592
Views
12
CrossRef citations to date
0
Altmetric
Review Article

Urine and oral fluid drug testing in support of pain management

, &
Pages 433-445 | Received 14 Jun 2017, Accepted 24 Sep 2017, Published online: 09 Oct 2017

References

  • National Institutes Of Health [Internet]. Pathways to prevention workshop: the role of opioids in the treatment of chronic pain; 2014 [cited 2017 May 19]. Available from: https://prevention.nih.gov/docs/programs/p2p/ODPPainPanelStatementFinal_10-02-14.pdf
  • Paulozzi L, Jones C, Mack K, et al. Vital signs: overdoses of prescription opioid pain relievers-United States, 1999-2008. MMWR Morb Mortal Wkly Rep. 2011;60:1487–1492.
  • Chang H, Daubresse M, Kruszewski S, et al. Prevalence and treatment of pain in emergency departments in the United States, 2000 to 2010. Am J Emerg Med. 2014;32:421–431.
  • Volkow ND, McLellan TA, Cotto JH, et al. Characteristics of opioid prescriptions in 2009. JAMA. 2011;305:1299–1301.
  • Rudd R, Aleshire N, Zibbell J, et al. Increases in drug and opioid overdose Deaths-United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016;64:1378–1382.
  • Rudd R, Seth P, David F, et al. Increases in drug and opioid-involved overdose deaths – United States, 2010–2015. Mmwr Morb Mortal Wkly Rep. 2016;65:1445–1452.
  • The National Academy of Clinical Biochemistry Laboratory [Internet]. Medicine practice guidelines: using clinical laboratory tests to monitor drug therapy in pain management patients; 2014 [cited 2017 May 19]. Available from: https://www.aacc.org/∼/media/practice-guidelines/pain-management/rough-draft-pain-management-lmpg-v6aacc.pdf?la=en)
  • VA/DoD clinical practice guideline for the management of opioid therapy for chronic pain version 3.0 [Internet]; 2017 [cited 2017 May 19]. Available from: https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOTCPGProviderSummary022817.pdf
  • 2017 Canadian guideline for opioids for chronic non-cancer pain [Internet]. [cited 2017 May 19]. Available from: http://nationalpaincentre.mcmaster.ca/documents/Opioid%20GL%20for%20CMAJ_01may2017.pdf
  • Wisconsin Medical Examining Board [Internet]. Opioid prescribing guideline-July 10; 2016 [cited 2017 May 19]. Available from: https://wisconsinhealthnews.com/wp-content/uploads/2016/11/20161116
  • Washington State interagency guideline on prescribing opioids for pain [Internet]. 3rd ed. 2015 [cited 2017 May 19]. Available from: http://www.agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf
  • (a) The ASAM appropriate use of drug testing in clinical addiction medicine; 2017 (accessed 6/114/2017). Available from: https://www.asam.org/quality-practice/guidelines-and-consensus-documents/drug-testing-appropriateness (b) Jarvis M, William J, Harford M, et al. Appropriate use of drug testing in clinical addiction medicine. J Addict Med. 2017;11:163–173.
  • Manchikanti L, Abdi S, Atluri S, et al. American society of interventional pain physicians (asipp) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2–guidance. Pain Physician. 2012;15:S67–S116.
  • Utah Department of Health [Internet]. Utah clinical guidelines on prescribing opioids for treatment of pain. Utah Department of Health; 2009 [cited 2017 May 19]. Available from: http://www.health.utah.gov/prescription/pdf/guidelines/final.04.09opioidGuidlines.pdf
  • APS-AAPM clinical guidelines for the use of chronic opioid herapy in chronic noncancer pain 2009; ASIPP guideline: opioids in the management of chronic non-cancer pain — an update of American Society of the Interventional Pain Physicians’ Guidelines; clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10:113–130.
  • Dowell D, Haegerich T, Chou R. CDC guideline for prescribing opioids for chronic pain – United States. 2016. Morb Mortal Wkly Rep. 2016;65(1):1–49.
  • Turner JA, Saunders K, Shortreed SM, et al. Chronic opioid therapy urine drug testing in primary care: prevalence and predictors of aberrant results. J Gen Intern Med. 2014;29:1663–1671.
  • Michna E, Jamison R, Pham L, et al. Urine toxicology screening among chronic pain patients on opioid therapy: frequency and predictability of abnormal findings. Clin J Pain. 2007;23:173–179.
  • Couto J, Romney M, Leider H, et al. High rates of inappropriate drug use in the chronic pain population. Popul Health Manag. 2009;12:185–190.
  • Reisfield G, Berthof R, Barkin R, et al. Urine drug test interpretation: what do physicians know? J Opioid Manag. 2007;3:80–86.
