PROFESSIONALISM AND COMMENTARY. Optimizing Urine Drug Testing for Monitoring Medication Compliance in Pain Management

Size: px
Start display at page:

Download "PROFESSIONALISM AND COMMENTARY. Optimizing Urine Drug Testing for Monitoring Medication Compliance in Pain Management"

Transcription

1 bs_bs_banner Pain Medicine 2013; 14: Wiley Periodicals, Inc. PROFESSIONALISM AND COMMENTARY Optimizing Urine Drug Testing for Monitoring Medication Compliance in Pain Management Disclosure: The authors have no disclosures or conflicts of interest. Key Words. Pain Management; Opioids; Chronic Pain; Urine Drug Testing; Quality Improvement Abstract Background. It can be challenging to successfully monitor medication compliance in pain management. Clinicians and laboratorians need to collaborate to optimize patient care and maximize operational efficiency. The test menu, assay cutoffs, and testing algorithms utilized in the urine drug testing panels should be periodically reviewed and tailored to the patient population to effectively assess compliance and avoid unnecessary testing and cost to the patient. Objective. Pain management and pathology collaborated on an important quality improvement initiative to optimize urine drug testing for monitoring medication compliance in pain management. Methods. We retrospectively reviewed 18 months of data from our pain management center. We gathered data on test volumes, positivity rates, and the frequency of false positive results. We also reviewed the clinical utility of our testing algorithms, assay cutoffs, and adulterant panel. In addition, the cost of each component was calculated. Results. The positivity rate for ethanol and 3,4- methylenedioxymethamphetamine were <1% so we eliminated this testing from our panel. We also lowered the screening cutoff for cocaine to meet the clinical needs of the pain management center. In addition, we changed our testing algorithm for 6-acetylmorphine, benzodiazepines, and methadone. For example, due the high rate of false negative results using our immunoassay-based benzodiazepine screen, we removed the screening portion of the algorithm and now perform benzodiazepine confirmation up front in all specimens by liquid chromatography-tandem mass spectrometry. Conclusion. Conducting an interdisciplinary quality improvement project allowed us to optimize our testing panel for monitoring medication compliance in pain management and reduce cost. Introduction An estimated 100 million people experience chronic pain in the United States, and $100 billion is spent annually to manage pain in these patients [1,2]. If the economic and societal impacts of pain are incorporated, the cost increases further. Pain management presents many challenges beyond the prevalence of the disease and the financial burden. Many of the drugs utilized to manage pain are not therapeutically optimal and have a high potential for abuse or misuse [3,4]. In addition, more than half of patients with pain require long-term drug therapy to regain and maintain some level of functionality, necessitating that physicians frequently monitor patients for both drug efficacy and potential abuse. Opioids are frequently prescribed when managing patients with chronic pain [4]. Due to their abuse potential, many physicians require that patients sign controlled substance agreements which outline the policy for use of opioid analgesics and criteria for compliance [5,6]. Despite these efforts, multiple groups, including ours, have reported potential diversion and undisclosed drug use illustrating the need to monitor medication compliance [7 10]. We found that 14.7% of our patients were potentially diverting drugs, and 28.7% were positive for nonprescribed or illicit drugs [9]. In total, we have demonstrated a rate of misuse of oral opioids of 40% [10]. Moreover, studies have shown that gender, dose of prescribed opioids, and/or type are poor predictors of noncompliance and possible diversion, indicating that all patients taking opioids should be assessed prospectively for the risk of opioid misuse and regularly monitored for adherence, termed, universal precautions in the literature [5,11]. Consequently, routine urine drug testing (UDT) to evaluate adherence to prescribed therapy has been incorporated into national and state practice guidelines for physicians who prescribe opioids for the management of chronic pain [5]. According to these guidelines, UDT should be performed to identify use of undisclosed substances, uncover diversion of prescribed substances, and determine compliance with prescribed substances. Furthermore, UDT 1813

2 Melanson et al. may be performed using class-specific immunoassay panels, but that positive immunoassay testing should be followed by more specific confirmatory techniques such as gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-tandem mass spectrometry (LC- MS/MS) to confirm the presence, or absence, of a specific drug and/or its metabolite(s) [5,6,12]. However, current guidelines do not make recommendations on what drugs or drug classes should be monitored; the selection of drugs tested, the methodology, and intervals between testing depend on the specific circumstances of a given patient. Therefore, most pain management centers are challenged, along with the laboratory performing the testing, with determining an appropriate test panel, cutoffs, and testing algorithms. The cost, benefits, and limitations of available methodologies and the range of prescribed and abused drugs in the patient population all need to be considered when optimizing UDT; data which can be difficult to gather. The number of drugs prescribed and/or abused is increasing and changing, which complicates data collection and necessitates a periodic review of the drugs included in the UDT panel. The cost can also be significant, making it critical that testing panels are closely tailored to the patient population to avoid large costs to patients and unnecessary testing. In addition, the methodology available and assay cutoffs are evolving to better monitor medication compliance, and menus should be updated accordingly. While sensitive and specific methods such as LC-MS/MS and GC-MS are preferred, many laboratories that support pain management centers must perform immunoassay screens only and send only certain specimens based on testing algorithm to reference laboratories for this confirmatory LC-MS/MS and/or GC-MS testing. In this article, we describe an interdisciplinary, quality improvement project in which we retrospectively reviewed 18 months of data from our pain management center, which includes patients undergoing chronic noncancer pain management, in order to optimize UDT for monitoring medication compliance in a pain medicine practice. We examine the performance characteristics of our initial UDT panel, and then developed a revised panel. In particular, we investigated the positivity rate and specificity of our immunoassays in order to determine which analytes should be included in the revised drug testing panel, what cutoffs should be deployed and the most appropriate testing algorithms. The utility of adulterant testing and cost of the testing were also considered. Methods This study was approved by the Partners Human Research Committee. UDT Panel Due to the increasing volume and cost of sending testing to a reference laboratory, the clinical chemistry laboratory at Brigham and Women s Hospital in-sourced the majority of the UDT used to assess medication compliance in pain management between 2009 and The initial test panel, designed in collaboration with the Pain Management Center at Brigham and Women s Hospital, is shown in Table 1. The results of an article published by Crews et al. [13]. prompted us to screen for 6-acetylmorphine (6-AM) in all specimens as opposed to the more traditional algorithm of screening for 6-AM only in specimens with morphine > 2,000 ng/ml. In most cases, an immunoassay screen for the analyte is performed, and positive screens are automatically reflexed for confirmation by LC-MS/MS or GC-MS. There are some exceptions shown in Table 1. For example, due to the high rate of positivity, no opiate screen is performed; instead, opioid confirmation is performed on all specimens. For methadone and its metabolite, 2-ethylidene-1,5 dimethyl-3,3-diphenylpyrrolidine (EDDP), confirmation is performed only if screening results are discrepant. This algorithm allowed us to significantly reduce the number of confirmations and their associated costs. Reflex confirmations are not performed for immunoassays screens, specifically barbiturates and tramadol, that achieved >99% sensitivity and specificity during initial assay validation. Immunoassay Screens and Specimen Integrity Testing Qualitative immunoassay screens (Table 1) are performed on Beckman AU480 analyzer (Beckman Coulter Inc., Brea, CA, USA) using a homogenous enzyme immunoassay (EIA) (Immunalysis Corporation, Pomona, CA, USA) for fentanyl [14] and tramadol; a Diagnostic Reagents Inc (DRI) EIA (Microgenics, now Thermo Scientific, Fremont, CA, USA) for amphetamines, barbiturates, cannabinoids, cocaine, ethanol, 3,4-methylenedioxymethamphetamine (MDMA), and methadone; an EIA (LinZhi International, Sunnyvale, CA, USA) for 6-AM and buprenorphine [15]; and a cloned enzyme donor immunoassay (Thermo Scientific) for benzodiazepines and EDDP. All methods rely on the measurement of a change in the enzymatic activity (a change in the rate of absorbance increase) after combining the patient sample with the antidrug antibody and enzyme drug conjugate. All of the assays positive/ negative cutoff concentrations are respectively reported in Table 1. A two-point calibration using the manufacturersupplied calibrators is performed, and the signal of calibrator that is utilized to define the assay cutoff (Table 1) is normalized to a value of 100. Signals greater than or equal to 100 (the normalized calibrator signal) are considered positive. Specimen integrity testing is performed on Beckman AU480 analyzer (Beckman Coulter Inc.) using DRI EIA (Thermo Scientific) for creatinine, ph, and oxidants. Table 2 summarizes the results and their interpretation. Opioid, Benzodiazepine, and Other Confirmations Opioid and benzodiazepine confirmation testing is performed using a Waters ACQUITY liquid chromatography 1814

