The Toxicology Laboratory's Role in Pain Management: Testing for Opiates
Continuing Education Credits
This course will provide an overview of general drugs of abuse testing with an emphasis on urine testing for opiates and other narcotics used in the practice of pain management.
Objectives
- List the common drugs of abuse that are tested on a routine urine drug screen.
- Describe the advantages of urine testing versus serum testing in the context of drugs of abuse testing.
- Describe testing methods used in the clinical toxicology laboratory.
- Define pain management in a clinical context and explain the lab's role in this practice.
- Identify parent and metabolite compounds of common opiate medications.
- Interpret urine drug screen and confirmation results and decide if the result is consistent with the patient's history and current prescriptions.
Course Outline
- Laboratory Testing Methods For Drugs of Abuse
- Course Introduction
- Drugs of Abuse (DOA) Screening Tests
- Drugs of Abuse (DOA) Screening Tests, continued
- Cutoff Concentrations for DOA Screening Tests
- Confirmation of Positives
- Mass Spectrometry (MS)
- False-Positive Opiate Results
- Contaminants in Opiate Tablets
- Laboratory Samples for DOA
- Adulterants
- Which of the following is the best example of adulteration of a urine sample that could result in a false negative result?
- The Use of Opiates For Pain Management and the Problem of Drug Abuse
- Pain Management Contracts
- Opiates
- Opiates, continued
- Opiate Abuse
- Other Drugs of Interest
- Pain Management: The Problem
- Pain Management: The Problem, continued
- Dependence versus Addiction
- Diversion is:
- The Goal of Pain Management (PM)
- Testing the Pain Management (PM) Patient
- Which of the following drugs is a synthetic opioid with a very long duration of action and is used to help wean patients from opiate dependency?
- True or False: In the practice of pain management, the absence of a compound in the urine is often just as significant as the presence of a compound.
- True or False: The goal of pain management is to have the patient live pain-free.
- Interpretation of Drugs of Abuse Testing in Pain Management
- Pain Management Drug Screen Interpretation Competencies
- Adulterants and Urine Samples Collected for Prescription Drug Monitoring
- Opiate Metabolites
- The Problem with Oxycodone and Oxymorphone (Oxys) In Immunoassay Methods
- Cross-Reactivities
- Common Pain Management (PM) Drugs and Trade Names
- True or False: Morphine is a metabolite of codeine.
- Half-Lives and Windows
- Which of the following drugs is a metabolite of another opiate but is also available as a prescription drug?
- Frequently Asked Questions (FAQs) To the Toxicology Laboratory
- Scenario 1A patient with a urine creatinine of 25 mg/dL who has reportedly been taking codeine has codeine present in her urine but no morphine present. Which statement is true?
- Scenario 2A clinician calls and says the laboratory made an error on a general opiate drug screen he had ordered for one of his patients to detect methadone, which was being prescribed for this patient. The clinician states that the patient always takes his/her methadone at the correct time each day, yet the urine opiate screen is negative. The clinician also wonders why the urine creatinine is fl
- Scenario 3A clinician has a patient taking Vicodin 750–7.5 mg daily (the numbers refer to 750 mg acetaminophen and 7.5 mg hydrocodone per tablet). The laboratory reported finding hydromorphone in the confirmation but did not report a positive result for hydrocodone. The clinician is now asking the toxicology laboratory professional if this result is consistent with the patient's prescription
- Summary
- A patient with hydrocodone, hydromorphone, codeine, and morphine in their urine would likely be taking which of the following drug combinations?
- References
- References
Additional Information
Level of instruction: Intermediate
Target audience: Medical laboratory scientists, medical laboratory technicians, and medical laboratory science students. This course may also be of interest to other healthcare professionals who are involved in pain management.
Author information: Kevin F. Foley, PhD, DABCC, MLS, SC is the Northwest chemistry, toxicology, immunology and POC director for Kaiser Permanente. He also teaches pharmacology, clinical chemistry, immunology and medicinal chemistry at Oregon Health Sciences University. Dr. Foley earned his PhD in clinical pharmacology and toxicology at East Carolina School of Medicine in North Carolina. His research areas include cardiovascular risk and inflammation markers as well as the neuropharmacology of amphetamine-like compounds. He is a frequent contributor to several clinical laboratory publications and is active in the American Association of Clinical Chemistry.
Reviewer information:
Robert E. Moore, MLS(ASCP)CMSCCM, TC(NRCC) is the lead technologist in the toxicology laboratory at Kaiser Permanente in Portland, Oregon where his responsibilities include review of QC data, instrument troubleshooting, and employee training and competency assessment. In his career as a medical laboratory scientist, he has held the positions of chemistry supervisor, toxicology supervisor, and laboratory director.
Joshua J. Cannon, MS, MLS(ASCP)CMSHCM received his Bachelor
of Science and Master of Science in Medical Laboratory Science from Thomas
Jefferson University in Philadelphia, PA. He holds Medical Laboratory Scientist
and Specialist in Hematology certifications through the ASCP Board of
Certification. He was a professor at Thomas Jefferson University for seven
years before transitioning into his current role as Education Developer at
MediaLab. His areas of expertise and professional passions include clinical
hematology and interprofessional education.
Content information: This course will provide an overview of general drugs of abuse testing with an emphasis on urine testing for opiates and other narcotics used in the practice of pain management.