Choosing the right laboratory: A review of clinical and forensic toxicology services for urine drug testing in pain management

Authors

  • Gary M. Reisfield, MD
  • Bruce A. Goldberger, PhD
  • Roger L. Bertholf, PhD

DOI:

https://doi.org/10.5055/jom.2015.0250

Keywords:

urine drug testing, clinical laboratory, forensic laboratory, forensic toxicology, pain management, opioid therapy, accreditation, certification, point-of-care testing, immunoassay, drugs of abuse in urine, drug screening, confirmation

Abstract

Urine drug testing (UDT) services are provided by a variety of clinical, forensic, and reference/specialty laboratories. These UDT services differ based on the principal activity of the laboratory. Clinical laboratories provide testing primarily focused on medical care (eg, emergency care, inpatients, and outpatient clinics), whereas forensic laboratories perform toxicology tests related to postmortem and criminal investigations, and drug-free workplace programs. Some laboratories now provide UDT specifically designed for monitoring patients on chronic opioid therapy. Accreditation programs for clinical laboratories have existed for nearly half a century, and a federal certification program for drug-testing laboratories was established in the 1980s. Standards of practice for forensic toxicology services other than workplace drug testing have been established in recent years. However, no accreditation program currently exists for UDT in pain management, and this review considers several aspects of laboratory accreditation and certification relevant to toxicology services, with the intention to provide guidance to clinicians in their selection of the appropriate laboratory for UDT surveillance of their patients on opioid therapy.

Author Biographies

Gary M. Reisfield, MD

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.

Bruce A. Goldberger, PhD

Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida.

Roger L. Bertholf, PhD

Department of Pathology, University of Florida Health Science Center, Jacksonville, Florida.

References

Substance Abuse and Mental Health Services Administration: Results from the 2011 National Survey on Drug Use and Health: Summary of national findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. Accessed at www.samhsa.gov/data/nsduh/2k11results/nsduhresults2011.htm. Accessed September 8, 2014.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies: Treatment Episode Data Set (TEDS): 1997-2007. National admissions to substance abuse treatment services, DASIS Series: S-47, DHHS Publication No. (SMA) 09-4379, Rockville, MD. Available at www.samhsa.gov/data/2k13/TEDS2011/TEDS2011N.pdf. Accessed September 8, 2014.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies: The DAWN Report: Trends in Emergency Department Visits Involving Nonmedical Use of Narcotic Pain Relievers. Rockville, MD, June 18, 2010. Available at www.samhsa.gov/data/2k10/dawn016/opioided.htm. Accessed September 8, 2014.

Warner M, Chen LH, Makuc DM, et al.: Drug poisoning deaths in the United States, 1980-2008. NCHS data brief, no 81. Hyattsville, MD: National Center for Health Statistics, 2011. Available at www.cdc.gov/nchs/data/databriefs/db81.htm. Accessed September 8, 2014.

Jones CM, Mack KA, Paulozzi LJ: Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013;309:657-659.

Katz N, Fanciullo GJ. Role of urine toxicology testing in the management of chronic opioid therapy. Clin J Pain 2002;18(4 Suppl):S76-82.

Michna E, Jamison RN, Pham LD, Ross EL, Janfaza D, Nedeljkovic SS, Narang S, Palombi D, Wasan AD. Urine toxicology screening among chronic pain patients on opioid therapy: frequency and predictability of abnormal findings. Clin J Pain 2007;23(2):173-9.

Ives TJ, Chelminski PR, Hammett-Stabler CA, Malone RM, Perhac JS, Potisek NM, Shilliday BB, DeWalt DA, Pignone MP. Predictors of opioid misuse in patients with chronic pain: a prospective cohort study. BMC Health Serv Res. 2006;6:46.

Turner JA, Saunders K, Shortreed SM, et al.: Chronic opioid therapy risk reduction initiative: Impact on urine drug testing rates and results. J Gen Intern Med. 2013; 29: 305-311.

Collen M. Profit-driven drug testing. J Pain Palliat Care Pharmacother 2012;26(1):13-7.

Reisfield GM, Bertholf RL, Barkin RL, Webb FJ, Wilson GR. Physicians' interpretative knowledge of urine drug tests. J Opioid Manag 2007;3(2):80-8.

Reisfield GM, Webb FJ, Bertholf, RL, et al.: Family physicians' proficiency in urine drug test interpretation. J Opioid Manag. 2007; 3(6): 333-337.

Starrels JL, Wu B, Peyser D, Fox AD, Batchelder A, Barg FK, Arnsten JH, Cunningham CO. It made my life a little easier: Primary care providers' beliefs and attitudes about using opioid treatment agreements. J Opioid Manag. 2014; 10(2): 95-102.

CDC grand rounds: prescription drug overdoses – A U.S. Epidemic. Morbidity and Mortality Weekly Report. 2011; 60: 1487-1492; 61: 10-13.

Scientific Working Group for Forensic Toxicology Web site. Available at www.swgtox.org. Accessed September 8, 2014.

Published

01/01/2015

How to Cite

Reisfield, MD, G. M., B. A. Goldberger, PhD, and R. L. Bertholf, PhD. “Choosing the Right Laboratory: A Review of Clinical and Forensic Toxicology Services for Urine Drug Testing in Pain Management”. Journal of Opioid Management, vol. 11, no. 1, Jan. 2015, doi:10.5055/jom.2015.0250.