Anomalous Opiate Detection in Compliance Monitoring
by Michael Evans, PhD; Scott Kriger, PhD; Joshua Gunn, PhD; and Eugene Schwilke
 The progression of urine drug testing to include cut-off levels and
drug panels appropriate for compliance monitoring has revolutionized the practice of pain
management. Compliance monitoring enables physicians to offer more effective patient care
by identifying drug misuse or addiction, verifying diagnoses, and determining potential
cross-reactants among prescribed medications. It also offers a level of protection from
legal liability for physicians and their clinics by providing proof of due diligence that
they are evaluating patients on a regular basis.
However, like all medical testing, compliance monitoring has its limitations. Even when
state-of-the-art lab equipment is used from the screen to the confirmation, you can only
glean so much from an instrument. Oftentimes there are outside factors that must be taken
into account before making a judgment based on a test result—specifically when
dealing with patients who are treated with relatively high doses of opiates.
The Practice of Testing for Compliance
Processes used for determining compliance can differ between laboratories and depend on
instrumentation, chain-of-custody procedures, and types of specimens received. At AIT
Laboratories, a full-service reference laboratory serving compliance monitoring, forensic,
clinical, and pharmaceutical clients, the process comprises an initial immunoassay screen
and a quantitative confirmation on all positive urine specimens. Positive specimens are
confirmed and quantified by GC/MS or LC/MS. Validity markers such as oxidants, specific
gravity, pH, and creatinine determination also give care providers additional information
regarding potential specimen tampering.
Please refer to the September 2009 issue for the complete text. In the event you need to order a back issue, please click here.
— September 2009
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