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Spotlight on Test Utilization: Quantitation, and Confirmation using Urine Drug Test Results

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Our ARUP Institute for Learning Spotlight Series is designed to provide brief educational overviews highlighting test utilization issues, new tests, and testing technology. In this video, Frederick Strathmann, PhD, DABCC (CC,TC) discusses the Quantitation, Confirmation and Compliance Determination using Urine Drug Test Results.

Of utah and medical director and toxicology at arup laboratories in the testing regarding quantitation confirmation and dose compliance with the screen with reflex to confirmation workflow regarding drug methods such as an immunoassay and if the results are positive and acid-based screen often provides little clinical value for example consider the if a physician ordered a

Standard drug screen with reflex to confirmation for classes such as benzodiazepines and amphetamines but would also expect a to interpret that positive opioid result for an opioid immunoassay targeted cross react to produce a positive result in the case of our example patient interpretation of a positive opioid screen but because our patient is heroine abuse hydromorphone

Ingestion or result is a classic example of a largely uninformative result that requires laboratory the more specific method is often chromatography coupled to mass typically provides a quantitative result such as 327 nanograms removal of but it is important to keep the concepts of confirmation and quantitation that use liquid chromatography time-of-flight mass spectrometry

Established cutoff concentrations much like traditional screening assays but specific form of mass spectrometry for many applications and non forensic use a identification with no need for further testing instead of reporting a single screen will report results for individual compounds such as morphine metabolites to further disentangle the concepts of confirmation and patients

Each with prescriptions for oxycodone patient one also has a alprazolam a targeted urine drug screen by time of flight mass spectrometry is and patient 2 had detectable oxycodone all of which are consistent with oxycodone ingestion patient one was while patient two was positive for alprazolam and the alpha hydroxy hydromorphone those are not related through metabolism to

Any of the can be confident in the identification but the results appear inconsistent with hydromorphone found and most importantly do these results indicate both patients clear that confirmatory testing is not actually what we need here since we hydrocodone and hydromorphone are actually present our targeted situation where quantitation can help let’s take a look at the

Results from an notice is that only opioid connotation was ordered since there is results for the benzodiazepines and metabolites from the targeted expectations the quantitative results for hydrocodone and hydromorphone the concentrations of hydrocodone and hydromorphone are consistent with ingested some formulation of hydrocodone in addition to the prescribed the oxycodone

Concentration this is important as current tolerances for formulations due to process impurities for patient 2 the quantitative results impurity and not ingestion of a hydrocodone formulation in these two were present in the urine but because these results included the detection of address a commonly asked follow-up question can these quantitative results patient 2 regarding

Their oxycodone prescriptions patient one has an concentration of 3202 nanograms per mil but one important and often overlooked creatinine is widely utilized to provide an indication of urine concentration if effects of urine concentration on the quantitative results patient 2 provided in addition differences in metabolism time of last dose and even food intake can make it

Difficult to generalize any currently proposed algorithms for population thanks for taking the time to view this short video general please don’t hesitate to contact us

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Spotlight on Test Utilization: Quantitation, and Confirmation using Urine Drug Test Results By ARUP Laboratories