MAY 28, 2014 10:30 AM PDT

Monitoring drugs and medications in pain and addiction patients

Speaker
  • Biography
      Amadeo J. Pesce received his BS in Biology from MIT, his Ph.D. from Brandeis University and was an NIH postdoctoral fellow in Biophysics at the University of Illinois at Urbana IL. He trained in Clinical Chemistry with Dr. Samuel Natelson at Michael Reese Hospital in Chicago. Starting in 1973, he served as a faculty member at the University of Cincinnati rising to the rank of Professor in the Department of Pathology and Laboratory Medicine and retiring as Professor Emeritus in 2006. He was Associate Director and then Director of the Toxicology Laboratory of University Hospital in Cincinnati from 1974 to 1997. He was acting Laboratory Director of Adams County Hospital and Drake Center from 1999 to 2006.  In 2007 he started with Millennium Laboratories of California as Laboratory Director. He was appointed as Adjunct Professor of Pathology and Laboratory Medicine at the UCSD School of Medicine in 2007. He became a Principal Investigator of the Millennium Research Institute in 2010. Dr. Pesce became NRCC qualified Clinical Chemist in 1971 and DABCC certified in 1972,. Dr. Pesce has served on the American Board of Clinical Chemistry, the certifying agency for Clinical Chemists Dr. Pesce is Co-Editor of Clinical Chemistry: Theory Analysis and Correlation now in its 5th Edition. He has written or co-edited 30 other books in clinical chemistry. He has written or co-authored more than 220 peer reviewed papers in the area of clinical chemistry. His awards include: Established Investigator, American Heart Association New York; Bernard J. Katchman Award from OVS-AACC; Alvin Dubin Award from National Academy of Clinical Biochemistry; Reggie Brockman Service Award Kidney Foundation of Greater Cincinnati Dr. Pesce has served as the Laboratory Director of Millennium Laboratories since 2008. The laboratorys focus has been on providing drug and medication testing for physicians providing pain management and addiction treatments.

    Abstract

    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.


    Objectives
    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


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