Clinical Interpretation of Urine Drug Tests: What Clinicians Need to Know About Urine Drug Screens.

Urine drug testing is frequently used in clinical, employment, educational, and legal settings and misinterpretation of test results can result in significant adverse consequences for the individual who is being tested. Advances in drug testing technology combined with a rise in the number of novel misused substances present challenges to clinicians to appropriately interpret urine drug test results. Authors searched PubMed and Google Scholar to identify published literature written in English between 1946 and 2016, using urine drug test, screen, false-positive, false-negative, abuse, and individual drugs of abuse as key words. Cited references were also used to identify the relevant literature. In this report, we review technical information related to detection methods of urine drug tests that are commonly used and provide an overview of false-positive/false-negative data for commonly misused substances in the following categories: cannabinoids, central nervous system (CNS) depressants, CNS stimulants, hallucinogens, designer drugs, and herbal drugs of abuse. We also present brief discussions of alcohol and tricyclic antidepressants as related to urine drug tests, for completeness. The goal of this review was to provide a useful tool for clinicians when interpreting urine drug test results and making appropriate clinical decisions on the basis of the information presented.

Treatments for methamphetamine abuse: a literature review for the clinician.

Methamphetamine (METH) use and dependence is a serious public health concern with implications across multiple areas from societal impact to burden on psychiatric and medical resources. An estimated 8% of admissions to substance abuse treatment programs are related to stimulants with METH/amphetamine abuse. To date, effective pharmacotherapy options to enhance abstinence have not been identified. The objective of this article is to critically review the literature of METH treatment options. Preclinical research and human research with compounds not yet available commercially in the United States will not be included. A literature review was conducted for research on pharmacological treatments for METH use and addiction. Trial information on the use of sertraline, bupropion, mirtazapine, modafinil, dextroamphetamine, ondansetron, risperidone, aripiprazole, baclofen, and gabapentin was reviewed. Aripiprazole trials appeared in the reviewed literature more frequently than the other medications. Based on the findings of this review, no single medication demonstrated consistent efficacy and each trial contained a variety of methodological limitations.

Ethylglucuronide as a biomarker for ethanol detection.

Many different biomarkers can be used to evaluate ethanol intake. Ethylglucuronide, a minor metabolite of ethanol, is a biomarker that is useful in determining ethanol intake up to 80 hours after ethanol consumption. To better understand the utility of this biomarker, a MEDLINE search of ethylglucuronide in the English-language literature from January 1987-August 2007 was performed; clinical trials and case reports were reviewed. In addition, relevant nonmedical media and government documents were reviewed. Ethylglucuronide has an extended window of detection compared with other biomarkers and can be detected in urine 1 hour after ethanol ingestion. However, incidental exposure to ethanol-containing products may cause false-positive results, and false-negative results have been reported when urine has been infected with certain bacteria that cause urinary tract infections. Before a urine sample is submitted for ethylglucuronide evaluation, a thorough drug history should be obtained. Misinterpretation of ethylglucuronide results can produce serious adverse medical and social consequences. When positive ethylglucuronide screen results are reported, further evaluation of the clinical picture and confirmation with ethylglucuronide quantification and self-report should be instituted. Clinicians should have a thorough understanding of the strengths and weaknesses of the ethylglucuronide test when used in various settings.

Urine drug screening: practical guide for clinicians.

Drug testing, commonly used in health care, workplace, and criminal settings, has become widespread during the past decade. Urine drug screens have been the most common method for analysis because of ease of sampling. The simplicity of use and access to rapid results have increased demand for and use of immunoassays; however, these assays are not perfect. False-positive results of immunoassays can lead to serious medical or social consequences if results are not confirmed by secondary analysis, such as gas chromatography-mass spectrometry. The Department of Health and Human Services' guidelines for the workplace require testing for the following 5 substances: amphetamines, cannabinoids, cocaine, opiates, and phencyclidine. This article discusses potential false-positive results and false-negative results that occur with immunoassays of these substances and with alcohol, benzodiazepines, and tricyclic antidepressants. Other pitfalls, such as adulteration, substitution, and dilution of urine samples, are discussed. Pragmatic concepts summarized in this article should minimize the potential risks of misinterpreting urine drug screens.