Drug testing and adherence monitoring in pain management: Oral fluid testing

Christine Moore, PhD, DSc, DABCC

doi:10.5055/jom.2015.0254

Authors

Christine Moore, PhD, DSc, DABCC

DOI:

https://doi.org/10.5055/jom.2015.0254

Keywords:

drug testing, oral fluid testing, pain management, adherence monitoring

Abstract

A review of the utility of oral fluid in drug testing and adherence monitoring in pain management is presented. The article includes a description of the “State of the Art”; drug deposition; advantages and drawbacks of oral fluid testing; and overall related literature.

Author Biography

Christine Moore, PhD, DSc, DABCC

Toxicology Research and Development, Immunalysis Corporation, Pomona, California.

References

Christo PJ, Manchikanti L, Ruan X, et al.: Urine drug testing in chronic pain. Pain Physician. 2011; 14(2): 123-143.

Manchikanti L, Malla Y, Wargo BW, et al.: Comparative evaluation of the accuracy of immunoassay with liquid chromatography tandem mass spectrometry (LC/MS/MS) of urine drug testing (UDT) opioids and illicit drugs in chronic pain patients. Pain Physician. 2011; 14(2): 1751-87.

McCarberg BH: A critical assessment of opioid treatment adherence using urine drug testing in chronic pain management. Postgrad Med. 2011; 123(6): 124-131.

Milone MC: Laboratory testing for prescription opioids. J Med Toxicol. 2012; 8(4): 408-416.

Couto JE, Romney MC, Leider HL, et al.: High rates of inappropriate drug use in the chronic pain population. Popul Health Manag. 2009; 12(4): 185-190.

Nafziger AN, Bertino JS: Utility and application of urine drug testing in chronic pain management with opioids. Clin J Pain. 2009; 25(1): 73-79.

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(6): 359-364.

McCloskey LJ, Dellabadia KA, Stickle DF: Receiver-operating characteristics of adjusted urine measurements of oxycodone plus metabolites to distinguish between three different rates of oxycodone administration. Clin Biochem. 2013; 46(1-2): 115-118.

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.

Allen KR: Screening for drugs of abuse: Which matrix, oral fluid or urine? Ann Clin Biochem. 2011; 48: 531-541.

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(8): 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(2): 75-80.

Vindenes V, Yttredal B, Oiestad EL, et al.: Oral fluid is a viable alternative for monitoring drug abuse: Detection of drugs in oral fluid by liquid chromatography-tandem mass spectrometry and comparison to the results from urine samples from patients treated with methadone or buprenorphine. J Anal Toxicol. 2011; 35(1): 32-39.

Conermann T, Gosalia AR, Kabazie AJ, et al.: Utility of oral fluid in compliance monitoring of opioid medications. Pain Physician. 2014; 17: 63-70.

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(2): 99-103.

Samyn N, Laloup M, De Boeck G: Bioanalytical procedures for determination of drugs of abuse in oral fluid. Anal Bioanal Chem. 2007; 388(7): 1437-1453.

Garnier M, Coulter C, Moore C: Selection of an immunoassay screening cut-off concentration for opioids in oral fluid. J Anal Toxicol. 2011; 35(6): 369-374.

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 (Biomed Applns.) 2007; 850: 370-375.

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(11): 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(2): 915-924.

Moore C, Crouch D: Oral fluid for the detection of drugs of abuse using immunoassay and LC-MS/MS. Bioanalysis. 2013; 5(12): 1555 -1569.

Moore C: Oral fluid for workplace drug testing: Laboratory implementation. Drug Test Anal. 2012; 4(2): 89-93.

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(6): 395-401.

Kim I, Barnes AJ, Oyler JM, et al.: Plasma and oral fluid pharmacokinetics and pharmacodynamics after oral codeine administration. Clin Chem. 2002; 48(9): 1486-1496.

Cone EJ, Clarke J, Tsanaclis L: Prevalence and disposition of drugs of abuse and opioid treatment drugs in oral fluid. J Anal Toxicol. 2007; 31(8): 424-433.

Gray TR, Dams R, Choo RE, et al.: Methadone disposition in oral fluid during pharmacotherapy for opioid-dependence. Forensic Sci Int. 2011; 206(1-3): 98-102.

Coulter C, Garnier M, Tuyay J, et al.: Determination of carisoprodol and meprobamate in oral fluid. J Anal Toxicol. 2012; 36: 217-220.

El-Sayed AAY, Mohamed KM, Hilal MA, et al.: Development and validation of high-performance liquid chromatography-diode array detector method for the determination of tramadol in human saliva. J Chromatogr Sep Tech. 2011; 2(4): 114-120.

Ardakani YH, Rouini MR: Pharmacokinetic study of tramadol and its three metabolites in plasma, saliva and urine. DARU. 2009; 17(4): 245-255.

Cone EJ, Huestis MH: Interpretation of oral fluid tests for drugs of abuse. Ann N Y Acad Sci. 2007; 1098: 51-103.

Kintz P, Villain M, Concheiro M, et al.: Screening and confirmatory method for benzodiazepines and hypnotics in oral fluid by LC-MS/MS. Forensic Sci Int. 2005; 150(2-3): 213-220.

Moore C, Kelley-Baker T, Lacey J: Interpretation of oxycodone concentrations in oral fluid. J Opioid Manag. 2012; 8(3): 161-166.

Hardy J, Norris R, Anderson H, et al.: Is saliva a valid substitute for plasma in pharmacokinetic studies of oxycodone and its metabolites in patients with cancer? Support Care Cancer. 2012; 20(4): 767-72.

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(2): 252-256.

Patsalos PN, Berry DJ: Therapeutic drug monitoring of antiepileptic drugs by use of saliva. Ther Drug Monit. 2013; 35(1): 4-29.

Liu H, Delgado MR: Therapeutic drug concentration monitoring using saliva samples. Focus on anticonvulsants. Clin Pharmacokinet. 1999; 36(6): 453-470.

Marchei E, Farrè M, Pellegrini M, et al.: Pharmacokinetics of methylphenidate in oral fluid and sweat of a pediatric subject. Forensic Sci Int. 2010; 196(1-3): 59-63.

Marchei E, Farré M, Pardo R, et al.: Correlation between methylphenidate and ritalinic acid concentrations in oral fluid and plasma. Clin Chem. 2010; 56(4): 585-592.

Gjerde H, Langel K, Favretto D, et al.: Estimation of equivalent cutoff thresholds in blood and oral fluid for drug prevalence studies. J Anal Toxicol. 2014; 38(2): 92-98.