Guidelines for physicians treating pain patients with chronic opioid therapy recommend the patients be monitored for the presence of their prescribed medications. In addition, it is often recommended that these patients be monitored for the possible presence of non-prescribed medications and drugs. Monitoring patients with substance abuse issues requires a similar testing menu that includes a wide spectrum of prescription medications and illicit agents. Analytical considerations in drug testing are important for health care providers to understand for optimal clinical decision-making. Point of care devices based on immunoassay principles have gained popularity for this type of testing. However, all immunoassays have limited ability to provide the required analytical sensitivity and specificity required for the clinician to make an accurate clinical assessment. Furthermore, the test menus are limited and do not include newer medications. Finally, immunoassay tests are readily deceived by the addition of small amounts of the medication tablet. The current method of choice for providing such testing is liquid chromatography tandem mass spectrometry. Because of its sensitivity and specificity for many drugs, testing can be performed with little sample preparation. Of additional benefit, it is possible to adjust cutoffs to meet clinical needs. Historically urine has been the fluid of choice for drug testing, but oral fluid is being used more frequently as it is an easily obtained witnessed collection. Interpretation of drug testing results should include quantitative evaluation of the inactive as well as the active metabolites of the administered medication.
1. Understand why patients on chronic opioid therapy are monitored.
2. Be able to describe the range of drugs encountered
3. Be able to discuss the differnces in specificity betweem immunoassays and mass spectrometry ones
4. Bio, title, BioBe able to describe the detection of drugs in urine and oral fluid