The Necessity of Sending for Drug Confirmation
Ignorance is no excuse! Sadly, this phrase is used far to frequently in the medico-legal arena when it comes to Urine Drug Testing (UDT). A provider who chooses to drug test with just a screening device, but does not send urine samples to a lab for confirmation, many times receives just enough information to get themselves in hot water. UDT, when used appropriately, accounts for the following: Improved patient adherence to their medication regiment, better provider/patient relationship and communication, alerts provider to possible drug abuse or diversion, decreases likelihood of audits and medico-legal problems and improves providers ability to monitor effective therapeutic dosages. Due to fear of over-testing or out of ignorance, some providers fail to recognize appropriate UDT includes both screening and confirmation. Screening tests were designed to give the provider immediate information on classes of drugs a patient may or may not be taking as well as some illicit drugs. The only way possible to determine what specific drug a patient is taking is to confirm the screening test. Due to the high cutoff levels, and the inability of screening devices to determine certain metabolites, many times it is impossible for a provider to know exactly what a patient is or isn’t taking. When a medical decision is made based strictly on a screen the provider is potentially putting their license and the patient’s health at risk.
To give you an example lets say you were scripting your patient oxycodone and they tested positive for oxycodone and opioids on the screening cup. Can you know for certain they didn’t take one oxycodone a few hours before the test to test positive for oxy? How do you know they aren’t taking hydrocodone and selling the oxycodone? Lets take another example. You scripted your patient Alprazolam. They screen positive for benzodiazepines so you know for a fact they are not taking their grandmothers Lorazepam and selling the Alprazolam on the street, right? Sure you do. Finally, what about the patient your staff and you think is a liar and drug abuser because their negative test is below the screening cutoff for the prescription you give them. How do you know they didn’t run out several days before which confirmation would verify due to the level of the metabolites present in their urine? The fact is, you don’t.
You get it. The bottom line is if you do drug screening, the medical community standard of care is to confirm at least the positive and inconsistent findings.