Urine drug test interpretation: what do physicians know?

OBJECTIVE: To determine the level of urine drug test (UDT) interpretive knowledge of physicians who use these instruments to monitor adherence in their patients on chronic opioid therapy. METHODS: A seven-question instrument consisting of six five-option, single-best-answer multiple choice questions and one yes/no question was completed by 114 physicians (77 who employ UDT and 37 who do not) attending one of three regional opioid education conferences. We calculated frequencies and performed chi2 analyses to examine bivariate associations between UDT utilization and interpretive knowledge. RESULTS: The instrument was completed by 80 percent of eligible respondents. None of the physicians who employ UDT answered all seven questions correctly, and only 30 percent answered more than half correctly. Physicians who employ UDT performed no better on any of the questions than physicians who do not employ UDT. CONCLUSIONS: Physicians who employ UDT to monitor patients receiving chronic opioid therapy are not proficient in test interpretation. This study highlights the need for improved physician education; it is imperative for physicians to work closely with certified laboratory professionals when ordering and interpreting these tests.

A rapid, qualitative ELISA test for the specific detection of morphine in serum or urine.

We describe a competitive inhibition ELISA technique, with a visual end-point, to detect free morphine in blood or urine. It has a sensitivity of 2 X 10(-7) mol/l using 5 microliter samples. No significant cross-reactivity was observed with other opiate derivatives. The assay has applications as a specific screen for morphine in drug abusers, or to study the metabolism of the drug in the body (as the metabolite, morphine-3-glucuronide, does not cross-react significantly with morphine in the assay).

[Methodology and problems in the study of drugs of abuse in urine]. / Methodik und Problematik der Suchtgiftuntersuchung im Harn.

The analysis of drugs of abuse in urine is a valuable tool for the detection of illicit drug use and the treatment and rehabilitation of addicts. In order for the results to be conclusive, however, several precautions have to be taken during the collection, storage, mailing and analysis of the urinary specimen. Since immunological methods for the determination of drugs of abuse are not completely specific, all positive results on immunoassay should be confirmed, at least for forensic purposes, by a chromatographic technique. Although much more complicated and time-consuming, some chromatographic techniques such as gas chromatography-mass spectrometry offer the possibility of unambiguously identifying drugs of abuse. However, in some cases, even with this method it is not possible to decide whether the identified metabolite of a drug of abuse stems from food or illicit or elicit drug use. A single urinary analysis is, therefore, sometimes not sufficient to provide unambiguous proof of the use of illicit drugs. However, definite evidence of repeated drug abuse can be obtained if the person involved is carefully instructed as to which medicines or food must not be taken during the investigation period and yet the analysis of several urinary specimens taken at intervals of one or two days proves positive.

Radioimmunoassay of hair for determining opiate-abuse histories.

Heroin and morphine metabolites can be detected in hair with the use of commercially available radioimmunoassay reagents and with minor sample preparation. Hair samples obtained from morphine-treated mice and heroin users contained nanogram levels of the drug per milligram of hair (single human hair). The results of the hair analyses for all subjects admitting the use of heroin were positive, whereas the results of only 30% of thin-layer chromatographic urinanalyses of these same subjects were positive. In addition, differences in drug concentration for sections of hair near the scalp and near the distal end correlated with the length of time the drug had been used. These results exemplify the potential advantages of the use of hair analysis over urine and serum analyses in terms of accessibility, sample stability, and long-term retention of information.