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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Tate, Jillian R. / Tsongalis, Gregory J.

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Analysis and interpretation of drug testing results from patients on chronic pain therapy: a clinical laboratory perspective

Stacy E.F. Melanson1 / Maria I. Kredlow1 / Petr Jarolim1

1Division of Clinical Laboratories, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

Corresponding author: Stacy E.F. Melanson, MD, PhD, Brigham and Women's Hospital, 75 Francis Street, Amory 2, Boston, MA 02115, USA Phone: +1-617-525-7237, Fax: +1-617-731-4872,

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 47, Issue 8, Pages 971–976, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2009.220, July 2009

Publication History

Received:
2009-04-03
Accepted:
2009-05-18
Published Online:
2009-07-10

Abstract

Background: Recent guidelines recommend monitoring for opioid and drug use in patients with chronic pain to detect use of undisclosed or illicit substances, and to determine compliance with prescribed medications. We examined the technical and clinical impact of drug testing for patients on chronic pain therapy in our clinical laboratory.

Methods: Testing volumes were obtained for 4 years. Volumes from three recent months were also examined in detail to determine average turnaround time, assay performance (i.e., number of positive screening and confirmatory tests and testing discrepancies) and consistency of patient results with medication history.

Results: Our testing volume continues to grow significantly, especially in the primary care setting, with an average yearly increase of 34%. Approximately 70% of patients confirmed positive for an opioid. Other drugs were positive in <30% of patients. Twenty-nine percent of patients tested positive for a medication without a prescription. Overall, the compliance rate was 85% indicating that 15% of patients had negative test results despite being prescribed a chronic pain medication.

Conclusions: Clinical laboratories should consider the impact of these guidelines and examine options to optimize testing such as limiting or modifying the test panel.

Clin Chem Lab Med 2009;47:971–6.

Keywords: chronic pain; clinical laboratory; opioids; pain clinic; urine drug testing

Citing Articles

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[2]
M. L. Snyder, A. Darragh, J. G. Flood, J. Jones, K. Ropar, P. Jarolim, and S. E. F. Melanson
Journal of Analytical Toxicology, 2014, Volume 38, Number 6, Page 375
[3]
Yan Zhang and Tai C. Kwong
Clinica Chimica Acta, 2014, Volume 427, Page 158
[4]
Ripple Sekhon, Noushin Aminjavahery, Charles N. Davis, Mary Jayne Roswarski, and Camille Robinette
Pain Medicine, 2013, Volume 14, Number 10, Page 1548
[5]
Stacy E.F. Melanson, Milenko J. Tanasijevic, Marion L. Snyder, Alicia Darragh, Cathleen Quade, and Petr Jarolim
Clinica Chimica Acta, 2013, Volume 422, Page 10
[6]
Joanna L. Starrels, Aaron D. Fox, Hillary V. Kunins, and Chinazo O. Cunningham
Journal of General Internal Medicine, 2012, Volume 27, Number 11, Page 1521
[7]
S. E. F. Melanson, M. L. Snyder, P. Jarolim, and J. G. Flood
Journal of Analytical Toxicology, 2012, Volume 36, Number 3, Page 201
[8]
Marion L. Snyder, Petr Jarolim, and Stacy E.F. Melanson
Clinica Chimica Acta, 2011, Volume 412, Number 11-12, Page 946
[9]
Stacy E.F. Melanson, Marion L. Snyder, Kenneth A. Bishop, Elisabetta Paci, and James G. Flood
Point of Care: The Journal of Near-Patient Testing & Technology, 2011, Volume 10, Number 2, Page 74

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