment. This study sought to examine the degree to which individuals with schizophrenia disclose their use of drugs on self-rated assessments, compared to laboratory assays, and to determine the contributors of under-reported drug use in this population.MethodA total of 1042 individuals with schizophrenia who participated in screening/baseline procedures for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) completed self-rated assessments of substance use and laboratory drug testing. Laboratory tests assayed cannabis, cocaine and methamphetamine use; the procedures included radioimmunoassay (RIA) and urine drug screens.ResultsA significant proportion of participants tested positive for drug use on laboratory measures (n = 397; 38%), and more than half (n = 229; 58%) did not report using these drugs. Logistic regression models confirmed that patients who were most likely to conceal their use tended to be older, and presented with greater neurocognitive deficits. Patients who accurately reported drug use tended to have greater involvement with the criminal justice system. Illness severity and psychopathology were not associated with whether patients disclosed drug use.ConclusionsRates of under-reported drug use are considerable among individuals with schizophrenia when compared to laboratory assays, and the exclusive reliance on self-rated assessments should be used with caution. Patients who under-report their drug use are more likely to manifest neurocognitive deficits, which could be improved by interventions attempting to optimize treatment.

scholarly journals Patterns of Marijuana Use in a 6-Month Pain Management Sample in the United States

2017 ◽  
Vol 11 ◽  
pp. 117822181772478 ◽  
Author(s):  
Hope M Smiley-McDonald ◽  
Katherine N Moore ◽  
David C Heller ◽  
Jeri D Ropero-Miller ◽  
Gregory L McIntire ◽  
...  
Keyword(s):  
Pain Management ◽  
Drug Use ◽  
Prescription Drugs ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Marijuana Use ◽  
The United States ◽  
Prescription Drug Use ◽  
Urine Drug Testing ◽  
Urine Drug

This study is a 6-month retrospective analysis of urine drug testing (UDT) data from a pain management population among specimens with clinician-ordered marijuana testing (N = 194 809). Descriptive statistics about the specimen positivity of clinician-ordered marijuana UDT are provided as well as other drug positivity. Specimens from men and adults aged 18 to 34 years had the highest prevalence rates of marijuana positivity. The prevalence of past-month marijuana use among a comparative national population was lower than the prevalence of positive marijuana tests in the UDT specimens by all characteristics. Among the specimens tested for illicit drugs and marijuana, 4.0% were positive for amphetamine, 2.8% were positive for cocaine, and 0.9% were positive for heroin. The most common prescription drugs listed were opioids (64.7%), benzodiazepines (20.5%), and antidepressants (19.9%). In sum, the findings reflect previous research showing high rates of marijuana use, illicit drug use, and prescription drug use in a pain management population.

scholarly journals Using Urine Drug Testing to Estimate the Prevalence of Drug Use

2020 ◽  
Vol 136 (1) ◽  
pp. 47-51
Author(s):  
Benjamin H. Han ◽  
Elizabeth Mello ◽  
Ellenie Tuazon ◽  
Denise Paone
Keyword(s):  
Drug Use ◽  
Prescription Drug ◽  
Drug Testing ◽  
Population Level ◽  
Drug Misuse ◽  
Prescription Drug Misuse ◽  
Weighted Estimates ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Nyc Hanes

Objectives Estimating the prevalence of drug use in the general population is important given its potential health consequences but is challenging. Self-reported surveys on drug use have inherent limitations that underestimate drug use. We evaluated the performance of linking urine drug testing with a local, representative health examination survey in estimating the prevalence of drug use in New York City (NYC). Methods We used urine drug testing from the NYC Health and Nutrition Examination Survey (NYC HANES) to estimate the prevalence of drug use (benzodiazepines, cocaine, heroin, and opioid analgesics) among the study sample and compare the findings with self-reported responses to questions about past–12-month drug use from the same survey. Results Of 1527 respondents to NYC HANES, urine drug testing was performed on 1297 (84.9%) participants who provided urine and consented to future studies. Self-reported responses gave past–12-month weighted estimates for heroin, cocaine, or any prescription drug misuse of 13.8% (95% CI, 11.6%-16.3%), for prescription drug misuse of 9.9% (95% CI, 8.1%-12.1%), and for heroin or cocaine use of 6.1% (95% CI, 4.7%-7.9%). Urine drug testing gave past–12-month weighted estimates for any drug use of 4.3% (95% CI, 3.0%-6.0%), for use of any prescription drug of 2.8% (95% CI, 1.9%-4.1%), and for heroin or cocaine use of 2.0% (95% CI, 1.2%-3.6%). Conclusion Urine drug testing provided underestimates for the prevalence of drug use at a population level compared with self-report. Researchers should use other methods to estimate the prevalence of drug use on a population level.

scholarly journals Illicit Drug Use in the Pain Patient Population Decreases with Continued Drug Testing

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. 189-193 ◽  
Author(s):  
Amadeo Pesce
Keyword(s):  
Drug Use ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Pain Patient ◽  
Spearman Correlation ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Pain Patients

Background: A major concern of physicians treating pain patients with chronic opioid therapy and similar drugs is determining whether the patients are also using illicit drugs. This is commonly determined by urine drug testing (UDT). However, there are few studies on whether or not monitoring patients by this technique decreases illicit drug use. Objective: To determine if the presence of illicit drugs decreases over a number of physician visits where UDT was performed. Method: The method involved a retrospective study of tests for the illicit drugs marijuana, cocaine, methamphetamine, ecstacy (MDMA) phencyclidine (PCP) and the heroin metabolite, 6-acetylmorphine as confirmed by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). A database of 150,000 patient visits was examined for the presence of any of these 6 drugs. Results: A total of 87,000 patients were initially tested. The number of patients who were repeatedly tested decreased over time. The percentage of patients positive for any of these illicit drugs decreased from 23% to 9% after 14 visits where UDT was performed. When graphed there was a trend to decreasing use. The Spearman correlation = -0.88, P < 0.0001. The major illicit drug was marijuana. When this was removed from the analysis, there was an even greater correlation with decreased illicit drug use. Spearman correlation = -0.92 (P < 0.0001) using a weighted correlation. Limitation: Patients continuing to use illicit drugs might be dismissed from practices thus biasing the study towards illicit drug avoidance. Conclusion: Continued UDT might decrease illicit drug use among pain patients. Key words: Pain patients, UDT, urine drug testing, LC-MS/MS, illicit drugs, decrease drug use

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