3 Commentary Table 1 Comprehensive in-house urine drug testing menu for monitoring medication compliance in pain management ( ) Analyte Urine Drug Screen Positive/Negative Cutoff Concentration* Conditions for Specimen Confirmation Testing Urine Drug Confirmation Positive/Negative Cutoff Concentration 6-Acetylmorphine, 10 ng/ml If drug screen is positive 5 ng/ml Heroin metabolite Amphetamines 1,000 ng/ml If drug screen is positive 50 ng/ml Barbiturates 200 ng/ml By clinician request only 100 ng/ml Benzodiazepines 200 ng/ml If drug screen is positive 50 ng/ml Buprenorphine 5 ng/ml If drug screen is positive 2.5 ng/ml Cannabinoids 50 ng/ml If drug screen is positive 3 ng/ml Cocaine 300 ng/ml If drug screen is positive 50 ng/ml EDDP, methadone 100 ng/ml If drug screen is discrepant with 100 ng/ml metabolite methadone Ethanol 10 mg/ml By clinician request only 10 mg/ml Fentanyl 2 ng/ml If drug screen is positive 1 ng/ml MDMA 500 ng/ml If drug screen is positive 50 ng/ml Methadone 300 ng/ml If drug screen is discrepant with EDDP 100 ng/ml Opioids NA All specimens 100 ng/ml Tramadol 200 ng/ml By clinician request only 20 ng/ml * The National Institute of Drugs of Abuse and SAMHSA recommend that following cutoffs: Cannabinoids = 50 ng/ml; cocaine = 150 ng/ml; opiates = 2,000 ng/ml; 6-acetylmorphine = 10 ng/ml; phencyclidine = 25 ng/ml; amphetamines = 500 ng/ ml; MDMA = 500 ng/ml. Opioid confirmation includes morphine, codeine, hydrocodone, hydromorphone, oxycodone, oxymorphone. Gray shading indicates areas that were revised. EDDP = 2-ethylidene-1,5dimethyl-3,3-diphenylpyrrolidine; MDMA = 3,4-Methylenedioxymethamphetamine; NA = not applicable. system (Waters Corporation, Milford, MA, USA) coupled to a Waters Xevo TQ tandem mass spectrometer (Waters Corporation) equipped with an electrospray ionization probe which was operated in positive ionization mode. Following enzymatic sample pretreatment with betaglucuronidase, the LC-MS/MS-based opioid procedure provides quantitative detection of morphine, codeine, hydrocodone, hydromorphone, oxycodone, and Table 2 Specimen integrity testing and result interpretation Urine Specimen Integrity Test Previous Result Previous Interpretation Revised Result Revised Interpretation Creatinine (mg/dl) <2.0 Specimen unusually dilute, suspect <2.0 Suspect specimen substitution specimen dilution/substitution Specimen unusually dilute Specimen dilute No comment Specimen normal >200 Specimen unusually concentrated >300 Specimen concentrated ph <3 Specimen unsatisfactory, abnormally low ph, suspect specimen adulteration <3 Specimen unsatisfactory, abnormally low ph, suspect specimen adulteration 3 11 Specimen within normal limits 3 11 Specimen within normal limits General Oxidants >11 Specimen unsatisfactory, abnormally high ph, suspect specimen adulteration >11 Specimen unsatisfactory, abnormally high ph, suspect specimen adulteration Negative Specimen within normal limits Negative Specimen within normal limits Positive Specimen unsatisfactory, presence of an oxidant detected, suspect specimen adulteration Positive Specimen unsatisfactory, presence of an oxidant detected, suspect specimen adulteration Gray shading indicates where revisions were made. 1815

4 Melanson et al. oxymorphone over the concentration range of ,000 ng/ml. The analogous benzodiazepine procedure provides quantitative detection of alphahydroxyalprazolam, 7-aminoclonazepam, lorazepam, nordiazepam, oxazepam, and temazepam over the concentration range of 50 10,000 ng/ml. All other LC-MS/MS and GC-MS drug confirmations, performed on specimens which had a positive immunoassay screening result, were performed by Mayo Medical Laboratories. Data Analysis All results obtained in 18-month period (March 2010 and September 2011) were analyzed with some exceptions. Results for 6-AM and buprenorphine were only examined from April 2011 to September 2011 because we switched immunoassays in April 2011 and only wanted to evaluate the performance of the current immunoassay screen. Results for benzodiazepines were only examined from March 2011 to September 2011 because we began confirmation testing by LC-MS/MS in house in March Finally, results for adulterant testing were gathered for a 1-year period (February 2011 to February 2012). The positivity rate for the immunoassays screens as well as the number of false positive results was determined. A false positive was defined as a positive screen by immunoassay followed by negative result for that analyte by LC-MS/MS or GC/MS confirmation testing. The number of false negatives generated by our benzodiazepine screening immunoassay was also determined. In addition, screening cutoff concentrations and testing algorithms were examined and compared with the recommendations of the National Institute of Drug Abuse (NIDA). To determine the utility of screening for 6-AM, the heroin metabolite, in all patients, as opposed to only patients with morphine > 2,000 ng/ml, we recorded the number of positive 6-AM screens in patients with morphine < 2,000 ng/ml. The percentage of specimens with abnormal results for adulterant testing was generated. The Current Procedural Terminology code for each test in the panel and its associated cost was also determined. Using the original panel as the baseline, the reduction in cost to the patient was calculated. Results/Discussion Test Menu and Positivity Rates The positivity rate was <5% for 6-AM, amphetamines, cocaine, ethanol, and MDMA (Table 3). In addition, no patients with morphine < 2,000 ng/ml had a positive 6-AM result. Based on these results and the fact that our laboratories new amphetamine assay cross-reacted with MDMA, we eliminated ethanol and MDMA from the testing panel (Table 4). We also decided to switch to the traditional algorithm of screening for 6-AM only in specimens with morphine > 2,000 ng/ml (Table 4). The clinicians Table 3 Positive and false positive rates for immunoassay-based urine drug screens Analyte Urine Drug Screen (N)* Urine Drug Screen Positivity Rate (%) Urine Drug Confirmation (N) Urine Drug Confirmation False Positivity Rate (%) 6-Acetylmorphine 768 <1 2 0 Amphetamines 2, Barbiturates 2, NA Benzodiazepines Buprenorphine Cannabinoids 2, Cocaine 2, EDDP 2, NA Ethanol 2, NA Fentanyl 2, MDMA 2,507 < Methadone 2, Opioids NA NA NA NA Tramadol 2, NA * Volumes represent testing from March 2010 to September 2011 with the exception of 6-acetylmorphine and buprenorphine for which results from April 2011 to September 2011 were analyzed and benzodiazepines for which results from March 2011 to September 2011 were analyzed. This represents the false positive rate only for positive methadone screens in which EDDP was negative. The true false positive rate could not be determined. NA = not applicable. 1816

