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Can I tell whether my patient has taken more (or less) than the dose of medication I prescribed?
Many aspects make it impractical to correlate urine drug concentration to a patient’s dosage. Using urine concentrations to monitor therapeutic levels is unreliable. Urine drug concentrations cannot determine:
- The amount of drug used
- Establish exactly when the last dose was taken
- Predict the source of the drug
What can I do if my patient’s results are discrepant?
When you receive results inconsistent with your patient's prescription regimen, there are several options to consider:
- Counsel the patient
- Modify the patient’s treatment plan
- Refer the patient to a substance abuse program
- Eliminate the patient from your practice
How do point-of-care (POC) cup results compare with test results from PtProtect pain management test panels?
Since POC urine testing cups are intended as a pre-screen, they produce a very limited result for drugs that may be present in a patient’s system. These limitations are true whether the indicators are on a dipstick or built into the cup. In some cases, a POC cup will produce a negative result while a PtProtect test panel will demonstrate a positive result. The positive result is correct due to lower threshold tolerances and the higher specificity available with mass spectrometry.
Clinical guidelines1 caution against making patient care decisions based on the results of a point-of-care urine drug test. For the highest accuracy and sensitivity, mass spectrometry testing should be used to verify all screen findings, whether positive or negative. See comparison of testing method senstitivities in Figure 1.
Does the Pain Management Panel provide an interpretation for the source of drug metabolites both major and minor?
Several of the opiate/opioid analgesics (codeine, hydrocodone, oxycodone) have major and minor metabolites, which are pharmacologically active (morphine, hydromorphone, oxymorphone respectively) and are available as prescription drugs. Specific ratios of the metabolite to parent drug determine whether these metabolites are actually coming from metabolism of the parent drug, are direct use of the individual drug, or are a combination of direct use and metabolism. This determination can be difficult and caution must be used to avoid falsely accusing your patient of abuse.
Does PeaceHealth Laboratories have clinical toxicologists available to provide expert interpretation and guidance for physicians and health care providers?
Yes! PeaceHealth Laboratories has experienced, board-certified clinical toxicologists available to answer your questions concerning interpretation of PtProtect test results. Call 800-826-3616 ext. 8137 to speak with a toxicologist.
1 Jeffrey A. Gudin, et al. Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, and/or Alcohol Use. Postgrad Med. 2013 July; 125(4): 115-130.