Urine Drug Testing: Putting It All Together

As we said in last month’s UDT post comparing immunoassay and laboratory testing, a positive immunoassay result is not necessarily a sign that a patient is “guilty” of aberrant behavior, as its results are not definitive. These are the tests that need to go to the laboratory for further analysis.  Many practitioners have complained that the reports that they receive from their labs are confusing and difficult to interpret. Having read many reports from different labs, this confusion is certainly understandable.  Choosing a lab with which to work should be taken seriously, given the substantial variance in the accessibility of different labs’ reports. Take the time to sit down with several lab representatives and go over sample reports with them.

Additionally, the prudent primary care clinician will ask the representative about what type of support is available for explaining results when they are not clear. Accurate interpretation is particularly important, given the results of a study of primary care residents in which accuracy of interpretation was found to be poor while resident confidence in their ability to interpret accurately was falsely high. Another study determined that physicians who utilized UDT’s knowledge of interpretation of results was no better than that of those physicians who did not incorporate UDT into their practices!

Although the data may be somewhat dated, Passik and colleagues determined that even physicians who performed UDT rarely followed up with their patients regarding the results. Hopefully, this situation has improved – although there is no data substantiating that this has been the case. We cannot lose sight of the reality that the diseases of chronic pain and addiction often coexist. Finally, we have to keep sight of the fact that UDT is not a “perfect” science, and that factors such as pharmacogenetic differences and drug-drug interactions may impact results.Read more here: http://www.hcplive.com/journals/family-practice-recertification/2015/February2015/Urine-Drug-Testing-Putting-It-All-Together

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