5 Commentary Table 4 Revised comprehensive urine drug testing panel for monitoring medication compliance in pain management Analyte Change in Urine Drug Testing Protocol Urine Drug Screen Positive/Negative Cutoff Concentration Conditions for Specimen Confirmation Testing Urine Drug Confirmation Positive/Negative Cutoff Concentration 6-Acetylmorphine Only screen if the concentration of morphine in the specimen is >2,000 ng/ml 10 ng/ml If drug screen is positive 5 ng/ml Amphetamines None 1,000 ng/ml If drug screen is positive 50 ng/ml Barbiturates None 200 ng/ml By clinician request only 100 ng/ml Benzodiazepines Eliminate drug screening and perform confirmation testing on all specimens NA All specimens 50 ng/ml Buprenorphine None 5 ng/ml If drug screen is positive 2.5 ng/ml Cannabinoids None 50 ng/ml If drug screen is positive 3 ng/ml Cocaine Change cutoff from 300 to 150 ng/ml 150 ng/ml If drug screen is positive 50 ng/ml EDDP Add confirmation testing for both EDDP and 100 ng/ml If drug screen is discrepant with methadone 100 ng/ml methadone for specimens with discrepant methadone and EDDP urine drug screening results Ethanol Eliminate all testing NA NA NA Fentanyl None 2 ng/ml If drug screen is positive 1 ng/ml MDMA Eliminate all testing NA NA NA Methadone See EDDP 300 ng/ml If drug screen is discrepant with EDDP 100 ng/ml Opioids None NA All specimens 100 ng/ml Tramadol None 200 ng/ml By clinician request only 20 ng/ml EDDP = 2-ethylidene-1,5dimethyl-3,3-diphenylpyrrolidine; MDMA = 3,4-Methylenedioxymethamphetamine; NA = not applicable. 1817

6 Melanson et al. elected to continue to include screening for cocaine and amphetamines due to the clinical consequences of a positive result (i.e., discontinuation of opioids and referral to addiction treatment). Positive/Negative Cutoff Concentrations We choose lower screening cutoffs for monitoring medication compliance in pain management in order to detect compliance and undisclosed diversion or abuse, as opposed to overdose or potential toxicity [16]. When comparing our cutoffs for drugs of abuse to the NIDA recommendations, there were some differences (Table 1). Based on input from pain management center and to be consistent with NIDA guidelines, we lowered the screening cutoff for cocaine from 300 ng/ml to 150 ng/ml (Table 4). We considered lowering our cutoff for amphetamines from 1,000 ng/ml to 500 ng/ml; however, the number of false positives increased and did not allow us to detect any additional patients abusing drugs in the amphetamine class. Phencyclidine (PCP), which NIDA includes in their screening panel, was not included in the initial panel due to the very infrequent abuse of PCP in our patient population. Testing Algorithm/Immunoassay Performance The false positive rate was 1% for 6-AM, cannabinoids, and cocaine suggesting that automatic confirmation may not be necessary. However, despite the low false positive rate for 6-AM, cannabinoids, and cocaine, the clinicians felt strongly that confirmatory testing should be performed. In the case of the cannabinoids which can be detected in the urine for up to 30 days after use, a quantitative concentration is helpful to ensure that the levels are decreasing over time. In the case of cocaine and 6-AM, the clinicians wanted more definitive proof of abuse because the presence of these illegal drugs is usually grounds for stopping opioid prescribing, as noted above. The false positive rate was 10% for fentanyl, MDMA, and methadone (Table 3). This reinforced the decision to eliminate MDMA from the panel (Table 4). It also prompted the laboratory to investigate other screening options for fentanyl; however, fentanyl immunoassays are relatively new to the market so implementation of a new assay has been slow. The high rate of false positives for methadone is misleading as 31% represents only the positive methadone with negative EDDP. We did not feel modification of the current assay was necessary. Previous studies have shown that immunoassay-based testing lacks sensitivity for detecting benzodiazepine use primarily due to their poor cross-reactivity with conjugated metabolites and newer benzodiazepine therapeutics [17]. Approximately 30% of patients in our population are prescribed benzodiazepines making it the second most common class of prescription drug. Our assay missed 60 out of 137 specimens positive for benzodiazepines, particularly those patients prescribed lorazepam or clonazepam. For this reason, we now perform LC-MS/MS confirmation on all specimens similar to opioids (Table 4). Adulteration Our interpretation of specimen adulteration (e.g., creatinine < 2 ng/ml, ph < 3) is consistent with Substance Abuse and Mental Health Services Administration guidelines (Table 2). Figure 1 demonstrates that no specimens in a 1-year period had creatinine suggesting specimen adulteration. In addition, no specimens had abnormal ph or positive oxidant results. However, it is important to communicate to the clinicians that our adulterant panel does not detect all forms of adulteration. Further examination of the results revealed opportunities for improvement. 13.2% (226/1,711) of specimens had creatinine between 201 and 300 ng/ml and were interpreted as unusually concentrated. The high percentage of specimens in the abnormal category suggested that our reference range was misleading. Therefore, as outlined in Table 2, we changed the creatinine ranges and interpretation to better reflect our patient population by increasing the concentration above which we interpreted as concentrated to >300 ng/ml and by removing the word unusually from the comment. Using the new interpretation, 5.1% (vs 18.4%) of specimens were considered concentrated (Figure 1). Although overt specimen adulteration was not apparent in the 1 year we examined, there were 73 (4.3%) patients with dilute urine ( ng/ml) which could signify excess water ingestion for the purposes of masking drugs. These results were helpful clinically and prompted clinicians to be more vigilant regarding potential drug abuse in these patients. Quantitative confirmatory testing is also useful in detecting adulteration. Patients frequently adulterate specimens and attempt to simulate compliance by adding the parent drug (e.g., methadone) directly to their urine. In these cases, the parent drug will be present at high concentrations, and the Figure 1 Relative distribution of specimen integrity testing results for creatinine. Specific result categories and their associated ranges are defined in Table

7 Commentary metabolite will be negative. During the analysis period, 13 specimens were positive for methadone and negative for EDDP and of those 9 (69%) confirmed positive for methadone. However, we realized EDDP was not quantitated by the reference laboratory that performed our confirmations, and because EDDP results were not available, we were not able to make a determination regarding adulteration (i.e., methadone positive, EDDP negative). As a result, we switched to a reference laboratory whose confirmation method quantitated both EDDP and methadone (Table 4). Cost Reduction and Improved Efficiency Table 4 shows the revised test panel incorporating all the changes described above. The changes we instituted as outlined in Table 4 lead to a 15% reduction in cost. In addition, we were able to save approximately $5,000 per year in reagents, calibrators, and quality control. There was no significant savings in labor, hardware, or service. Conclusions In this article, we describe a quality improvement initiative that was a collaborative effort between the laboratory and the pain management clinicians. We illustrate how a retrospective review of UDT from a pain management center treating patients for chronic pain can be utilized to optimize the test menu and testing algorithm for monitoring compliance in pain management and limit the cost to patients and/or payers. Our results highlight the value and necessity of an iterative process in optimizing the use of urine drug screens to monitor opioid compliance. This process has resulted in potentially improved: assay quality, appropriateness of obtaining a urine screen, interpretation of results, patient care, and cost. Other pain management centers who would like to initiate a similar quality improvement project may use this article as a guide. STACY E. F. MELANSON, MD, PhD,* ADAM S. PTOLEMY, PhD, and AJAY D. WASAN, MD, MSc Departments of *Pathology and Anesthesia, Perioperative and Pain Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Clinical Development and Quality Assurance, Gamma-Dynacare Medical Laboratories, London, Ontario, Canada References 1 Hammett-Stabler CA, Magnani B. Supporting the pain service. In: Magnani B, Bissell MG, Kwong TC, Wu AHB, eds. Clinical Toxicology Testing: A Guide for Laboratory Professionals. Northfield, IL: CAP Press; 2012: Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: Institute of Medicine; Available at: relievingpain (accessed 19 November 2012). 3 Trescot AM, Glaser SE, Hansen H, et al. Effectiveness of opioids in the treatment of chronic non-cancer pain. Pain Physician 2008;1:S Trescot AM, Helm S, Hansen H, et al. Opioids in the management of chronic non-cancer pain: An update of American Society of the Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician 2008; 11:S Manchikanti L, Atluri S, Trescot AM, Giordano J. Monitoring opioid adherence in chronic pain patients: Tools, techniques, and utility. Pain Physician 2008;11:S U.S. Food and Drug Administration. Risk Evaluation and Mitigation Strategies (REMS) Available at: PostmarketDrugSafetyInformationforPatientsand Providers/ucm htm. (accessed 31 May 2013). 7 Cone EJ, Caplan YH, Black DL, Robert T, Moser F. Urine drug testing of chronic pain patients: Licit and illicit drug patterns. J Anal Toxicol 2008;32: Katz NP, Sherburne S, Beach M, et al. Behavioral monitoring and urine toxicology testing in patients receiving long-term opioid therapy. Anesth Analg 2003;97: Melanson SE, Kredlow MI, Jarolim P. Analysis and interpretation of drug testing results from patients on chronic pain therapy: A clinical laboratory perspective. Clin Chem Lab Med 2009;47: Michna E, Jamison RN, Pham LD, et al. Urine toxicology screening among chronic pain patients on opioid therapy: Frequency and predictability of abnormal findings. Clin J Pain 2007;23: Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: A rational approach to the treatment of chronic pain. Pain Med 2005;6: Trescot AM, Boswell MV, Atluri SL, et al. Opioid guidelines in the management of chronic non-cancer pain. Pain Physician 2006;9: Crews B, Mikel C, Latyshev S, et al. 6-Acetylmorphine detected in the absence of morphine in pain management patients. Ther Drug Monit 2009;31: Snyder ML, Jarolim P, Melanson SE. A new automated urine fentanyl immunoassay: Technical performance and clinical utility for monitoring fentanyl compliance. Clin Chim Acta 2011;412:

8 Melanson et al. 15 Melanson SE, Snyder ML, Jarolim P, Flood JG. A new highly specific buprenorphine immunoassay for monitoring buprenorphine compliance and abuse. J Anal Toxicol 2012;36: Magnani B, Kwong T. Urine drug testing for pain management. Clin Lab Med 2012;32: Glover SJ, Allen KR. Measurement of benzodiazepines in urine by liquid chromatography-tandem mass spectrometry: Confirmation of samples screened by immunoassay. Ann Clin Biochem 2010;47:

Analysis and interpretation of drug testing results from patients on chronic pain therapy: a clinical laboratory perspective

Analysis and interpretation of drug testing results from patients on chronic pain therapy: a clinical laboratory perspective Article in press - uncorrected proof Clin Chem Lab Med 2009;47(8):971 976 2009 by Walter de Gruyter Berlin New York. DOI 10.1515/CCLM.2009.220 2009/180 Analysis and interpretation of drug testing results

More information

Using Liquid Chromatography Tandem Mass Spectrometry Urine Drug Testing to Identify Licit and Illicit Drug-Use in a Community-based Patient Population

Using Liquid Chromatography Tandem Mass Spectrometry Urine Drug Testing to Identify Licit and Illicit Drug-Use in a Community-based Patient Population Using Liquid Chromatography Tandem Mass Spectrometry Urine Drug Testing to Identify Licit and Illicit Drug-Use in a Community-based Patient Population Adam S. Ptolemy 1, Colleen Murray 2, Edward Dunn 3,

More information

Immunoassay-Based Drug Tests Are Inadequately Sensitive for Medication Compliance Monitoring in Patients Treated for Chronic Pain

Immunoassay-Based Drug Tests Are Inadequately Sensitive for Medication Compliance Monitoring in Patients Treated for Chronic Pain Pain Physician 2017; 20:SE1-SE9 ISSN 2150-1149 Review Immunoassay-Based Drug Tests Are Inadequately Sensitive for Medication Compliance Monitoring in Patients Treated for Chronic Pain Marion L. Snyder,

More information

Urine Drug Testing to Monitor Opioid Use In Managing Chronic Pain

Urine Drug Testing to Monitor Opioid Use In Managing Chronic Pain Faculty Disclosure Henry C. Nipper, PhD, DABCC Dr. Nipper has listed no financial interest/arrangement that would be considered a conflict of interest. Urine Drug Testing to Monitor Opioid Use In Managing

More information

The Drug Testing Process. Employer or Practice

The Drug Testing Process. Employer or Practice Disclosures Clinical Professor, Jefferson Medical College BOD MROCC [Medical Review Officer Certification Council] BOD National Sleep Foundation BOD POEMS [Pennsylvania Occupational & Environmental Medicine

More information

A New Highly Specific Buprenorphine Immunoassay for Monitoring Buprenorphine Compliance and Abuse

A New Highly Specific Buprenorphine Immunoassay for Monitoring Buprenorphine Compliance and Abuse Journal of Analytical Toxicology 2012;36:201 206 doi:10.1093/jat/bks003 Article A New Highly Specific Buprenorphine Immunoassay for Monitoring Buprenorphine Compliance and Abuse Stacy E.F. Melanson 1 *,

More information

3/8/2018. Reasons for Doing UDT. UDT: A Tool in Risk Assessment. Faculty/Presenter Disclosure. Urine Drug Testing in Chronic Pain Management

3/8/2018. Reasons for Doing UDT. UDT: A Tool in Risk Assessment. Faculty/Presenter Disclosure. Urine Drug Testing in Chronic Pain Management Urine Drug Testing in Chronic Pain Management March 8, 2018 Faculty/Presenter Disclosure Faculty: Andrew J Smith, MDCM Relationships with commercial interests: None to report Andrew J Smith, MDCM Staff

More information

URINE DRUG TOXICOLOGY

URINE DRUG TOXICOLOGY Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences URINE DRUG TOXICOLOGY Suzanne E. Rapp, MD GENERAL DISCLOSURES The University of Washington School of Medicine also

More information

Substance abuse is a significant problem in the United

Substance abuse is a significant problem in the United Interpretation and Utility of Drug of Abuse Immunoassays Lessons From Laboratory Drug Testing Surveys Stacy E. F. Melanson, MD, PhD; Leland Baskin, MD; Barbarajean Magnani, PhD, MD; Tai C. Kwong, PhD;

More information

EDUCATIONAL COMMENTARY METHADONE

EDUCATIONAL COMMENTARY METHADONE EDUCATIONAL COMMENTARY METHADONE Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE credits see the Continuing Education

More information

Clinical Policy: Outpatient Testing for Drugs of Abuse Reference Number: PA.CP.MP.50

Clinical Policy: Outpatient Testing for Drugs of Abuse Reference Number: PA.CP.MP.50 Clinical Policy: Reference Number: PA.CP.MP.50 Effective Date: 01/18 Last Review Date: 09/17 Coding Implications Revision Log Description Urine drug testing is a key diagnostic and therapeutic tool that

More information

September HCMC Toxicology Transition: Additional information and Frequently Asked Questions

September HCMC Toxicology Transition: Additional information and Frequently Asked Questions September 2016 HCMC Toxicology Transition: Additional information and Frequently Asked Questions Many clinicians have asked for more information about the Urine Drug Compliance Analysis (LAB8742) switch

More information

EDUCATIONAL COMMENTARY rd TEST EVENT Chemistry Urine Drug Testing

EDUCATIONAL COMMENTARY rd TEST EVENT Chemistry Urine Drug Testing EDUCATIONAL COMMENTARY 2003 3 rd TEST EVENT Chemistry Urine Drug Testing Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE

More information

Pain Medication Management Program Monitors Patient Compliance

Pain Medication Management Program Monitors Patient Compliance PeaceHealth Laboratories UPDATE 2014/15 Edition Pain Medication Management Program Monitors Patient Compliance BENEFITS Monitors analgesic medication adherence to ensure patient safety and protect your

More information

Illicit Drug Use Correlates with Negative Urine Drug Test Results for Prescribed Hydrocodone, Oxycodone, and Morphine

Illicit Drug Use Correlates with Negative Urine Drug Test Results for Prescribed Hydrocodone, Oxycodone, and Morphine Pain Physician 2012; 15:E687-E692 ISSN 2150-1149 Retrospective Evaluation Illicit Drug Use Correlates with Negative Urine Drug Test Results for Prescribed Hydrocodone, Oxycodone, and Morphine Amadeo Pesce,

More information

Gold Standard for Urine Drug Testin Urine Drug Testing Why U rine? Urine?