  • Reisfield G, Webb F, Bertholf R, et al. Family physicians’ proficiency in urine drug testing interpretation. J Opioid Management. 2007;6:333–337.
  • Starrels J, Fox A, Kunins H. They don't know what they don't know: internal medicine residents' knowledge and confidence in urine drug test interpretation for patients with chronic pain. J Gen Intern Med. 2012;27:1521–1527.
  • Melanson S, Baskin L, Magnani BJ, et al. Interpretation and utility of drug abuse immunoassays: lessons from laboratory drug testing surveys. Arch Pathol Lab Med. 2010;134:735–739.
  • Moeller KE, Kissack JC, Atayee RS, et al. Clinical interpretation of urine drug tests: what clinicians need to know about urine drug screens. Mayo Clin Proc. 2017;92:774–796.
  • Kwong TC, Magnani BJ. Urine drug testing in opioid therapy for chronic pain management. In: Kwong T, Magnani B, Rosano T, editors. The clinical toxicology laboratory. 2nd ed. Washington (DC): AACC Press; 2013. p. 447–457.
  • Pesce A, West C, Egan City K, et al. Interpretation of urine drug testing in pain patients. Pain Med. 2012;13:868–885.
  • Kwong TC, Dasgupta A, Magnani BJ, et al. Drug screening by immunoassays. In: Kwong T, Magnani B, Rosano T, editors. The clinical toxicology laboratory. 2nd ed. Washington (DC): AACC Press; 2013. p. 411–422.
  • Saitman A, Park H-D, Fitzgerald RL. False-positive interferences of common urine drug screen immunoassays: a review. J Anal Toxicol. 2014;38:387–396.
  • Mikel C, Almazan P, West R, et al. LC-MS/MS extends the range of drug analysis in pain patients. Ther Drug Monit. 2009;31:746–748.
  • Crews B, Mikel C, Latyshev S, et al. 6-acetylmorphine detected in the absence of morphine in pain management patients. Ther Drug Monit. 2009;31:749–752.
  • Knight J, Puet BL, DePriest A, et al. Prevalence of heroin markers in urine for pain management patients. Forensic Sci Int. 2014;243:79–83.
  • Mikel C, Pesce AJ, Rosenthal M, et al. Therapeutic monitoring of benzodiazepines in the management of pain: current limitations of point of care immunoassays suggest testing by mass spectrometry to assure accuracy and improve patient safety. Clin Chim Acta. 2012;413:1199–1202.
  • Darragh A, Snyder ML, Ptolemy AS, et al. KIMS, CEDIA, and HS-CEDIA immunoassays are inadequately sensitive for detection of benzodiazepines in urine from patients treated for chronic pain. Pain Physician. 2014;17:359–366.
  • West R, Pesce A, West C, et al. Comparison of clonazepam compliance by measurement of urinary concentration by immunoassay and LC-MS/MS in pain management population. Pain Physician. 2010;13:71–78.
  • Pyle-Eilola AL, Thornton DJ, Hays HL, et al. Is this drug screen really negative? Special investigation of drug screening in pediatrics. J Appl Lab Med. 2017;1:437–440.
  • Wingert WE. Lowering cutoffs for initial and definitive testing for cocaine and marijuana: large-scale study of effects on the rates of drug-positive results. Clin Chem. 1997;43:100–103.
  • Hattab E, Goldberger B, Johannsen L, et al. Modification of screening immunoassays to detect sub-threshold concentrations of cocaine, cannabinoids, and opiates in urine: use for detecting maternal and neonatal drug exposures. Ann Clin Lab Sci. 2000;30:85–91.
  • Luzzi VI, Saunders AN, Koenig JW, et al. Analytic performance of immunoassays for drugs of abuse below established cutoff values. Clin Chem. 2004;50:717–722.
  • Pesce A, Rosenthal M, West R, et al. An evaluation of the diagnostic accuracy of liquid chromatography-tandem mass spectrometry versus immunoassay drug testing in pain patients. Pain Physician. 2010;13:273–281.
  • Cone EJ, Caplan YH, Moser F, et al. Evidence that morphine is metabolized to hydromorphone but not to oxymorphone. J Anal Toxicol. 2008;32:319–323.
  • Wasan AD, Michna E, Janfaza D, et al. Interpreting urine drug tests: prevalence of morphine metabolism to hydromorphone in chronic pain patients treated with morphine. Pain Med. 2008;9:918–923.
  • Reisfield GM, Chronister CW, Goldberger BA, et al. Unexpected urine drug testing results in a hospice patient on high-dose morphine therapy. Clin Chem. 2009;55:1765–1769.
  • Haddox JD, Kupper RJ, Cone EJ. Clinical considerations for interpretation of unexpected results from urine drug testing. Paper presented at: The 27th Annual Meeting of the American Academy of Pain Medicine; 2011 Mar 24–27; Washington (DC).
