Frequently Asked Questions

 

Why would a patient not have a drug present that was prescribed?

One of more of the following circumstances could be responsible:

  • Non-adherence to the prescription regimen
  • Diversion of prescription drugs
  • ​Fast metabolizer of prescription drugs
  • Drug-induced metabolism (e.g. rifampin)
  • Poor drug absorption (e.g. celiac disease)
  • Diluted urine

Why would a patient have a drug present that was not prescribed?

One of more of the following circumstances could be responsible:

  • Normal opiate and opioid metabolite from a legitimate prescription
  • Opiate and opioid metabolite found when high doses of codeine or morphine are used
    ​-High-dose codeine can metabolize to hydrocodone
    -High-dose morphine can metabolize to hydromorphone
  • Prescription from another physician
  • Medication obtained from a spouse or friend
  • Illicit use of drug obtained without prescription

What is the relationship between heroin and morphine in my patient’s results?

  • Detection of 6-monoacetylmorphine is consistent with heroin use.
  • Absence of 6-monoacetylmorphine does not rule out heroin use when morphine is present.
  • Common reasons for the presence of morphine include a morphine prescription, codeine prescription (since codeine metabolizes to morphine), dietary poppy seeds or the use of heroin.

What is included in a report’s interpretive comments?

PtProtect® reports provide interpretive comments based on prescribed medications reported by the provider, and the analytical test results. We compare medications prescribed, medications detected and the ratio of metabolite to parent substance to facilitate your understanding of the test data.

An interpretive comment is included even when prescription medication use is:

  • ​Undisclosed on your requisition or laboratory order
  • Unknown to you
  • Not currently part of the patient’s care plan under your supervision

Can I receive a report with medication compliance information specific to my practice?

A clinic-specific discrepancy report is a useful tool that provides an overall snapshot detailing the compliance of your patients to their prescription regimen over a specific time period.  A discrepant result occurs when a pain medication is detected, but not prescribed; or when a pain medication is prescribed, but not detected. The discrepancy rate is the percent of the total specimens tested where one or more discrepancies are identified in your patient's test results (when presciption regimen is provided).  Your clinic's discrepancy rate is compared with PeaceHealth Laboratories' average rate of patient medication compliance.  This useful report can help you determine which specific controlled substances are highly discrepant in your pain patient population.

Click here to see a sample discrepancy report.​

 

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. ​​​​​​​​