Gold Standard for Urine Drug Testin Urine Drug Testing Why U rine? Urine? Gold Standard for Urine Drug Testing Developed by TRMC Pain Management Center Jill Duffy, RN,BC Pam Kennell, RN, BC Heidi Beisch, RN Urine Drug Testing A DIAGNOSTIC tool For an OBJECTIVE test Based on

More information

Urine Drug Testing PracticeNotes Clinical Guide

Urine Drug Testing PracticeNotes Clinical Guide PracticeNotes Clinical Guide This PracticeNotes Clinical Guide offers a quick overview of the essentials of a patient-centered approach to urine drug testing (UDT), which remains an important tool for

More information

1/27/ New Release, Quest Diagnostics Nichols Institute, Valencia

1/27/ New Release, Quest Diagnostics Nichols Institute, Valencia NEW TESTS Please Note: Not all test codes assigned to each assay are listed in the table of contents. Please refer to the complete listing on the page numbers indicated. Test Code Test Name Effective Date

More information

Laboratory Testing to Support Pain Management: Methods, Concepts and Case Studies

Laboratory Testing to Support Pain Management: Methods, Concepts and Case Studies Laboratory Testing to Support Pain Management: Methods, Concepts and Case Studies Frederick G. Strathmann, PhD, DABCC, (CC,TC) Medical Director, Toxicology Associate Scientific Director of MS ARUP Laboratories

More information

Laboratory Service Report

Laboratory Service Report 4 05/25/19 Client C702884-DLP ROCHESTER Amphetamines, Confirmation Positive Confirmed POSITIVE by LC-S/S for the following: Amphetamine = 52 ethamphetamine = 124 ethamphetamine exists in the d- and l-isomeric

More information

Urine Drug Testing. Methadone/Buprenorphine 101 Workshop. Ron Joe, MD, DABAM December 10, 2016

Urine Drug Testing. Methadone/Buprenorphine 101 Workshop. Ron Joe, MD, DABAM December 10, 2016 Urine Drug Testing Methadone/Buprenorphine 101 Workshop Ron Joe, MD, DABAM December 10, 2016 Learning objectives Clarify the purpose of urine drug testing (UDT) Distinguish between UDT for detection of

More information

Pain Medication Management Program Supports Patient Outcomes and Adherence

Pain Medication Management Program Supports Patient Outcomes and Adherence PeaceHealth Laboratories UPDATE 2015 Revised Edition Pain Medication Management Program Supports Patient Outcomes and Adherence BENEFITS Monitors analgesic medication adherence to ensure patient safety

More information

Drug Screening: Things You Need to Know

Drug Screening: Things You Need to Know Drug Screening: Things You Need to Know (a view inside the clinical laboratory) Gary L. Horowitz, MD Director, Clinical Chemistry, Beth Israel Deaconess Medical Center Associate Professor of Pathology,

More information

Learning Objectives. Drug Testing 10/17/2012. Utilization of the urine drug screen: The good, the bad, and the ugly

Learning Objectives. Drug Testing 10/17/2012. Utilization of the urine drug screen: The good, the bad, and the ugly Utilization of the urine drug screen: The good, the bad, and the ugly Jennifer A. Lowry, MD Chief, Section of Medical Toxicology Children s Mercy Hospital Kansas City, MO Learning Objectives Describe the

More information

Trust but verify is good advice

Trust but verify is good advice PRINTER-FRIENDLY VERSION Available AT PainMedicineNews.com The Role of Urine Drug Monitoring in Pain Management Lynn R. Webster, MD Medical Director CRILifetree Research Salt Lake City, Utah President

More information

Test Definition: PDSOX Pain Clinic Drug Screen, Chain of Custody, Urine

Test Definition: PDSOX Pain Clinic Drug Screen, Chain of Custody, Urine Reporting Title: Pain Clinic Drug Screen, CoC, U Performing Location: Rochester Specimen Requirements: Container/Tube: Chain-of-Custody Kit (Supply T282) containing the specimen containers, seals, and

More information

MEDICAL POLICY Drug Testing

MEDICAL POLICY Drug Testing POLICY: PG0069 ORIGINAL EFFECTIVE: 01/01/11 LAST REVIEW: 11/13/18 MEDICAL POLICY Drug Testing GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by each

More information

Clinical Policy: Outpatient Testing for Drugs of Abuse Reference Number: PA.CP.MP.50

Clinical Policy: Outpatient Testing for Drugs of Abuse Reference Number: PA.CP.MP.50 Clinical Policy: Reference Number: PA.CP.MP.50 Effective Date: 01/18 Last Review Date: 09/18 Coding Implications Revision Log Description Urine drug testing is a key diagnostic and therapeutic tool that

More information

Overview of the AACC Academy s LMPG: Using clinical laboratory tests to monitor drug therapy in pain management patients

Overview of the AACC Academy s LMPG: Using clinical laboratory tests to monitor drug therapy in pain management patients Overview of the AACC Academy s LMPG: Using clinical laboratory tests to monitor drug therapy in pain management patients Gwen McMillin, PhD, DABCC(CC,TC) Professor, University of Utah Medical Director,

More information

Test Definition: PCDSO Pain Clinic Drug Screen, Urine

Test Definition: PCDSO Pain Clinic Drug Screen, Urine Reporting Title: Pain Clinic Drug Screen, U Performing Location: Rochester Specimen Requirements: Collection Container/Tube: Plastic urine container Submission Container/Tube: Plastic, 60-mL urine bottle

More information

Patient-Centered Urine Drug Testing. Douglas Gourlay, MD, MSc, FRCPC, FASAM

Patient-Centered Urine Drug Testing. Douglas Gourlay, MD, MSc, FRCPC, FASAM Patient-Centered Urine Drug Testing Douglas Gourlay, MD, MSc, FRCPC, FASAM Declaration of Potential Conflict of Interest The content of this presentation is non- commercial and does not represent any conflict

More information

Pain Management Drug Testing: A Laboratory Perspective

Pain Management Drug Testing: A Laboratory Perspective Ernest Jimenez III, M.T.(ASCP) Nothing to declare. Laboratory manager at Pharos Diagnostics, LLC., located in Tucson, AZ. Pain Management Drug Testing: A Laboratory Perspective 1 2 Pain Management Drug

More information

MEDICAL POLICY Drug Testing

MEDICAL POLICY Drug Testing POLICY: PG0069 ORIGINAL EFFECTIVE: 01/01/11 LAST REVIEW: 04/10/18 MEDICAL POLICY Drug Testing GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by each

More information

Urine Drug Testing Methods 3-5

Urine Drug Testing Methods 3-5 Urine Drug Testing Methods 3-5 Type of Test Logistics Pearls Initial Screening Test: Immunoassay Confirmatory Test: Gas chromatography-mass spectrometry (GCMS) + or Liquid chromatography-mass spectrometry

More information

A Simple and Accurate Method for the Rapid Quantitation of Drugs of Abuse in Urine Using Liquid Chromatography

A Simple and Accurate Method for the Rapid Quantitation of Drugs of Abuse in Urine Using Liquid Chromatography Application Note LCMS-109 A Simple and Accurate Method for the Rapid Quantitation of Drugs of Abuse in Urine Using Liquid Chromatography Time of Flight (LC-TOF) Mass Spectrometry Introduction Many clinical

More information

Linking Opioid Treatment in Primary Care. Roxanne Lewin M.D.