  • West R, West C, Crews B, et al. Anomalous observations of hydrocodone in patients on oxycodone. Clin Chim Acta. 2011;412:29–32.
  • West R, Crews B, Mikel C, et al. Anomalous observations of codeine in patients on morphine. Ther Drug Monit. 2009;31:776–778.
  • Nafziger AN, Bertino JS. Utility and application of urine drug testing in chronic pain management with opioids. Clin J Pain. 2009;25:73–79.
  • Marin SJ, Roberts M, Wood M, et al. Sensitive UPLC-MS-MS assay for 21 benzodiazepine drugs and metabolites, zolpidem and zopiclone in serum or plasma. J Anal Toxicol. 2012;36:472–476.
  • Marin SJ, Hughes JM, Lawlor BG, et al. Rapid screening for 67 drugs and metabolites in serum or plasma by accurate-mass LC-TOF-MS. J Anal Toxicol. 2012;36:477–486.
  • Crews BO, Pesce AJ, West R, et al. Evaluation of high-resolution mass spectrometry for urine toxicology screening in a pain management setting. J Anal Toxicol. 2012;36:601–607.
  • Henry H, Sobhi HR, Scheibner O, et al. Comparison between a high-resolution single-stage Orbitrap and a triple quadrupole mass spectrometer for quantitative analyses of drugs. Rapid Commun Mass Spectrom. 2012;26:499–509.
  • Tsai IL, Weng TI, Tseng YJ, et al. Screening and definitive of 62 drugs of abuse and metabolites in urine by ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry. J. Analytical Toxicol. 2013;37:642–651.
  • Marin SJ, Sawyer JC, He X, et al. Comparison of drug detection by three quadrupole time-of-flight mass spectrometry platforms. J Anal Toxicol. 2014;39:89–95.
  • Melanson SEF, Ptolemy AS, Wasan AD. Optimizing urine drug testing for monitoring medication compliance in pain management. Pain Med. 2013;14:1813–1820.
  • McMillin GA, Marin SJ, Johnson-Davis, et al. A hybrid approach to urine drug testing using high-resolution mass spectrometry and select immunoassays. Am J Clin Pathol. 2015;143:234–240.
  • Langman LJ, Korman E, Stauble ME, et al. Therapeutic monitoring of opioids: a sensitive LC-MS/MS method for quantitation of several opioids including hydrocodone and its metabolites. Ther Drug Monit. 2013;35:352–359.
  • Deer TR, Gunn J. Blood testing in chronic pain management. Pain Physician. 2015;18:E157–E161.
  • Reisfield GM, Salazar E, Berthold RL. Rational use and interpretation of urine drug testing in chronic opioid therapy. Ann Clin Lab Sci. 2007;37:301–314.
  • Couto JE, Webster L, Romney MC, et al. Use of an algorithm applied to urine drug screening to assess adherence to an oxycontin regimen. J Opioid Manag. 2009;5:359–364.
  • MacCall CA, Ritchie G, Sood M. Oral fluid testing as an alternative to urine testing for drugs of abuse in inpatient forensic settings: giving patient’s choice. Scott Med J. 2013;58:99–103.
  • Kunkel F, Fey E, Borg D, et al. Assessment of the use of oral fluid as a matrix for drug monitoring in patients undergoing treatment for opioid addiction. J Opioid Manag. 2015;11:435–442.
  • Moy KV, Ma JD, Morello CM, et al. Monitoring oxycodone use in patients with chronic pain: analysis of oxycodone and metabolite excretion in saliva and urine. J Opioid Manag. 2014;10:47–56.
  • Moore C, Kelley-Baker T, Lacey J. Interpretation of oxycodone concentrations in oral fluid. J Opioid Manag. 2012;8:161–166.
  • Ardakani YH, Rouini MR. Pharmacokinetic study of tramadol and its three metabolites in plasma, saliva and urine. DARU. 2009;17:245–255.
  • Cone EJ, DePriest AZ, Heltsley R, et al. Prescription opioids. IV: disposition of hydrocodone in oral fluid and blood following single-dose administration. J Anal Toxicol. 2015;39:510–518.
  • Concheiro M, Jones HE, Johnson RE. Preliminary buprenorphine sublingual tablet pharmacokinetic data in plasma, oral fluid and sweat during treatment of opioid-dependent pregnant women. Ther Drug Monit. 2011;33:619–626.
  • Hsu YC, Chen BG, Yang SC, et al. Methadone concentrations in blood, plasma, and oral fluid determined by isotope-dilution gas chromatography–mass spectrometry. Anal Bioanal Chem. 2013;405:3921–3928.
