Emergency Medicine Half and Half MAT Waiver Training-Module 2: Drug Testing in the ED in the Patient with OUD

Module 2: Drug Testing in the ED in the Patient with OUD

Pdf Summary

Drug testing in the emergency department (ED) for patients with opioid use disorder (OUD) serves a different purpose than testing in a clinic setting. The goal of testing in the office-based treatment is to assist the provider in helping the patient, not to catch the patient. The language used to discuss test results is important and it is advised to avoid using terms like "clean" or "dirty" and instead refer to patients as having an opioid use disorder.<br /><br />In office-based treatment, drug testing has several advantages, including screening, treatment planning, monitoring adherence, and evaluating treatment effectiveness. Random testing with observed urine collection is ideal, although not always practical. In the ED, the information obtained and the environment are different.<br /><br />Screening tests, which are rapid and inexpensive, are commonly used in drug testing. They can have false positives and false negatives and generally provide a yes or no result with cutoffs. Confirmatory tests are slower and more expensive, requiring more expertise and must be done in a specialized lab. They typically use chromatography and mass spectrometry and have high specificity.<br /><br />The interpretation of true positive opiate screens depends on factors such as patient compliance, possible use of other opioids, and ingestion of poppy seeds. True negative opiate screens can indicate non-compliance, diversion, incorrect assay, or collection/lab errors. Specimen validity testing may be helpful for both positive and negative results.<br /><br />Immunoassays have limitations and do not detect all opioids or other substances. Confirmatory testing, such as gas chromatography/mass spectrometry or liquid chromatography/tandem mass spectrometry, is the gold standard for confirmation.<br /><br />Testing for buprenorphine in the clinic is different and not part of the standard drug screens obtained in the ED. Testing for metabolites can assist with monitoring treatment and dosing adjustment.<br /><br />The ED may also require other tests, such as HIV and hepatitis C, but checking liver function tests is usually not necessary. Adulterated urine suggests a need to review the treatment plan in the clinic.<br /><br />Overall, drug testing in the ED should be approached differently than in an office-based treatment setting and understanding the nuances of the drug screen used in the hospital is important for accurate interpretation. The purpose of testing is never punitive but rather to assist the patient and provide appropriate care.

Keywords

Drug testing

emergency department

opioid use disorder

office-based treatment

screening tests

confirmatory tests

interpretation

specimen validity testing

immunoassays

gold standard