Linking Opioid Treatment in Primary Care. Roxanne Lewin M.D. Roxanne Lewin M.D. The Facts Fewer than 10 percent of individuals with an alcohol use disorder and only about 20 percent of individuals with an opioid use disorder receive specialty treatment. Many individuals

More information

80305, 80306, 80307,G0480, G0481, G0482, G0483, G0659

80305, 80306, 80307,G0480, G0481, G0482, G0483, G0659 80305, 80306, 80307,G0480, G0481, G0482, G0483, G0659 CMS Policy for Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont Local policies are determined by the performing

More information

Interpretation of Pain Management Testing Results Using Case Examples

Interpretation of Pain Management Testing Results Using Case Examples Interpretation of Pain Management Testing Results Using Case Examples Philip M. Sobolesky, 1 * Breland E. Smith, 1 Amadeo J. Pesce, 2 and Robert L. Fitzgerald 1 Background: Because of the increasing volume

More information

Urine Drug Screening: The Essentials of Interpretation

Urine Drug Screening: The Essentials of Interpretation Urine Drug Screening: The Essentials of Interpretation Loralie J Langman, PhD DABCC (CC, MD, TC), F-ABFT Director Clinical and Forensic Toxicology Laboratory, Mayo Clinic Professor, Mayo Clinic College

More information

What Your Drug Test Really Means. Krista Beiermann, RN, OHS Occupational Health Services, Columbus Hospital

What Your Drug Test Really Means. Krista Beiermann, RN, OHS Occupational Health Services, Columbus Hospital What Your Drug Test Really Means Krista Beiermann, RN, OHS Occupational Health Services, Columbus Hospital Disclosure There are no relevant financial relationships with commercial interests associated.

More information

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

Lower Cutoffs for LC-MS/MS Urine Drug Testing Indicates Better Patient Compliance Pain Physician 2017; 20:E1107-E1113 ISSN 2150-1149 Retrospective Study Lower Cutoffs for LC-MS/MS Urine Drug Testing Indicates Better Patient Compliance Kevin Krock, PhD, Amadeo Pesce, PhD, Dennis Ritz,

More information

Urine Opioid Dependency Panel (UODP) 1

Urine Opioid Dependency Panel (UODP) 1 Drug Testing Panels Urine Opioid Dependency Panel (UODP) 1 Amphetamines Amphetamine Methamphetamine Methylenedioxyamphetamine Adderall, Dexedrine, Vyvanse, Lisdexamfetamine (Speed, Bennies, Crystal Meth,

More information

Frequently Asked Questions: Opiate Dependency and Methadone Maintenance Treatment program follow-up

Frequently Asked Questions: Opiate Dependency and Methadone Maintenance Treatment program follow-up Frequently Asked Questions: Opiate Dependency and Methadone Maintenance Treatment program follow-up Dr. Bhushan M. Kapur Associate Professor Department of Laboratory Medicine and Pathobiology, Faculty

More information

Controlled Substance Monitoring in the Age of the Opioid Epidemic

Controlled Substance Monitoring in the Age of the Opioid Epidemic Controlled Substance Monitoring in the Age of the Opioid Epidemic Paul E. Hilliard, MS, MD Hospital Pain Committee Chair Department of Anesthesiology CME housekeeping I have no financial disclosures AKA,

More information

Urine drug testing it s not always crystal clear

Urine drug testing it s not always crystal clear Urine drug testing it s not always crystal clear Kirk Moberg, MD, PhD, FASAM Executive Medical Director, UnityPoint Health Illinois Institute for Addiction Recovery Clinical Professor of Internal Medicine

More information

3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D years

3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D years Drug Adherence Assessment Report CleanAssure TM (DRIED BLOOD SPOT): Detection Range see NOTES. Prescribed Medications: NO MEDICATION LIST PROVIDED CONSISTENT RESULTS - MEDICATION DETECTED (PARENT DRUG

More information

Urine Testing for Opioids

Urine Testing for Opioids Urine Testing for Opioids J. David Haddox, DDS, MD Vice President Risk Management & Health Policy Purdue Pharma L.P. Tufts Health Care Institute Program on Opioid Risk Management The Role of Urine Drug

More information

Testing for Controlled Substances

Testing for Controlled Substances Testing for illicit drugs Testing for Controlled Substances 1 Purposes: Employment Sports Screening medical eval. Legal Monitoring Treatment Probation Prescribing controlled substances Forensics 2 Drug

More information

Powering Efficient Behavioral Health Care Services

Powering Efficient Behavioral Health Care Services Powering Efficient Behavioral Health Care Services Streamlining behavioral health care decisions through comprehensive and efficient drug monitoring Quest Diagnostics has you and your patients covered

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Drug Testing in Pain Management and Substance Abuse Treatment File Name: Origination: Last CAP Review: Next CAP Review: Last Review: drug_testing_in_pain_management_and_substance_abuse_treatment

More information

B. To assess an individual when clinical evaluation suggests use of non-prescribed medications or illegal substances; or

B. To assess an individual when clinical evaluation suggests use of non-prescribed medications or illegal substances; or Integrated Reference #: MP/D010 Page: 1 of 7 PRODUCT APPLICATION: PreferredOne Community Health Plan (PCHP) PreferredOne Administrative Services, Inc. (PAS) ERISA PreferredOne Administrative Services,

More information

Validation Report for the Neogen Fentanyl Kit for ELISA Screening of Whole Blood and Urine Specimens

Validation Report for the Neogen Fentanyl Kit for ELISA Screening of Whole Blood and Urine Specimens Validation Report for the Neogen Fentanyl Kit for ELISA Screening of Whole Blood and Urine Specimens This document describes the validation of a Neogen Fentanyl kit for the semi-quantitative analysis of

More information

WELCOME! 12/13/2018. Today s Topic: Urine Drug Screens in OUD Treatment UW PACC

WELCOME! 12/13/2018. Today s Topic: Urine Drug Screens in OUD Treatment UW PACC Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences 12/13/2018 WELCOME! Today s Topic: Urine Drug Screens in OUD Treatment Should I test and how should I do drug testing

More information

One of These Tests is Not Like the Other: Comparative effectiveness, cost-effectiveness and utilization guidance in pain management testing

One of These Tests is Not Like the Other: Comparative effectiveness, cost-effectiveness and utilization guidance in pain management testing & One of These Tests is Not Like the Other: Comparative effectiveness, cost-effectiveness and utilization guidance in pain management testing Speaker Frederick G. Strathmann Learning Objectives Discuss

More information

A Comprehensive Screening of Illicit and Pain Management Drugs from Whole Blood Using SPE and LC/MS/MS

A Comprehensive Screening of Illicit and Pain Management Drugs from Whole Blood Using SPE and LC/MS/MS A Comprehensive Screening of Illicit and Pain Management Drugs from Whole Blood Using SPE and LC/MS/MS Introduction Drug analysis from whole blood is gaining popularity due to a more complete measurement

More information

Medical Policy Outpatient Drug Screening and Testing. No Prior Authorization X X

Medical Policy Outpatient Drug Screening and Testing. No Prior Authorization X X Medical Policy Outpatient Drug Screening and Testing Document Number: 030 Authorization required Commercial and Qualified Health Plans MassHealth No Prior Authorization X X Overview The purpose of this

More information

Cutoff levels for hydrocodone in a blood test

Cutoff levels for hydrocodone in a blood test Cutoff levels for hydrocodone in a blood test The premier DNA and drug testing company in the North Texas area. Specializing in legal cases but also provide testing for employers and private individuals.

More information

Conflict of Interest Disclosure

Conflict of Interest Disclosure Patient Rx Drug Misuse and Abuse: Compliance Toxicology Monitoring in Clinical Practice Toxicology Staff Andrea Terrell, Ph.D., DABCC Chief Scientific Officer George Behonick, Ph.D., DABFT, Manager, FBU

More information

Welcome! Supreme Court of Ohio Specialized Dockets Conference. October 23-24, 2017

Welcome! Supreme Court of Ohio Specialized Dockets Conference. October 23-24, 2017 Welcome! Supreme Court of Ohio Specialized Dockets Conference October 23-24, 2017 Drug Testing: Do you know enough to be dangerous? Presented by William L. Parker President & CEO American Court & Drug

More information

Medical Affairs Policy

Medical Affairs Policy Medical Affairs Policy Service: Urine Drug/Alcohol Screening and Testing PUM 250-0013-1803 Medical Policy Committee Approval 03/06/18 Effective Date 07/01/18 Prior Authorization Needed No Disclaimer: This

More information

Evaluation of the Impact of Expanding ELISA Screening in DUID Investigations. Aileen Lu*, Karen S. Scott, Aya Chan-Hosokawa, and Barry K.

