Skip to main content
SpringerLink
Log in
Book cover

Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches pp 151–160Cite as

Toxicology Screening for Opioids

  • Chapter
  • First Online:

  • 4423 Accesses

Abstract

Monitoring compliance in the field of pain medicine is critically important. The medications that are used are powerful, and the potential for abuse is high. Some patients do not take the prescribed medications in favor of diversion or trafficking (Braithwaite et al., Ann Clin Biochem 32:123–53, 1995; Gourlay et al., Urine drug testing in primary care. Monograph for California Academy of Physicians, 2002), and some patients may abuse opioids other than those prescribed. Further complicating matters is that laboratory testing for opioids, though it seems straightforward, can be confusing. Physicians rarely receive adequate training in test ordering and interpretation. Laboratory methods vary tremendously; in addition, laboratorians are rarely consulted and, when they are, may be ill-equipped to answer clinically important questions.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Braithwaite RA, Jarvie DR, Minty PS, et al. Screening for drugs of abuse (I): opiates, amphetamines and cocaine. Ann Clin Biochem. 1995;32:123–53.

    PubMed  CAS  Google Scholar 

  2. Gourlay D, Heit HA, Caplan YH. Urine drug testing in primary care. Dispelling the myths & designing strategies. Monograph for California Academy of family Physicians. 2002. http://www.alaskaafp.org/udt.pdf. Accessed on 24 Aug 2012.

  3. Hammett-Stabler CA, Pesce AJ, Cannon DJ. Urine drug screening in the medical setting. Clin Chim Acta. 2002;315:125–35.

    Article  PubMed  CAS  Google Scholar 

  4. Wu AHB, McKay C, Broussard LA, et al. Laboratory medicine practice guidelines: recommendations for the use of laboratory tests to support poisoned patients who present to the emergency department. Clin Chem. 2003;49:357–9.

    Article  PubMed  CAS  Google Scholar 

  5. Bailey DN. Results of limited versus comprehensive toxicology screening in a university medical center. Am J Clin Pathol. 1996;105:572–5.

    PubMed  CAS  Google Scholar 

  6. Annesley TM, Rockwood AL, Sherman NE. Chromatography. In: Burtis CA, Ashwood ER, Bruns DE, editors. Tietz fundamentals of clinical chemistry. 6th ed. St. Louis: Saunders Elsevier; 2008. p. 112–27.

    Google Scholar 

  7. Annesley TM, Rockwood AL, Sherman NE. Mass spectrometry. In: Burtis CA, Ashwood ER, Bruns DE, editors. Tietz fundamentals of clinical chemistry. 6th ed. St. Louis: Saunders Elsevier; 2008. p. 128–39.

    Google Scholar 

  8. Heit HA, Gourlay D. Urine drug testing in pain medicine. J Pain Symptom Manage. 2004;27:260–7.

    Article  PubMed  Google Scholar 

  9. Rubenstein KE, Schneider RS, Ullman EF. “Homogeneous” enzyme immunoassay: new immunochemical technique. Biochem Biophys Res Commun. 1972;47:846–51.

    Article  PubMed  CAS  Google Scholar 

  10. Caplan YH, Levine B, Goldberger B. Fluorescence polarization immunoassay evaluated for screening amphetamine and methamphetamine in urine. Clin Chem. 1987;33:1200–2.

    PubMed  CAS  Google Scholar 

  11. Adler FL, Liu CT. Detection of morphine by hemagglutination-inhibition. J Immunol. 1971;106:1684–5.

    PubMed  CAS  Google Scholar 

  12. Henderson DR, Friedman SB, Harris JD, et al. CEDIA, a new homogeneous immunoassay system. Clin Chem. 1986;32:1637–41.

    PubMed  CAS  Google Scholar 

  13. Kricka LJ. Principles of immunochemical techniques. In: Burtis CA, Ashwood ER, Bruns DE, editors. Tietz fundamentals of clinical chemistry. 6th ed. St. Louis: Saunders Elsevier; 2008. p. 155–70.

    Google Scholar 

  14. Baden LR, Horowitz G, Jacoby H, Eliopoulos GM. Quinolones and false-positive urine screening for opiates by immunoassay technology. JAMA. 2001;286:3115–9.

    Article  PubMed  CAS  Google Scholar 

  15. van As H, Stolk LM. Rifampicin cross-reacts with opiate immunoassay. J Anal Toxicol. 1999;23:71.

    PubMed  Google Scholar 

  16. Daher R, Haidar JH, Al-Amin H. Rifampin interference with opiate immunoassays. Clin Chem. 2002;48:203–4.

    PubMed  CAS  Google Scholar 

  17. Wolff K, Farrell M, Marsden J, et al. A review of biological indicators of illicit drug use, practical considerations and clinical usefulness. Addiction. 1999;94:1279–98.

