scholarly journals Dose Dependent Urine Concentrations of Gabapentin (Neurontin®)

2020 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Drug Testing ◽  
Concentration Data ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Urine Concentrations ◽  
Low Toxicity ◽  
High Doses ◽  
Dose Dependent ◽  
Positive Results ◽  
Urine Specimens

Gabapentin (Neurontin®) is frequently prescribed for a number of conditions including adjunctive therapy for partial seizures and neuropathic pain. Gabapentin is unique to most drugs in that it is titrated quickly to high doses (1,800-3,600mg/day or greater) due to its low toxicity. It is not metabolized but excreted primarily unchanged in the urine at extremely high levels ranging from 5µg/ml to >30,000µg/ml. The work reported here looks at gabapentin urine drug testing (UDT) results from 6 months of clinical urine specimens in which gabapentin was detected (n=35,526), prescribed (n=23,432, 66%) or not prescribed (n=12,094, 34%). In the prescribed population, gabapentin was primarily prescribed to females (61%). The overall age for positive results ranged from 14 to 97 years with an average age of 56.5 years. Interestingly, the average age of those patients positive for gabapentin without a prescription and positive for any illicit was 42.7 years. These data indicate that at a maximum, 34% of the total gabapentin positive samples are from abuse (no prescription). Attempts at normalization and transformation of drug concentration data using creatinine normalization did lead to a near Gaussian distribution where +/- 3 standard deviations may be estimated. It remains difficult to determine if a patient is abusing the drug when the UDT values are extremely high for patients prescribed gabapentin.

Storage of urine specimens in point of care (POC) urine drug testing cups reduces concentrations of many drugs

2019 ◽  
Vol 499 ◽  
pp. 81-86 ◽  
Author(s):  
Mehran Haidari ◽  
Sravan Mansani ◽  
Dezaray Ponds ◽  
Lissett Romero ◽  
Christine Cobb ◽  
...  
Keyword(s):  
Drug Testing ◽  
Point Of Care ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Urine Specimens

scholarly journals KIMS, CEDIA, and HS-CEDIA Immunoassays Are Inadequately Sensitive for Detection of Benzodiazepines in Urine from Patients Treated for Chronic Pain

2014 ◽  
Vol 4;17 (4;7) ◽  
pp. 259-266
Author(s):  
Stacy Melanson
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Diagnostic Accuracy ◽  
Drug Testing ◽  
Medication Compliance ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Benzodiazepine Use ◽  
Urine Specimens ◽  
Higher Sensitivity

Background: Patients treated for chronic pain may frequently undergo urine drug testing to monitor medication compliance and detect undisclosed prescribed or illicit drug use. Due to the increasing use and abuse of benzodiazepines, this class of medications is often included in drug screening panels. However, immunoassay-based methods lack the requisite sensitivity for detecting benzodiazepine use in this population primarily due to their poor cross-reactivity with several major urinary benzodiazepine metabolites. A High Sensitivity Cloned Enzyme Donor Immunoassay (HS-CEDIA), in which betaglucuronidase is added to the reagent, has been shown to perform better than traditional assays, but its performance in patients treated for chronic pain is not well characterized. Objectives: To determine the diagnostic accuracy of HS-CEDIA, as compared to the Cloned Enzyme Donor Immunoassay (CEDIA) and Kinetic Interaction of Microparticles in Solution (KIMS) screening immunoassays and liquid chromatography-tandem mass spectrometry (LC-MS/MS), for monitoring benzodiazepine use in patients treated for chronic pain. Study Design: A study of the diagnostic accuracy of urine benzodiazepine immunoassays. Setting: The study was conducted at an academic tertiary care hospital with a clinical laboratory that performs urine drug testing for monitoring medication compliance in pain management. Methods: A total of 299 urine specimens from patients treated for chronic pain were screened for the presence of benzodiazepines using the HS-CEDIA, CEDIA, and KIMS assays. The sensitivity and specificity of the screening assays were determined using the LC-MS/MS results as the reference method. Results: Of the 299 urine specimens tested, 141 (47%) confirmed positive for one or more of the benzodiazepines/metabolites by LC-MS/MS. All 3 screens were 100% specific with no false-positive results. The CEDIA and KIMS sensitivities were 55% (78/141) and 47% (66/141), respectively. Despite the relatively higher sensitivity of the HS-CEDIA screening assay (78%; 110/141), primarily due to increased detection of lorazepam, it still missed 22% (31/141) of benzodiazepine-positive urines. The KIMS, CEDIA, and HS-CEDIA assays yielded accuracies of 75%, 79%, and 90%, respectively, in comparison with LC-MS/MS. Limitations: This study was limited by its single-site location and the modest size of the urine samples utilized. Conclusions: While the HS-CEDIA provides higher sensitivity than the KIMS and CEDIA assays, it still missed an unacceptably high percentage of benzodiazepine-positive samples from patients treated for chronic pain. LC-MS/MS quantification with enzymatic sample pretreatment offers superior sensitivity and specificity for monitoring benzodiazepines in patients treated for chronic pain. Key words: High sensitivty immunoassay, benzodiazepine, beta-glucoronidase, pain management, compliance, LC-MS/MS, screening

