scholarly journals Diagnostic Accuracy and Interpretation of Urine Drug Testing for Pain Patients: An Evidence-Based Approach

10.5772/16692 ◽  
2012 ◽  
Author(s):  
Amadeo Pesce ◽  
Cameron West ◽  
Kathy Egan-City ◽  
William Clarke
Keyword(s):  
Diagnostic Accuracy ◽  
Drug Testing ◽  
Evidence Based ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Pain Patients

scholarly journals Urine Drug Testing of Chronic Pain Patients. II. Prevalence Patterns of Prescription Opiates and Metabolites

2010 ◽  
Vol 34 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Rebecca Heltsley ◽  
Anne Zichterman ◽  
David L. Black ◽  
Beverly Cawthon ◽  
Tim Robert ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Drug Testing ◽  
Chronic Pain Patients ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Pain Patients

scholarly journals Urine Drug Testing of Chronic Pain Patients. IV. Prevalence of Gabapentin and Pregabalin

2011 ◽  
Vol 35 (6) ◽  
pp. 357-359 ◽  
Author(s):  
Rebecca Heltsley ◽  
Anne DePriest ◽  
David L. Black ◽  
Tim Robert ◽  
Yale H. Caplan ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Drug Testing ◽  
Chronic Pain Patients ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Pain Patients

scholarly journals Urine Drug Testing of Chronic Pain Patients. III. Normetabolites as Biomarkers of Synthetic Opioid Use

2010 ◽  
Vol 34 (8) ◽  
pp. 444-449 ◽  
Author(s):  
A. DePriest ◽  
R. Heltsley ◽  
D. L. Black ◽  
B. Cawthon ◽  
T. Robert ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Drug Testing ◽  
Opioid Use ◽  
Chronic Pain Patients ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Pain Patients

The need for evidence based urine drug testing protocols to improve outcomes

Pain Practice ◽  
2021 ◽  
Author(s):  
Thomas Cheriyan ◽  
Srinand Mandyam ◽  
Amit Patel ◽  
Chhaya Patel ◽  
Sean Rosario ◽  
...  
Keyword(s):  
Drug Testing ◽  
Evidence Based ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Testing Protocols

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

scholarly journals Protocol for Accuracy of Point of Care (POC) or In-Office Urine Drug Testing (Immunoassay) in Chronic Pain Patients: A Prospective Analysis of Immunoassay and Liquid Chromatography Tandem Mass Spectometry (LC/MS/MS)

2010 ◽  
Vol 1;13 (1;1) ◽  
pp. E1-E22
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Diagnostic Accuracy ◽  
Prescription Drugs ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Point Of Care ◽  
Diagnostic Accuracy Study ◽  
Controlled Substances ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Accuracy Study

Background: Therapeutic use, overuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain continues to be an issue for physicians and patients. It has been stated that physicians, along with the public and federal, state, and local government; professional associations; and pharmaceutical companies all share responsibility for preventing abuse of controlled prescription drugs. The challenge is to eliminate or significantly curtail abuse of controlled prescription drugs while still assuring the proper treatment of those patients. A number of techniques, instruments, and tools have been described to monitor controlled substance use and abuse. Thus, multiple techniques and tools available for adherence monitoring include urine drug testing in conjunction with prescription monitoring programs and other screening tests. However, urine drug testing is associated with multiple methodological flaws. Multiple authors have provided conflicting results in relation to diagnostic accuracy with differing opinions about how to monitor adherence in a non-systematic fashion. Thus far, there have not been any studies systematically assessing the diagnostic accuracy of immunoassay with laboratory testing. Study Design: A diagnostic accuracy study of urine drug testing. Study Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objective: To compare the information obtained by point of care (POC) or in-office urine drug testing (index test) to the information found when all drugs and analytes are tested by liquid chromatography tandem mass spectroscopy (LC/MS/MS) reference test in the same urine sample. Methods: The study is designed to include 1,000 patients with chronic pain receiving controlled substances. The primary outcome measure is the diagnostic accuracy. Patients will be tested for various controlled substances, including opioids, benzodiazepines, and illicit drugs. The diagnostic accuracy study is performed utilizing the Standards for Reporting of Diagnostic Accuracy Studies (STARD) initiative which established reporting guidelines for diagnostic accuracy studies to improve the quality of reporting. The prototypical flow diagram of diagnostic accuracy study as described by STARD will be utilized. Results: Results of diagnostic accuracy and correlation of clinical factors in relation to threshold levels, prevalence of abuse, false-positives, false-negatives, influence of other drugs, and demographic characteristics will be calculated. Limitations: The limitations include lack of availability of POC testing with lower cutoff levels. Conclusion: This article presents a protocol for a diagnostic accuracy study of urine drug testing. The protocol also will permit correlation of various clinical factors in relation to threshold levels, prevalence of abuse, false-positives, false-negatives, influence of other drugs, and demographic characteristics. Clinical Trial Registration: NCT 01052155 Key words: Controlled substances, opioids, benzodiazepines, illicit drugs, abuse, diversion, adherence monitoring, prescription monitoring programs

scholarly journals Illicit Drug Use in the Pain Patient Population Decreases with Continued Drug Testing

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. 189-193 ◽  
Author(s):  
Amadeo Pesce
Keyword(s):  
Drug Use ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Pain Patient ◽  
Spearman Correlation ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Pain Patients

Background: A major concern of physicians treating pain patients with chronic opioid therapy and similar drugs is determining whether the patients are also using illicit drugs. This is commonly determined by urine drug testing (UDT). However, there are few studies on whether or not monitoring patients by this technique decreases illicit drug use. Objective: To determine if the presence of illicit drugs decreases over a number of physician visits where UDT was performed. Method: The method involved a retrospective study of tests for the illicit drugs marijuana, cocaine, methamphetamine, ecstacy (MDMA) phencyclidine (PCP) and the heroin metabolite, 6-acetylmorphine as confirmed by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). A database of 150,000 patient visits was examined for the presence of any of these 6 drugs. Results: A total of 87,000 patients were initially tested. The number of patients who were repeatedly tested decreased over time. The percentage of patients positive for any of these illicit drugs decreased from 23% to 9% after 14 visits where UDT was performed. When graphed there was a trend to decreasing use. The Spearman correlation = -0.88, P < 0.0001. The major illicit drug was marijuana. When this was removed from the analysis, there was an even greater correlation with decreased illicit drug use. Spearman correlation = -0.92 (P < 0.0001) using a weighted correlation. Limitation: Patients continuing to use illicit drugs might be dismissed from practices thus biasing the study towards illicit drug avoidance. Conclusion: Continued UDT might decrease illicit drug use among pain patients. Key words: Pain patients, UDT, urine drug testing, LC-MS/MS, illicit drugs, decrease drug use

scholarly journals Urine Drug Testing of Chronic Pain Patients: Licit and Illicit Drug Patterns

2008 ◽  
Vol 32 (8) ◽  
pp. 530-543 ◽  
Author(s):  
E. J. Cone ◽  
Y. H. Caplan ◽  
D. L. Black ◽  
T. Robert ◽  
F. Moser
Keyword(s):  
Chronic Pain ◽  
Drug Testing ◽  
Illicit Drug ◽  
Chronic Pain Patients ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Pain Patients

scholarly journals Interpretation of Urine Drug Testing in Pain Patients

Pain Medicine ◽  
2012 ◽  
Vol 13 (7) ◽  
pp. 868-885 ◽  
Author(s):  
Amadeo Pesce ◽  
Cameron West ◽  
Kathy Egan City ◽  
Jennifer Strickland
Keyword(s):  
Drug Testing ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Pain Patients
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