An Overview of Urine Drug Testing (UDT)
Lonnie Riley III - General Manager10-11-19
2019 Opiate Conference:“OPIOIDS AND YOUR PATIENTS: WHERE DO YOU GO FROM HERE?”
Disclosure(s)
© 2019 Trident Labs2
Lonnie Riley III - General Manager of Trident Labs- Trident provides testing for some McLaren Physicians
UDT Overview
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Course of Treatment
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Direct Methods:● Drug Testing
Adherence Monitoring Indirect Methods:● Pill Counts● Self-Reporting● Questionnaire
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Course of Treatment
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Adherence Monitoring - No/Weak Program
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Adherence Monitoring - The Opioid Fight
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Adherence Monitoring - The Opioid Fight
Course of Treatment
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Success with UDT
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Limitations of UDT
Source:quickfixsynthetic.com
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SPE
Positive/ Negative
123.4 ng/mL
Testing Overview
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- Patient Demographics- Ordered Testing- Sample Integrity
Receiving Samples
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Validity Testing
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- Enzyme Immunoassay (EIA)- Identifies drug class- Qualitative Results
○ Positive/ Negative
Screening Samples
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Active Enzyme Substrate Drug Class Present
Observation
Combination Product
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● Solid Phase Extraction (SPE)
Sample Preparation
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Confirmation: LC-MS/MS
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Selection Criteria Parameters
S/N >10
Ion Ratios Analyte Dependent
RT ∓ 0.1
Confirmation: LC-MS/MS
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EIA Screen LC-MS/MS
Screen (Presumptive) Confirmation (Definitive)
Qualitativei.e . Negative/ Positive
Quantitativei.e. 123.4 ng/mL
Identifies Drug Class Identifies Drugs & Associated Analytes
High Cutoff Levels Lower Detection Levels
Lower Specificity Higher Specificity
Screening Confirmationvs
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Data Analysis
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- Fax and/or Portal- Interpreting Results:
- Sample validity- Screen Results- Confirmation Results- Result history
- Questions?
Reporting
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Conclusions
Case StudyPt: Test, Patient
Rx: Morphine
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ND
ND
123ng/mL
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Acknowledgments
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Daniel Kelsey - President Nicole Kelsey - BillingMatthew Rycenga, PhD - Lab DirectorPeter Shireman, MD - Medical DirectorLonnie Riley III - General ManagerVal Voss - Office ManagerFred Winkle - Compliance
Lab Team:Sarah Flowers - Technical SupervisorCaitlin LocRebecca JonesMorgan MorehouseMichael AlsanteRachel GreenAnthea MitchellAlexandra VanSumerenCarlos CastelloMatthew Moorman
Patti Wesenick - CME CoordinatorBarry Schmidt
McLaren Physicians & Support Staff
Bill FreckmanTom BauerRod WesthuisJeff BosmaDon RitzBob SharpPrabhat Malviya
© 2019 Trident Labs
Questions?
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References/ Resources
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- AACC: Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients (LMPG)
- 1. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. Morb Mortal Wkly Rep. ePub: 21 December 2018.