Evaluation of the Impact of Expanding ELISA Screening in DUID Investigations. Aileen Lu*, Karen S. Scott, Aya Chan-Hosokawa, and Barry K. Evaluation of the Impact of Expanding ELISA Screening in DUID Investigations Aileen Lu*, Karen S. Scott, Aya Chan-Hosokawa, and Barry K. Logan FSF Emerging Forensic Scientist Award Oral Presentation Disclosure

More information

Guidelines for Urine Drug Monitoring for the Pain Patient in a Clinical Practice

Guidelines for Urine Drug Monitoring for the Pain Patient in a Clinical Practice Guidelines for Urine Drug Monitoring for the Pain Patient in a Clinical Practice Howard A. Heit, M.D., F.A.C.P., F.A.S.A.M. Board Certified in Internal Medicine and Gastroenterology/Hepatology Certified

More information

The Utility of Urine Drug Screening

The Utility of Urine Drug Screening The Utility of Urine Drug Screening Treating Addiction, Saving Lives Sea Cruises Bye Tazmania, still far from New Zealand February 8 th, 2018 Mandy Manak, MD FASAM, ISAM, CSAM, MRO Medical Director, ICDO

More information

Clinical Policy: Outpatient Testing for Drugs of Abuse

Clinical Policy: Outpatient Testing for Drugs of Abuse Clinical Policy: Reference Number: CP.MP.50 Last Review Date: 07/18 See Important Reminder at the end of this policy for important regulatory and legal information. Coding Implications Revision Log Description

More information

Rapid Alcohol Screening Devices. p19

Rapid Alcohol Screening Devices. p19 CLIA-WAIVED Product Catalog RAPID DRUG SCREENING DEVICES Rapid Urine Drug Screening Devices. p5 Rapid Alcohol Screening Devices. p19 Complementary Products. p23 HELPING YOU MAKE INFORMED DECISIONS ABOUT

More information

Evaluation of the Integrated E-Z Split Key Cup II for Rapid Detection of Twelve Drug Classes in Urine

Evaluation of the Integrated E-Z Split Key Cup II for Rapid Detection of Twelve Drug Classes in Urine Technical Note Evaluation of the Integrated E-Z Split Key Cup II for Rapid Detection of Twelve Drug Classes in Urine Dina N. Greene, Christopher M. Lehman, and Gwendolyn A. McMillin* University of Utah

More information

MEDICAL POLICY No R2 DRUG TESTING

MEDICAL POLICY No R2 DRUG TESTING Summary of Changes MEDICAL POLICY DRUG TESTING Effective Date: April 10, 2017 Review Dates: 5/15, 5/16, 11/16, 2/17 Date Of Origin: May 13, 2015 Status: Current Clarifications: Deletions: Additions: Pg.

More information

Toxicology Testing Is it a Good Fit for Your Laboratory? Rebecca Kenner, BA, MT, DLM(ASCP) Leigh Ann Smith, BS, MLS(ASCP), CLS

Toxicology Testing Is it a Good Fit for Your Laboratory? Rebecca Kenner, BA, MT, DLM(ASCP) Leigh Ann Smith, BS, MLS(ASCP), CLS Thursday April 6, 2017 B16 Toxicology Testing Is it a Good Fit for Your Laboratory? Rebecca Kenner, BA, MT, DLM(ASCP) Leigh Ann Smith, BS, MLS(ASCP), CLS Global Analytical Development DESCRIPTION: Are

More information

Get Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization

Get Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization Get Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization Prepared and presented by Jennifer Bolen, JD Disclosures for Jennifer Bolen, JD Consultant - Generation

More information

Disclosures. You're in Control or Urine Control Clinical Pearls of Drug Testing Case Studies. 9/20/17

Disclosures. You're in Control or Urine Control Clinical Pearls of Drug Testing Case Studies.   9/20/17 You're in Control or Urine Control Clinical Pearls of Drug Testing Case Studies Jeffrey Fudin, BS, PharmD, FCCP, FASHP www.paindr.com Disclosures Astra Zeneca (Speakers Bureau) Collegium (Consultant) Daiichi

More information

Disclosures. Get Your Specimens in Order:

Disclosures. Get Your Specimens in Order: Get Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization Jennifer Bolen, JD Disclosures Jennifer Bolen, JD Consultant to Generation Partners Consultant to Abbott

More information

Welcome - SAMHSA s Role. Welcome SAMHSA Key Messages 4. Welcome SAMHSA s Direction

Welcome - SAMHSA s Role. Welcome SAMHSA Key Messages 4. Welcome SAMHSA s Direction Welcome - SAMHSA s Role 2 Welcome and Opening Remarks The National Conference on Substance Abuse, Child Welfare and the Courts Division of Workplace Programs Ron R. Flegel, BSMT, M.S. and Charles Lodico,

More information

Detection of Neonatal Drug Exposure Using Umbilical Cord Tissue and Liquid Chromatography Time-of-Flight Mass Spectrometry

Detection of Neonatal Drug Exposure Using Umbilical Cord Tissue and Liquid Chromatography Time-of-Flight Mass Spectrometry ORIGINAL ARTICLE Detection of Neonatal Drug Exposure Using Umbilical Cord Tissue and Liquid Chromatography Time-of-Flight Mass Spectrometry Stephanie J. Marin, PhD,* Anna Metcalf, BS, Matthew D. Krasowski,

More information

Procedure for Toxicology Analysis Version 7 Toxicology Unit Effective Date: 03/14/2014 Issued by Drug Chemistry Forensic Scientist Manager

Procedure for Toxicology Analysis Version 7 Toxicology Unit Effective Date: 03/14/2014 Issued by Drug Chemistry Forensic Scientist Manager Toxicology Analysis 1.0 Purpose - This procedure specifies the required elements for analyzing toxicology submissions and reporting drug testing results. 2.0 Scope This procedure applies to all submissions

More information

Payment Policy: Urine Specimen Validity Testing Reference Number: CC.PP.056 Product Types: ALL Effective Date: 11/01/2017 Last Review Date:

Payment Policy: Urine Specimen Validity Testing Reference Number: CC.PP.056 Product Types: ALL Effective Date: 11/01/2017 Last Review Date: Payment Policy: Reference Number: CC.PP.056 Product Types: ALL Effective Date: 11/01/2017 Last Review Date: Coding Implications Revision Log See Important Reminder at the end of this policy for important

More information

10/9/18. Learning Objectives. Get Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization

10/9/18. Learning Objectives. Get Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization Get Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization Prepared and presented by Jennifer Bolen, JD Disclosures for Jennifer Bolen, JD Consultant - Generation

More information

LCMS-8050 Drugs of Abuse: 113 Analytes with Polarity Switching

LCMS-8050 Drugs of Abuse: 113 Analytes with Polarity Switching Liquid Chromatography Mass Spectrometry SSI-LCMS-8 LCMS-8 Drugs of Abuse: Analytes with Polarity Switching LCMS-8 Summary Seventy six analytes and their internal standards are described below. Multiple

More information

DRUG TESTING POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: October 1, Related Policies None

DRUG TESTING POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: October 1, Related Policies None DRUG TESTING POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 259.1 T0 Effective Date: October 1, 2017 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE LINES

More information

QuickTox Drug Screen Dipcard (with and without Adulteration Tests)

QuickTox Drug Screen Dipcard (with and without Adulteration Tests) QuickTox Drug Screen Dipcard (with and without Adulteration Tests) Training and Certification Program Presented by Branan Medical Corporation Branan Medical Corporation 10015 Muirlands Road Irvine, California

