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Clinical Drug Monitoring
Brought to you by Quest Diagnostics and Practical Pain Management

Real-World Testing Scenarios

It is important that prescribing clinicians—whether in primary care, pain specialty care, or behavioral/addiction medicine—understand the drug complexity involved in ordering and interpreting drug monitoring screens. For example, having a solid grasp on how certain medications metabolize in the body and how definitive testing can play a role in determining patient compliance will help providers know what to expect and what not to expect in screening results.

Here, 3 cases highlight common but complicated testing scenarios that may arise in drug monitoring.

Image: iStock

Scenario 1: Gabapentinoids in a Patient with Several Comorbidities

A patient on buprenorphine, hydrocodone/acetaminophen, alprazolam, quetiapine, pantoprazole, and venlafaxine tests negative for opiates, benzodiazepines, and buprenorphine but tests positive for methadone, tetrahydrocannabinol (THC), and phencyclidine (PCP). Here’s why and what to do.

Image: iStock

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Scenario 2: THC in a Patient on Opioids and NSAIDs

A patient on hydrocodone/acetaminophen, ibuprofen, and a lidocaine patch tests positive for opiates as expected but also for THC. Here’s why and what to do.

Image: iStock

Scenario 3: Buprenorphine Metabolite Missing in an Opioid-Addicted, MAT Patient

A patient successfully tapered off an oxymorphone regimen as part of a medication-assisted treatment (MAT) plan for opioid use disorder is maintained on buprenorphine. The patient tests positive for buprenorphine and benzodiazepine but negative for the buprenorphine metabolite, norbuprenorphine. Here’s why and what to do.

 

Next, Additional Resources, including downloadable FAQs for your patients

 

Last updated on: May 7, 2020
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