Interpretation of Urine Drug Testing in Pain Patients

Pesce, Amadeo J.; West, Cameron; City, Kathy Egan; Strickland, Jennifer

doi:10.1111/j.1526-4637.2012.01350.x

Cited by 52 publications

(30 citation statements)

References 146 publications

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“…For the drugs that overlap with SAMHSA, the proposed cutoffs for medication adherence monitoring are notably lower than those utilized by SAMHSA. 9 While this proposed list is useful, it is important to recognize that the cutoffs cannot be universally compared, without also comparing the sample preparation and detection methods. For example, clean-up of a sample before analysis to minimize matrix effects, or a high resolution instrument may be required to achieve low cutoffs.…”

Section: Urine Drug Testing To Support Pain Managementmentioning

confidence: 99%

“…24 Proposed cutoff concentrations adjusted for creatinine are included in Table 3. 9 Creatinine and specific gravity normalization are particularly useful to help interpret serial results for drugs with a long half-life, such as marijuana. [25][26][27] Preparation of Urine for Targeted Analysis All targeted analytical methods for urine drug testing incorporate preanalytical sample preparation steps and/or reactions.…”

Section: Urine As a Samplementioning

confidence: 99%

See 1 more Smart Citation

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

McMillin¹,

Slawson²,

Marin³

et al. 2013

Journal of Pain & Palliative Care Pharmacotherapy

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This comprehensive review of analytical methods used for urine drug testing for the support of pain management describes the methods, their strengths and limitations, and types of analyses used in clinical laboratories today. Specific applications to analysis of opioid levels are addressed. Qualitative versus quantitative testing, immunoassays, chromatographic methods, and spectrometry are discussed. The importance of proper urine sample collection and processing is addressed. Analytical explanations for unexpected results are described. This article describes the scientific basis for urine drug testing providing information which will allow clinicians to differentiate between valid and questionable claims for urine drug testing to monitor medication adherence among chronic pain patients.

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Section: Urine Drug Testing To Support Pain Managementmentioning

confidence: 99%

Section: Urine As a Samplementioning

confidence: 99%

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

McMillin¹,

Slawson²,

Marin³

et al. 2013

Journal of Pain & Palliative Care Pharmacotherapy

View full text Add to dashboard Cite

show abstract

“…UDT can be complicated by false-positive or false-negative results and is subject to erroneous interpretations [13, 14]. For example, false-positive cocaine findings were determined by more sensitive chromatography-mass spectrometry (GC-MS) testing in surgical patients [15], although it is noted that false positive cocaine findings are rather rare as compared to false positive amphetamine findings.…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Cohen

et al. 2016

Pain Med

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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.

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“…Most widely used tests are based on an immunoassay technique [5]. They have a good sensitivity and specificity to diagnose typical recreational drugs like marihuana, cocaine, benzodiazepine, or amphetamine.…”

Section: Discussionmentioning

confidence: 99%

Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery System

Voigt

2013

Case Reports in Critical Care

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Background. The use of transdermal fentanyl systems has increased over recent years, especially in patients with chronic pain. Large misuse potential and fatal outcomes have been described. Case Presentation. A 58-year-old patient presenting with clinical signs of opioid poisoning (hypoventilation, bradycardia, hypotension, and miosis) was admitted to our ICU. The first body check revealed a 75 mcg per hour fentanyl patch at the patient's right scapula. Some months ago, patient's aunt died after suffering from an oncological disease. During breaking up of her household, the patches were saved by the patient. Not knowing the risk of this drug, he mistook it as a heat plaster. Investigations. Laboratory test showed an impaired renal function and metabolic acidosis. Urine drug test was negative at admittance and 12 h later. CCT scan presented a global hypoxic brain disease. Treatment and Outcome. The patient was discharged 30 days after admittance in a hemodynamic stable condition but a vegetative state and transferred to a rehabilitation center. Learning Points. With the ongoing increase in fentanyl patch prescriptions for therapeutic reasons, it is likely that misuse cases will become more relevant. Conventional urine drug screening tests are not able to exclude the diagnosis fentanyl intoxication. History taking should include family member's drug prescriptions.

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Interpretation of Urine Drug Testing in Pain Patients

Cited by 52 publications

References 146 publications

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

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

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

Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery System

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