More information

Based on our criteria and assessment of the peer-reviewed literature, presumptive (immunoassay) in office or pointof-care

Based on our criteria and assessment of the peer-reviewed literature, presumptive (immunoassay) in office or pointof-care MEDICAL POLICY SUBJECT: URINE DRUG TESTING PAGE: 1 OF: 10 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including an

More information

Drug Testing in Pain Management and Substance Use Disorder Treatment

Drug Testing in Pain Management and Substance Use Disorder Treatment Drug Testing in Pain Management and Substance Use Disorder Treatment Policy Number: 2.04.98 Last Review: 3/2018 Origination: 3/2017 Next Review: 3/2019 Policy Blue Cross and Blue Shield of Kansas City

More information

Fast and easy separation of 23 drugs of abuse. including high, stable resolution of isobaric opioids from human urine by UHPLC-MS/MS

Fast and easy separation of 23 drugs of abuse. including high, stable resolution of isobaric opioids from human urine by UHPLC-MS/MS TECHNICAL NOTE 21883 Fast and easy separation of 23 drugs of abuse including high, stable resolution of isobaric opioids from human urine by UHPLC-MS/MS Authors Kean Woodmansey 1, Jon Bardsley 1 and Stacy

More information

OPIOIDS, SUBSTANCE ABUSE & ADDICTIONS SECTION. Review Articles Interpretation of Urine Drug Testing in Pain Patientspme_

OPIOIDS, SUBSTANCE ABUSE & ADDICTIONS SECTION. Review Articles Interpretation of Urine Drug Testing in Pain Patientspme_ bs_bs_banner Pain Medicine 2012; 13: 868 885 Wiley Periodicals, Inc. OPIOIDS, SUBSTANCE ABUSE & ADDICTIONS SECTION Review Articles Interpretation of Urine Drug Testing in Pain Patientspme_1350 868..885

More information

DRUG TESTING POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: January 1, Related Policies None

DRUG TESTING POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: January 1, Related Policies None DRUG TESTING POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 259.2 T0 Effective Date: January 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE LINES

More information

Schedule of Accreditation issued by United Kingdom Accreditation Service 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK

Schedule of Accreditation issued by United Kingdom Accreditation Service 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK Schedule of ccreditation United Kingdom ccreditation Service 2 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3HR, UK ccredited to Laboratory locations: Gavenny Court Brecon Road bergavenny Monmouthshire

More information

T R A I N I N G G U I D E

T R A I N I N G G U I D E TRAINING GUIDE InstaCube Oral Fluid Drug Test For Forensic Use Only Powered By: Contents 3 The information in this presentation is a general overview on performing and interpreting the InstaCube Oral Fluid

More information

How Can a Methadone and an Opiate-Positive Immunoassay Result be Reconciled in a Patient Prescribed only OxyContin and Wellbutrin?

How Can a Methadone and an Opiate-Positive Immunoassay Result be Reconciled in a Patient Prescribed only OxyContin and Wellbutrin? 190 Available online at www.annclinlabsci.org How Can a Methadone and an Opiate-Positive Immunoassay Result be Reconciled in a Patient Prescribed only OxyContin and Wellbutrin? Jude M. Abadie Department

More information

FEP Medical Policy Manual

FEP Medical Policy Manual FEP Medical Policy Manual FEP POLICY 2.04.98 Drug Testing in Pain Management and Substance Abuse Treatment Effective Date: April 15, 2017 Related Policies: None Drug Testing in Pain Management and Substance

More information

executive summary Specifically, this paper provides: 2 precision diagnostics Statistics and trends on prescription drug abuse, misuse, and diversion

executive summary Specifically, this paper provides: 2 precision diagnostics Statistics and trends on prescription drug abuse, misuse, and diversion nextgen precision testing TM delivering unprecedented results a white paper on evolving clinical drug testing cutoff levels to effectively identify drug abuse, misuse, and diversion executive summary Financial,

More information

Applications of High Resolution Mass Spectrometry in Forensic Toxicology. Patrick Kyle, PhD.

Applications of High Resolution Mass Spectrometry in Forensic Toxicology. Patrick Kyle, PhD. Applications of High Resolution Mass Spectrometry in Forensic Toxicology Patrick Kyle, PhD pkyle@umc.edu Financial Disclosures Grant/Research Support: None Salary/Consultant Fees: None Board/Committee/Advisory

More information

2013 Clinical drug and alcohol testing solutions. Product Catalog. CLIA-waived point of care test devices

2013 Clinical drug and alcohol testing solutions. Product Catalog. CLIA-waived point of care test devices 2013 Clinical drug and alcohol testing solutions Product Catalog CLIA-waived point of care test devices HELPING YOU MAKE INFORMED DECISIONS ABOUT ABUSE. Substance abuse testing with more substance. 2 of

More information

Clinical UM Guideline

Clinical UM Guideline Clinical UM Guideline UniCare Health Plan of West Virginia, Inc. Medicaid Managed Care December 2018 Subject: Drug Testing or Screening in the Context of Substance Use Disorder and Chronic Pain Guideline

More information

Drug Testing Policy. Reimbursement Policy CMS Approved By. Policy Number. Annual Approval Date. Reimbursement Policy Oversight Committee

Drug Testing Policy. Reimbursement Policy CMS Approved By. Policy Number. Annual Approval Date. Reimbursement Policy Oversight Committee Reimbursement Policy CMS 1500 Drug Testing Policy Policy Number 2017R6005A Annual Approval Date 05/10/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY

More information

INTERPATH LABORATORY, INC. TEST UPDATES

INTERPATH LABORATORY, INC. TEST UPDATES EFFECTIVE DATE: February 16, 2016 INTERPATH LABORATORY, INC. TEST UPDATES Please take note of the following test updates and make the appropriate changes in your Interpath Service Manual. Feel free to

More information

Drug Testing: How to Evaluate Results

Drug Testing: How to Evaluate Results Drug Testing: How to Evaluate Results Prepared for you by the West Virginia Drug Testing Laboratory Drug testing, whether for an individual or a large corporation, consists of two necessary steps - specimen

More information

DRUG TESTING POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: March 1, Related Policies None

DRUG TESTING POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: March 1, Related Policies None DRUG TESTING POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 259.3 T0 Effective Date: March 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE LINES OF

More information

Community Drug Early Warning System (CDEWS-3): Washington, DC - Site 3 of 4

Community Drug Early Warning System (CDEWS-3): Washington, DC - Site 3 of 4 Community Drug Early Warning System (CDEWS-3): Washington, DC - Site 3 of 4 Office of National Drug Control Policy Executive Office of the President May 2017 ACKNOWLEDGMENTS This report was funded by Cooperative

More information

SmartNotes. Understanding the SAMHSA Guidelines for Drugs of Abuse Testing

SmartNotes. Understanding the SAMHSA Guidelines for Drugs of Abuse Testing DIAGNOSTICS SAMHSA Guidelines SmartNotes Understanding the SAMHSA Guidelines for Drugs of Abuse Testing The Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency within the US

More information

QuickTox Drug Screen Dipcard (with and without Adulteration Tests)

QuickTox Drug Screen Dipcard (with and without Adulteration Tests) QuickTox Drug Screen Dipcard (with and without Adulteration Tests) Training and Certification Program Presented by CLIAwaived.com, San Diego, CA Distributed by CLIAwaived.com www.cliawaived.com 1-858-481-5031

More information

High-Throughput Quantitative LC-MS/MS Analysis of 6 Opiates and 14 Benzodiazepines in Urine

High-Throughput Quantitative LC-MS/MS Analysis of 6 Opiates and 14 Benzodiazepines in Urine High-Throughput Quantitative LC-MS/MS Analysis of and 14 Benzodiazepines in Urine Bill Yu, Kristine Van Natta, Marta Kozak, Thermo Fisher Scientific, San Jose, CA Application Note 588 Key Words Opiates,

More information