  • Bista SR, Haywood A, Norris R, et al. Saliva versus plasma for pharmacokinetic and pharmacodynamics studies of fentanyl in patients with cancer. Clin Ther. 2015;37:2468–2475.
  • Toennes SW, Kauert GF, Steinmeyer S, et al. Driving under the influence of drugs – evaluation of analytical data of drugs in oral fluid, serum and urine, and correlation with impairment symptoms. Forens Sci Int. 2005;152:149–155.
  • Jang M, Chang H, Yang W, et al. Development of an LC-MS/MS method for the simultaneous determination of 25 benzodiazepines and zolpidem in oral fluid and its application to authentic samples from regular drug users. J Pharm Biomed Anal. 2013;74:213–222.
  • Heltsley R, DePriest A, Black DL, et al. Oral fluid drug testing of chronic pain patients. I. Positive prevalence rates of licit and illicit drugs. J Anal Toxicol. 2011;35:529–540.
  • Heltsley R, DePriest A, Black DL, et al. Oral fluid drug testing of chronic pain patients. II. Comparison of paired oral fluid and urine specimens. J Anal Toxicol. 2012;36:75–80.
  • Conermann T, Gosalia AR, Kabazie AJ, et al. Utility of oral fluid in compliance monitoring of opioid medications. Pain Physician. 2014;17:63–70.
  • Moore C. Oral fluid for workplace drug testing: laboratory implementation. Drug Test Anal. 2012;4:89–93.
  • DePriest AZ, Black DL, Robert TA. Immunoassay in healthcare testing applications. J Opioid Manag. 2015;11:13–25.
  • Melanson SE, Griggs D, Bixho I, et al. 7-aminoclonazepam is superior to clonazepam for detection of clonazepam use in oral fluid by LC-MS/MS. Clin Chim Acta. 2016;455:128–133.
  • Vindenes V, Strand DH, Koksaeter P, et al. Detection of nitrobenzodiazepines and their 7-amino metabolites in oral fluid. J Anal Toxicol. 2016;40:310–312.
  • Moore C, Rana S, Coulter C. Determination of meperidine, tramadol and oxycodone in human oral fluid using solid phase extraction and gas chromatography-mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2007;850:370–375.
  • Enders JR, McIntire GL. A dilute-and-shoot LC-MS method for quantitating opioids in oral fluid. J Anal Toxicol. 2015;39:662–667.
  • Badawi N, Simonsen KW, Steentoft A, et al. Simultaneous screening and quantification of 29 drugs of abuse in oral fluid by solid-phase extraction and ultra-performance LC-MS/MS. Clin Chem. 2009;55:2004–2018.
  • Concheiro M, Gray TR, Shakleya DM, et al. High-throughput simultaneous analysis of buprenorphine, methadone, cocaine, opiates, nicotine, and metabolites in oral fluid by liquid chromatography tandem mass spectrometry. Anal Bioanal Chem. 2010;398:915–924.
  • Tuyay J, Coulter C, Rodrigues W, et al. Disposition of opioids in oral fluid: importance of chromatography and mass spectral transitions in LC-MS/MS. Drug Test Anal. 2012;4:395–401.
  • Mortier KA, Maudens KE, Lambert WE, et al. Simultaneous, quantitative determination of opiates, amphetamines, cocaine and benzoylecgonine in oral fluid by liquid chromatography quadrupole-time-of-flight mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2002;779:321–330.
  • Patsalos PN, Berry DJ. Therapeutic drug monitoring of antiepileptic drugs by use of saliva. Ther Drug Monit. 2013;35:4–29.
  • Ghareeb M, Akhlaghi F. Development and validation of a sensitive and selective LC-MS/MS method for determination of tacrolimus in oral fluids. J Chromatogr B Analyt Technol Biomed Life Sci. 2016;1038:136–141.
  • Coulter C, Garnier M, Tuyay J, et al. Determination of carisoprodol and meprobamate in oral fluid. J Anal Toxicol. 2012;36:217–220.
  • Heiskanen T, Langel K, Gunnar T, et al. Opioid concentrations in oral fluid and plasma in cancer patients with pain. J Pain Symptom Manage. 2015;50:524–532.
  • Kim I, Barnes AJ, Oyler JM, et al. Plasma and oral fluid pharmacokinetics and pharmacodynamics after oral codeine administration. Clin Chem. 2002;48:1486–1496.
  • Gjerde H, Langel K, Favretto D, et al. Detection of 4 benzodiazepines in oral fluid as biomarker for presence in blood. Ther Drug Monit. 2014;36:252–256.
  • Gjerde H, Mordal J, Christophersen AS, et al. Comparison of drug concentrations in blood and oral fluid collected with the Intercept sampling device. J Anal Toxicol. 2010;34:204–209.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.