Lowering the federally mandated cannabinoid immunoassay cutoff increases true-positive results

1994 ◽  
Vol 40 (5) ◽  
pp. 729-733 ◽  
Author(s):  
M A Huestis ◽  
J M Mitchell ◽  
E J Cone
Keyword(s):  
Mass Spectrometry ◽  
Human Services ◽  
Drug Testing ◽  
Gas Chromatography Mass Spectrometry ◽  
True Positive ◽  
Health And Human Services ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Sensitivity Specificity ◽  
Positive Results

Abstract Proposed changes to the Health and Human Services Guidelines for forensic urine drug testing will lower the required cannabinoid immunoassay cutoff concentration from 100 to 50 micrograms/L. We investigated the effect of this change on the sensitivity, specificity, and efficiency of eight cannabinoid immunoassays: Syva Emit d.a.u. 100; Syva Emit II 100; Syva Emit d.a.u. 50; Syva Emit II 50; Roche Abuscreen Online; Roche Abuscreen radioimmunoassay; Diagnostic Reagents; and Abbott ADx. All specimens also were assayed by gas chromatography/mass spectrometry. Lowering the cutoff concentration from 100 to 50 micrograms/L increased efficiencies and sensitivities for all immunoassays, with minor decreases in specificity (1.0-2.6%). There was a 23.2-53.6% increase in the number of true-positive specimens identified. Thus, lowering the cannabinoid immunoassay cutoff concentration from 100 to 50 micrograms/L resulted in detection of a substantial number of additional true-positive specimens, with an accompanying small increase in unconfirmed positive results.

Status of drugs-of-abuse testing in urine under blind conditions: an AACC study.

1989 ◽  
Vol 35 (5) ◽  
pp. 891-894 ◽  
Author(s):  
C S Frings ◽  
D J Battaglia ◽  
R M White
Keyword(s):  
Quality Assurance ◽  
Drug Testing ◽  
Drugs Of Abuse ◽  
The United States ◽  
Accuracy Rate ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Chain Of Custody ◽  
A Chain ◽  
Positive Results

Abstract We report results of a blind study designed to determine the accuracy of drugs-of-abuse testing in urine as done in 31 laboratories across the United States. The drugs studied were amphetamines, cannabinoids, cocaine, opiates, and phencyclidine. These laboratories confirmed all positive drug results with a different analytical method. Ten urine samples were sent to each laboratory, which resulted in 1486 trials. There were no false-positive results. The overall accuracy rate was 97%. Our study demonstrates that urine drug testing can be accurate when performed by qualified staff, using up-to-date screening and confirmation methods, appropriate quality-assurance measures, and a chain of custody.

scholarly journals Fingerstick Plasma Drug Testing of Chronic Pain Patients: Comparison of Paired Fingerstick Plasma and Urine Specimens

2020 ◽  
Vol 5 (1) ◽  
pp. 5-10
Author(s):  
MP George ◽  
◽  
Roza George ◽  
Jessica Almonds ◽  
◽  
...  
Keyword(s):  
Drug Testing ◽  
Addiction Treatment ◽  
Illicit Drugs ◽  
Complete Agreement ◽  
Current Standard ◽  
Perfect Agreement ◽  
Limit Of Quantitation ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Urine Specimens

