An Overview of Urine Drug Testing (UDT)

Lonnie Riley III - General Manager10-11-19

2019 Opiate Conference:“OPIOIDS AND YOUR PATIENTS: WHERE DO YOU GO FROM HERE?”

Disclosure(s)

© 2019 Trident Labs2

Lonnie Riley III - General Manager of Trident Labs- Trident provides testing for some McLaren Physicians

UDT Overview

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Course of Treatment

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Direct Methods:● Drug Testing

Adherence Monitoring Indirect Methods:● Pill Counts● Self-Reporting● Questionnaire

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Course of Treatment

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Adherence Monitoring - No/Weak Program

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Adherence Monitoring - The Opioid Fight

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Adherence Monitoring - The Opioid Fight

Course of Treatment

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Success with UDT

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Limitations of UDT

Source:quickfixsynthetic.com

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SPE

Positive/ Negative

123.4 ng/mL

Testing Overview

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- Patient Demographics- Ordered Testing- Sample Integrity

Receiving Samples

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Validity Testing

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- Enzyme Immunoassay (EIA)- Identifies drug class- Qualitative Results

○ Positive/ Negative

Screening Samples

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Active Enzyme Substrate Drug Class Present

Observation

Combination Product

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● Solid Phase Extraction (SPE)

Sample Preparation

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Confirmation: LC-MS/MS

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Selection Criteria Parameters

S/N >10

Ion Ratios Analyte Dependent

RT ∓ 0.1

Confirmation: LC-MS/MS

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EIA Screen LC-MS/MS

Screen (Presumptive) Confirmation (Definitive)

Qualitativei.e . Negative/ Positive

Quantitativei.e. 123.4 ng/mL

Identifies Drug Class Identifies Drugs & Associated Analytes

High Cutoff Levels Lower Detection Levels

Lower Specificity Higher Specificity

Screening Confirmationvs

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Data Analysis

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- Fax and/or Portal- Interpreting Results:

- Sample validity- Screen Results- Confirmation Results- Result history

- Questions?

Reporting

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Conclusions

Case StudyPt: Test, Patient

Rx: Morphine

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ND

ND

123ng/mL

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Acknowledgments

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Daniel Kelsey - President Nicole Kelsey - BillingMatthew Rycenga, PhD - Lab DirectorPeter Shireman, MD - Medical DirectorLonnie Riley III - General ManagerVal Voss - Office ManagerFred Winkle - Compliance

Lab Team:Sarah Flowers - Technical SupervisorCaitlin LocRebecca JonesMorgan MorehouseMichael AlsanteRachel GreenAnthea MitchellAlexandra VanSumerenCarlos CastelloMatthew Moorman

Patti Wesenick - CME CoordinatorBarry Schmidt

McLaren Physicians & Support Staff

Bill FreckmanTom BauerRod WesthuisJeff BosmaDon RitzBob SharpPrabhat Malviya

© 2019 Trident Labs

Questions?

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References/ Resources

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- AACC: Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients (LMPG)

- 1. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. Morb Mortal Wkly Rep. ePub: 21 December 2018.