Urine Drug Monitoring in Your Clinic

Urine Drug MonitoringIn a study of 470 patients in an urban pain clinic, 45% were found to have inconsistent urine screens

A. Absence of prescribed opioid

B. Presence of illicit substance

C. Presence of unauthorized prescription medication

D. Adulterated urine sample

Urine Drug MonitoringUrine Drug Monitoring (UDM) can:

• Assist with diagnosis and therapeutic decisions

• Verify and document a patient’s claim of treatment adherence

• Detect the presence of prescribed medications

• Detect the presence of unauthorized substances (illicit or non-prescription)

Urine Drug Monitoring

UDM can also:

• Provide data to assess individual patient medication management and metabolism

• Provide documentation for workplace or legal reasons

Urine Drug MonitoringUDM is commonly accomplished by:

• Urine Drug Screening (UDS): Immunoassay Screen

• Urine Drug Testing (UDT):

• Gas Chromatography-Mass Spectrometry (GC-MS)

• Liquid Chromatography-Mass Spectrometry (LC-MS)

Urine Drug MonitoringScreen Testing

Test Method Immunoassay Screen GC-MS or LC-MS

Test Location In Clinic In Clinic or Send Out

Turnaround Time Rapid - within minutes

Slower - Hours or Days

Results Guidance for treatment

Definitive ID and concentration

Interpretation Cross-Reactivity and High cutoff levels

False Positive Rare False Negative Rare

Outsourcing UDTAdvantages

• Minimal clinical responsibility

Disadvantages

• Slow turnaround time

• Lapses in service

• Missing Revenue

Testing in Your Clinic• Partnership with Cornerstone LP to:

• Purchase the correct LCMS instrument

• Hire or train Medical Technician(s) to perform analysis

• Network the instrument with your CIS

• Meet all required CLIA documentation and personnel requirements

Example PartnershipCornerstone LP Provides Clinic Provides

Portion of Instrument Capital Portion of Instrument Capital

Trained, Qualified Instrument Technician

Facility for Laboratory (100-200 sq ft)

Clinical Laboratory Personnel Site Renovations (if any)

Methods and technology to rapidly test samples Utilities and Lab Supplies

Network of vendors and service providers Urine Samples

SOP’s and CLIA Documentation Insurance Billing

Typical Installation

LC-MS Commissioning

Next Steps• Revenue estimates

• Agreement contract

ReferencesWebster, Lynn R. The Role of Urine Drug Testing in Chronic Pain Management: 2013 Update. Pain Medicine News Special Edition, December 2013.