The opioid abuse epidemic, with its high rates of overdoses and deaths, has brought the issue of pain medicine to the forefront. Urine drug testing is critically important in helping manage pain patients, assess adherence, and detect diversion, yet clinicians often don’t know how to use or interpret this type of testing. That’s where clinical laboratory professionals come in.
A new AACC Laboratory Medicine Practice Guideline (LMPG), now in draft form, provides evidence-based recommendations on urine drug testing for pain medications. The goal is to provide more targeted results and help clinicians make better decisions and justify those decisions to regulators and payers.
Three members of the 11-member LMPG committee, Loralie Langman, PhD, of the Mayo Clinic, Nancy Bratanow, MD, of Midwest Comprehensive Pain Care, and Robin Hamill-Ruth, MD, of the University of Virginia Health System, will discuss the guideline at the 68th AACC Annual Scientific Meeting & Clinical Lab Expo during a symposium, NACB LMPG on Laboratory Testing to Support Pain Management, on August 1, from 12:30 p.m. to 2 p.m.
“Anyone who orders, interprets, or performs drug testing for pain management patients should attend,” said Langman, who will moderate the panel.
The guideline was developed after an update last year of a 2012 systemic review of thousands of academic papers.
Among its key recommendations:
- Obtain a urine drug screen before initiating any controlled substance pain therapy, with random drug testing at least once or twice a year for low-risk patients, more frequently for high-risk patients (those with a history of substance abuse or addiction).
- Use targeted, definitive testing, such as mass spectrometry–based assays, as a first-line test whenever possible. Although immunoassays are still clinically useful, they have limitations that definitive testing can overcome.
- Perform urine adulterant testing on all samples prior to analysis. Do not test the sample if adulteration is suspected.
The LMPG also divides drugs and drug metabolites into categories based on whether they should be tested routinely, only for high-risk patients, or only as clinically indicated. This recommendation is designed to counteract marketing messages that encourage laboratories and clinicians to use panels with hundreds of analytes.
Most important, the guidelines urge collaboration between clinicians and laboratorians.
The draft guidelines are available online for AACC members to review and comment by August 7. AACC hopes to publish the final guideline in early fall.