Urine Drug Test Interpretation: An Educational Program's Impact on Resident Knowledge and Comfort Level

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.

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They Don’t Know What They Don’t Know: Internal Medicine Residents’ Knowledge and Confidence in Urine Drug Test Interpretation for Patients with Chronic Pain

Journal of General Internal Medicine ◽

10.1007/s11606-012-2165-7 ◽

2012 ◽

Vol 27 (11) ◽

pp. 1521-1527 ◽

Cited By ~ 32

Author(s):

Joanna L. Starrels ◽

Aaron D. Fox ◽

Hillary V. Kunins ◽

Chinazo O. Cunningham

Keyword(s):

Internal Medicine ◽

Chronic Pain ◽

Test Interpretation ◽

Drug Test ◽

Internal Medicine Residents ◽

Urine Drug ◽

Urine Drug Test

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Urine drug test interpretation: What do physicians know?

Journal of Opioid Management ◽

10.5055/jom.2007.0044 ◽

2007 ◽

Vol 3 (2) ◽

pp. 80 ◽

Cited By ~ 39

Author(s):

Gary M. Reisfield, MD ◽

Roger Bertholf PhD ◽

Robert L. Barkin, MBA, PharmD ◽

Fern Webb, PhD ◽

George Wilson, MD

Keyword(s):

Multiple Choice ◽

Opioid Therapy ◽

Physician Education ◽

Test Interpretation ◽

Chronic Opioid Therapy ◽

Drug Test ◽

Urine Drug ◽

Urine Drug Test

Objective: To determine the level of urine drug test (UDT) interpretive knowledge of physicians who use these instruments 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 ques¬tions and one yes/no question was completed by 114 physicians (77 who employ UDT and 37 who do not) attending one of three regional opioid education confer¬ences. We calculated frequencies and performed %2 analyses to examine bivariate associations between UDT utilization and interpretive knowledge.Results: The instrument was completed by 80percent of eligible respondents. None of the physicians who employ UDT answered all seven questions correctly, and only 30 percent answered more than half correctly. Physicians who employ UDTperformed no better on any of the ques¬tions than physicians who do not employ UDT.Conclusions: Physicians who employ UDT to monitor patients receiving chronic opioid therapy are not profi¬cient in test interpretation. This study highlights the need for improved physician education; it is imperative for physicians to work closely with certified laboratoryprofes- sionals when ordering and interpreting these tests.

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A Prediction Model for Positive Infant Meconium and Urine Drug Tests

American Journal of Perinatology ◽

10.1055/s-0040-1721688 ◽

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

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Evaluating the Athlete's Claim of an Unintentional Positive Urine Drug Test

Current Sports Medicine Reports ◽

10.1249/jsr.0b013e318224575f ◽

2011 ◽

Vol 10 (4) ◽

pp. 191-196 ◽

Cited By ~ 7

Author(s):

Jeffrey M. Anderson

Keyword(s):

Drug Test ◽

Positive Urine ◽

Urine Drug ◽

Urine Drug Test

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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

Journal of Opioid Management ◽

10.5055/jom.2021.0610 ◽

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.

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