Aim A clinical study was conducted to evaluate fingerstick blood as a viable biological matrix for monitoring prescription and illicit drugs in a clinical setting on patients undergoing pain and addiction treatment. The current standard for monitoring patients’ medication use, misuse, and diversion is urine drug testing (UDT). Materials and Methods This study compared 632 paired urine and fingerstick blood specimens collected at three pain management clinics and one suboxone clinic for 35 drugs and/or metabolites. Plasma from the fingerstick blood was used for the analysis. The urine and plasma specimens were analyzed by validated liquid chromatography–tandem mass spectrometry (LC-MS-MS) procedures. The urine cutoff used by most pain testing laboratories were used to identify positive and negative drugs in urine. Limit of quantitation was used to identify positive and negative drugs in plasma. Drugs and/or metabolites were quantified in both urine and plasma using deuterium-labeled internal standards. Results Results were tabulated for urine and plasma specimens for data analysis. The results showed that 8.7% of plasma specimens detected more drugs compared to the corresponding urine specimens, and 2.2% of the urine specimens detected a drug that was negative in the corresponding plasma specimen. Overall 89.1% of the specimens had complete agreement between urine and plasma specimens for detection. The observed Cohen’s Kappa value for overall drug detection was 0.96 an “almost perfect” agreement as characterized by Landis and Koch. Conclusion Based on the observed data, the authors conclude that plasma collected from fingerstick blood is a better matrix to monitor patients currently prescribed pain medications or patients currently undergoing medication-assisted opioid treatment compared to urine drug testing.

scholarly journals Reducing Opioid Analgesic Deaths in America: What Health Providers Can Do

2015 ◽  
Vol 3;18 (3;5) ◽  
pp. E307-E322 ◽  
Author(s):  
Taghogho Agarin
Keyword(s):  
Health Care Providers ◽  
Associated Factors ◽  
Drug Testing ◽  
Opioid Analgesic ◽  
Health Providers ◽  
Care Providers ◽  
Chronic Noncancer Pain ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
High Doses

Background: Available data have shown steady increases of drug overdose deaths between 1992 and 2011. We review evidenced-based recommendations provided by a few prominent North American pain societies and suggest ways on how health providers might help reduce opioid analgesic deaths by implementing these practices. Objective: To identify health care providers’ roles in reducing opioid analgesic deaths. Study Design: A comprehensive review of current literature. Methods: The review included relevant literature identified through searches of MEDLINE, Cochran reviews, and Google Scholar, PubMed and EMBASE from January 1998 to January 2014. The level of evidence was classified as I (good), II (fair), and III (limited) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Results: Several practices such as too high doses overall, giving too high doses to opioid naive patients, too fast opioid titration, insufficient use and knowledge of urine drug testing, not updating knowledge of drug metabolism/interactions, and inadequate patient monitoring are associated with higher risks of opioid analgesic deaths. Suboptimal risk stratification of patients, rotation practices, and use of opioids analgesics in chronic noncancer pain are also associated factors. Limitations: There were a paucity of good evidence studies which show recommendations reduce death. Conclusion: Providers should be aware of all associated factors with opiate analgesic deaths and apply the available evidence in reducing opioid analgesic deaths. Key words: Opioid analgesic deaths, methadone deaths, opioid mortality, opioid guidelines, genetic testing for opioids, urine drug testing

Analytical and technical aspects of testing for drug abuse: confirmatory procedures.

1988 ◽  
Vol 34 (3) ◽  
pp. 471-473 ◽  
Author(s):  
M A Peat
Keyword(s):  
Drug Testing ◽  
Analytical Procedure ◽  
Gas Chromatography Mass Spectrometry ◽  
Technical Aspects ◽  
Governmental Agencies ◽  
Accuracy And Precision ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Chemical Technique ◽  
Layer Chromatography

Abstract Many laboratories are now performing urine drug testing for employers, governmental agencies, and other institutions. It is now recognized that presumptive positive screening results have to be confirmed by an analytical procedure based on a different chemical technique with greater than or equal sensitivity to the screening test. Thin-layer chromatography has been widely used for this; however, it is relatively insensitive for certain drugs, and it cannot satisfy the accuracy and precision requirements needed to determine threshold concentrations reliably. Gas chromatography-mass spectrometry is able to satisfy these threshold requirements and has become the method of choice for confirming initial immunoassay results.

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