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Patients treated with opioids for noncancer chronic pain are known to exhibit aberrant drug behaviors. The urine drug screen or UDS complements behavior monitoring as an objective means to assess patient compliance. UDS results can impact decisions related to a patient’s treatment, including discontinuation of opioid therapy or removal of the patient from the treatment program, explains Barbarajean Magnani, MD, PhD, FCAP, in this CAPcast interview.
Details
Julie McDowell:
Patients treated with opioids for noncancer chronic pain are known to exhibit aberrant drug behaviors. The urine drug screen, or UDS, complements behavior monitoring as an objective means to assess patient compliance. UDS results can impact decisions related to a patient's treatment, including discontinuation of opioid therapy, or removal of the patient from the treatment program, explains Dr. Barbarajean Magnani in this CAPcast interview. Dr. Magnani, a renowned expert in toxicology, helped develop a Clinical Pathology Improvement Program or CPIP course on this topic. Dr. Magnani, what are some of the challenges pathologists face when trying to keep up with the need for opioid screening?
Dr. Barbarajean Magnani:
Well, having the correct toxicology test menu is critically important. For example, illicit fentanyl is widely abused and oxycodone is widely prescribed, and both these drugs should be on every clinical laboratory's test menu. It's important for the pathologist to recognize what drugs are being utilized by the patient population at hand.
Julie McDowell:
Now, do pathologists have a role in assessing aberrant drug behaviors? And how should they go about making that assessment?
Dr. Barbarajean Magnani:
Let me explain aberrant drug behaviors. These are behaviors that include not using prescribed medications, not using prescribed medications as they are prescribed, using non-prescribed medications, diverting prescribed medications, and/or using illicit drugs. And the urine drug test is an objective means for identifying what drugs the patient is or is not taking.
Julie McDowell:
What are some of the limitations of the opiates immunoassay?
Dr. Barbarajean Magnani:
It's important to understand that the opiates immunoassay is a class assay and does not detect a specific analyte, but rather a class of drugs or analytes. So a positive result determines that an opiate or opioid is present, but it does not identify the specific drug. And so further testing would be required.
Julie McDowell:
Finally, Dr. Magnani, how can pathologists ensure appropriate evaluation of quantitative UDS results?
Dr. Barbarajean Magnani:
Well, pathologists again, need to appreciate the limitations of the immunoassay results and also understand that with quantitative testing, some detected drugs may be primary drugs, they may be metabolites of the primary drugs, or may even be a pharmaceutical impurity.
Julie McDowell:
Thank you, Dr. Magnani. As mentioned earlier in this episode, Dr. Magnani led the development of a course on this topic entitled Urine Drug Testing for Chronic Noncancer Pain Management, which is part of the CAP's Clinical Pathology Improvement Program, or CPIP. For more information, go to cap.org, search for CPIP, and then search for the course title. Thank you for listening to this CAPcast. Be sure to listen to our other CAPcasts from the CAP on our SoundCloud channel by downloading the SoundCloud app on your mobile device. And we're also on Apple Podcasts and the Stitcher app. To find this podcast, search for the word CAPcast on these apps. Once you find our podcast, be sure to click the subscribe button so you don't miss new CAPcast episodes.