- What is presumptive drug testing?
- Do I need to run confirmatory drug testing?
- Should I worry about false-positive or false-negative results?
These are some of the issues that a health care provider has to manage when treating and testing patients. Urine drug testing (UDT) is complex due to the variety of offerings from laboratories and reimbursements from health plans. As challenging as it is to know what test to order, interpreting UDT results can be even more difficult. And to top it off, there are no standards or guidelines to help a provider navigate testing nor to determine when definitive or confirmatory testing is medically necessary.
A recent study by Suzuki et al surveyed psychiatry residents and fellows to determine the confidence and knowledge of this physician population to interpret UDTs. The participants were surveyed on their confidence to interpret UDTs and then given a seven-item knowledge test. The researchers found that psychiatry residents do not often receive training in UDT interpretation and, while they state a high level of confidence that they can properly interpret results (62.6%), they lack the knowledge to perform UDT interpretation (mean total score for the knowledge test was 3.5).
There are a few peer-reviewed articles that describe results and how to manage false-positive and false-negative. One such review by Moeller et al. in the Mayo Clinical Proceedings, Clinical Interpretation of Drug Tests for health care providers offers practical data for common drugs including cut-off values, drug detection times, and other substances that may interact in UDT. Such articles can be informative, but difficult to use in a practical way with complex clinical patients and results.
Beyond articles and interpretation pamphlets, there are computer-based tools that support health care providers in interpreting UDT. This technology can help providers decipher the results and assist with making therapeutic decisions. One such resource, called “myTOPCARE” (Transforming Opioid Prescribing in Primary Care), was created from a team of researchers from Boston Medical Center to help health care providers decrease misuse of prescription opioids. myTOPCARE also includes a section about UDTs for providers and links to tools for interpreting results of an opiates screening test, interpreting unexpected screening UDT results, and determining what tests to order as well as an illicit screening test cross-reference table.
Another UDT interpretation technology is Urintel®, which is available as a software application for use on office computers and both Apple and Android-based devices. Dr. Jeffrey Fudin, PharmD developed Urintel® to help health care providers better analyze UDT results and make more appropriate clinical decisions — and especially when there are unexpected results. The software allows the user to input results from a presumptive UDT at the point-of-care. The product can provide guidance to direct the provider and suggest actions to take when there are unexpected results, true and false positive or negative results, and when to quantify results through definitive testing. This tool may be helpful for patients who have complex regimes in order to determine if any other medications could be causing false-positive results.
Urintel® is also capable of providing dose-appropriate interpretations for patients who may be on varying levels of medication, allowing for fast and effective risk mitigation. Another feature is that providers can import the results from the software and place the clinical notes directly into the patient’s chart. This feature allows for transparency for any additional testing performed.
In the pain management and/or substance abuse space, there is a need for tools to better manage UDT interpretation results. It will be important to develop products that can provide a high level of patient safety while helping with the patient-health care provider dialogue and shared decision-making process.
- Suzuki J, Garayalde S, Dodoo M, Rodriguez C. Psychiatry residents’ and fellows’ confidence and knowledge in interpreting urine drug testing results related to opioids. Subst Abus. 2018 Apr 26:1-4.
- Moeller KE, Kissack JC, Atayee RS, Lee KC. Clinical Interpretation of Urine Drug Tests: What Clinicians Need to Know About Urine Drug Screens. Mayo Clin Proc. 2017;92(5):774-796 https://www.mayoclinicproceedings.org/article/S0025-6196(16)30825-4/pdf
- MyTOPcare is available at http://mytopcare.org/
- Urintel® is available at http://www.remitigate.com/