Demystifying Analytical Approaches for Urine Drug Testing to Evaluate Medication Adherence in Chronic Pain Management

McMillin, Gwendolyn A.; Slawson, Matthew H.; Marin, Stephanie J.; Johnson-Davis, Kamisha L.

doi:10.3109/15360288.2013.847889

Cited by 22 publications

(12 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, nonconfirmed immunoassay results can misinform clinicians and even cause a risk when drug-testing results are used during judicial decisions. Note that the issues discussed here for ADHD medicines are very similar to the controversy over urine drug testing in pain management monitoring (McMillin et al 2013;Reisfield et al 2007b).…”

Section: Confirmatory Analysismentioning

confidence: 92%

Patients in medical treatment for attention deficit/hyperactivity disorder (ADHD): Are they at risk in drug screening?

Jensen

Breindahl

2018

ADHD Atten Def Hyp Disord

View full text Add to dashboard Cite

The use of medicines to treat attention deficit/hyperactivity disorder (ADHD) has increased worldwide, including the use of amphetamine-based medicines or prodrugs that metabolise to amphetamine in vivo. At the same time, drugs-of-abuse testing by non-specific, point-of-care immunoassay methods ('quick tests') has increased. This article discusses the risk of 'false positive' results or post-analytical misinterpretations of results when immunoassays are used to analyse biological samples from ADHD patients. A rapid evidence review was conducted to identify studies that have focused on the risk of 'false positive' test results in immunoassay testing of patients treated with atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil. There is only evidence to suggest that bupropion should cause 'false positive' immunoassay results. However, there is a lack of systematic, updated evaluations and validations of cross-reactivity patterns for immunoassays in the literature. Advanced laboratory methods can distinguish the use of medicines from illicit amphetamine by stereospecific analysis of dextro-and levoamphetamine; however, these analytical services are not commonly available for routine drug testing. The present situation calls for more awareness, proper education and information on these critical ethical issues in drug testing, both for clinicians, other healthcare professionals involved in drug testing and for patients in medical treatment for ADHD. The pitfalls of immunoassays due to cross-reactivity and insufficient specificity/sensitivity can have serious negative consequences for patients safety with regard to incorrect laboratory drug-testing results. Consequently, confirmatory laboratory analysis should always be performed for 'presumptive' positive immunoassay screening results.

show abstract

Section: Confirmatory Analysismentioning

confidence: 92%

Patients in medical treatment for attention deficit/hyperactivity disorder (ADHD): Are they at risk in drug screening?

Jensen

Breindahl

2018

ADHD Atten Def Hyp Disord

View full text Add to dashboard Cite

show abstract

“…In addition to the need for identifying and monitoring unfamiliar yet critical quality aspects of a clinical MS test such as ion suppression, 12 sample preparation techniques are often significantly more complex than routine clinical testing. 13 Furthermore, the expertise needed to troubleshoot assay performance issues must span a complex workflow that includes numerous steps in the sample preparation, chromatographic separation (if included), and detection by the various forms of MS that may be used.…”

Section: Approaches To Drug Testingmentioning

confidence: 99%

“…More detailed reviews on the principles of MS can be found elsewhere. 13,20 Since LC-MS/MS does not use antibodies for detection, there is no concern for cross-reactivity with other compounds, and therefore it is not susceptible to the falsepositive results commonly encountered with immunoassays. Disadvantages of LC-MS/MS include decreased accessibility and increased expense.…”

Section: Principles Of Ms Testing: Lc-ms/msmentioning

confidence: 99%

Pathology Consultation on Urine Compliance Testing and Drug Abuse Screening

Ward

Hackenmueller

Strathmann

2014

American Journal of Clinical Pathology

View full text Add to dashboard Cite

show abstract

“…However, its long-term clinical use can be complicated by misuse, abuse, and aberrant behaviors [1, 2]. Urine drug test (UDT) has been used to evaluate the compliance of opioid therapy and detect illicit drug use in chronic pain management [3–9]. In a clinical study of nearly one million urine samples, a large number of patients appeared to be non-compliant with their prescribed pain medications.…”

Section: Introductionmentioning

confidence: 99%

Profiles of Urine Drug Test in Clinical Pain Patients vs Pain Research Study Subjects

Lee

Cohen

et al. 2016

Pain Med

View full text Add to dashboard Cite

Objective To examine similarities and differences in urine drug test (UDT) results in clinical pain patients and pain subjects participating in pain research studies. Design An observational study with retrospective chart review and data analysis. Methods We analyzed 1,874 urine drug test (UDT) results obtained from 1) clinical pain patients (Clinical Group; n=1,529) and 2) pain subjects consented to participate in pain research studies (Research Group; n=345). Since several medications such as opioids used in pain management are drugs of abuse (DOA) and can result in a positive UDT, we specifically identified those cases of positive UDT due to non-prescribed DOA and designated these cases as positive UDT with DOA (PUD). Results We found that 1) there was a higher rate of PUD in clinical pain patients (41.3%) than in pain research study subjects (14.8%); 2) although subjects in the Research Group were informed ahead of time that UDT will be conducted as a screening test, a substantial number (14.8%) of pain research study subjects still showed PUD; 3) there were different types of DOA between clinical pain patients (cannabinoids as the top DOA) and research study subjects (cocaine as the top DOA); and 4) a common factor associated with PUD was opioid therapy in both Clinical Group and Research Group. Conclusion These results support previous findings that PUD is a common finding in clinical pain patients, particularly in those prescribed opioid therapy, and we suggest that UDT be used as routine screening testing in pain research studies.

show abstract

Demystifying Analytical Approaches for Urine Drug Testing to Evaluate Medication Adherence in Chronic Pain Management

Cited by 22 publications

References 46 publications

Patients in medical treatment for attention deficit/hyperactivity disorder (ADHD): Are they at risk in drug screening?

Patients in medical treatment for attention deficit/hyperactivity disorder (ADHD): Are they at risk in drug screening?

Pathology Consultation on Urine Compliance Testing and Drug Abuse Screening

Profiles of Urine Drug Test in Clinical Pain Patients vs Pain Research Study Subjects

Contact Info

Product

Resources

About