    Article  PubMed  CAS  Google Scholar 

  18. Baselt RC. Disposition of toxic drugs and chemicals in man. 7th ed. Foster City: Biomedical Publications; 2004. p. 759–63.

    Google Scholar 

  19. Hayes LW, Krasselt WG, Mueggler PA. Concentrations of morphine and codeine in serum and urine after ingestion of poppy seeds. Clin Chem. 1987;33:806–8.

    PubMed  CAS  Google Scholar 

  20. Cook JD, Caplan YH, LoDico CP, Bush DM. The characterization of human urine for specimen validity determination in workplace drug testing: a review. J Anal Toxicol. 2000;24:579–88.

    PubMed  CAS  Google Scholar 

  21. Wu AHB. Urine adulteration before testing for drugs of abuse. In: Shaw LM, Kwong TC, editors. The clinical toxicology laboratory. Washington D.C.: AACC Press; 2001. p. 157–72.

    Google Scholar 

  22. Magnani B. Concentrations of compounds that produce positive results. In: Shaw LM, Kwong TC, editors. The clinical toxicology laboratory. Washington D.C.: AACC Press; 2001. p. 491–2.

    Google Scholar 

  23. Lee PR, Shahala DE. Changes to the cutoff levels for opiates for federal workplace drug testing programs. Substance abuse and mental health services administration. Fed Regist. 1995;60:575–85.

    Google Scholar 

  24. White RM, Black ML. Pain management. Washington D.C.: AACC Press; 2007.

    Google Scholar 

  25. Simpson D, Braithwaite RA, Jarvie DR, et al. Screening for drugs of abuse (II): cannabinoids, lysergic acid diethylamide, buprenorphine, methadone, barbiturates, benzodiazepines, and other drugs. Ann Clin Biochem. 1997;34:460–510.

    PubMed  CAS  Google Scholar 

  26. Backer RC, Monforte JR, Poklis A. Evaluation of the DRI® oxycodone immunoassay for the detection of oxycodone in urine. J Anal Toxicol. 2005;29:675–7.

    PubMed  CAS  Google Scholar 

  27. McCutcheon JR, Wood PG. Snack crackers yield opiate-positive urine. Clin Chem. 1995;41:769–70.

    PubMed  CAS  Google Scholar 

  28. Reisfeld GM, Chronister CW, Goldberger BA, Bertholf RL. Unexpected urine drug testing results in a hospice patient on high-dose morphine therapy. Clin Chem. 2009;55:1765–9.

    Article  Google Scholar 

  29. Smith HS. Opioid metabolism. Mayo Clin Proc. 2009;84:613–24.

    PubMed  CAS  Google Scholar 

  30. Schneider J, Miller A. Oxycodone to oxymorphone metabolism. Pract Pain Manag. 2009;7:71–3.

    Google Scholar 

  31. von Euler M, Villen T, Svensson J-O, Stahle L. Interpretation of the presence of 6-monoacetylmorphine in the absence of morphine-3-glucoruronide in urine samples: evidence of heroin abuse. Ther Drug Monit. 2003;25:645–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA

    Gary L. Horowitz M.D.

  2. Harvard Medical School, Boston, MA, USA

    Gary L. Horowitz M.D.

Authors
  1. Gary L. Horowitz M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gary L. Horowitz M.D. .

Editor information

Editors and Affiliations

  1. The Center for Pain Relief, Inc., West Virginia University, 400 Court Street, Suite 100, Charleston, 25301, West Virginia, USA

    Timothy R. Deer

  2. Stanford Pain Management Center, Redwood City, CA, Clinic Chief, Stanford University School of Medicine, Stanford, 94065, California, USA

    Michael S. Leong

  3. Department of Anesthesiology, Rush Medical College, Professor, Rush University Medical Center, Chicago, 60612, Illinois, USA

    Asokumar Buvanendran

  4. Pennsylvania State University, College of Medicine, Department of Anesthesiology, Milton S. Hershey Medical Center, Hershey, 17033-0850, Pennsylvania, USA

    Vitaly Gordin

  5. Center for Interventional Pain and Spine, Newark, DE USA, Medical Director, Bryn Mawr Hospital, Bryn Mawr, 19010, Pennsylvania, USA

    Philip S. Kim

  6. President, National Institute of Pain, Tampa, 33558, Florida, USA

    Sunil J. Panchal

  7. The LITE Center, Clinical Associate Professor, Medical Director, School of Medicine, Miami, 33143, Florida, USA

    Albert L. Ray

Rights and permissions

Reprints and permissions

Copyright information

© 2013 American Academy of Pain Medicine

About this chapter

Cite this chapter

Horowitz, G.L. (2013). Toxicology Screening for Opioids. In: Deer, T., et al. Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1560-2_15

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-1560-2_15

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-1559-6

  • Online ISBN: 978-1-4614-1560-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation