title: Protocol for accuracy of point of care (POC) or in-office urine drug testing (immunoassay) in chronic pain patients: a prospective analysis of immunoassay and liquid chromatography tandem mass spectometry (LC/MS/MS).
abstract: BACKGROUND
  Therapeutic use, overuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain continues to be an issue for physicians and patients. It has been stated that physicians, along with the public and federal, state, and local government; professional associations; and pharmaceutical companies all share responsibility for preventing abuse of controlled prescription drugs. The challenge is to eliminate or significantly curtail abuse of controlled prescription drugs while still assuring the proper treatment of those patients. A number of techniques, instruments, and tools have been described to monitor controlled substance use and abuse. Thus, multiple techniques and tools available for adherence monitoring include urine drug testing in conjunction with prescription monitoring programs and other screening tests. However, urine drug testing is associated with multiple methodological flaws. Multiple authors have provided conflicting results in relation to diagnostic accuracy with differing opinions about how to monitor adherence in a non-systematic fashion. Thus far, there have not been any studies systematically assessing the diagnostic accuracy of immunoassay with laboratory testing.
  
  
  METHODS
  A diagnostic accuracy study of urine drug testing.
  
  
  METHODS
  An interventional pain management practice, a specialty referral center, a private practice setting in the United States.
  
  
  OBJECTIVE
  To compare the information obtained by point of care (POC) or in-office urine drug testing (index test) to the information found when all drugs and analytes are tested by liquid chromatography tandem mass spectroscopy (LC/MS/MS) reference test in the same urine sample.
  
  
  METHODS
  The study is designed to include 1,000 patients with chronic pain receiving controlled substances. The primary outcome measure is the diagnostic accuracy. Patients will be tested for various controlled substances, including opioids, benzodiazepines, and illicit drugs. The diagnostic accuracy study is performed utilizing the Standards for Reporting of Diagnostic Accuracy Studies (STARD) initiative which established reporting guidelines for diagnostic accuracy studies to improve the quality of reporting. The prototypical flow diagram of diagnostic accuracy study as described by STARD will be utilized.
  
  
  RESULTS
  Results of diagnostic accuracy and correlation of clinical factors in relation to threshold levels, prevalence of abuse, false-positives, false-negatives, influence of other drugs, and demographic characteristics will be calculated.
  
  
  CONCLUSIONS
  The limitations include lack of availability of POC testing with lower cutoff levels.
  
  
  CONCLUSIONS
  This article presents a protocol for a diagnostic accuracy study of urine drug testing. The protocol also will permit correlation of various clinical factors in relation to threshold levels, prevalence of abuse, false-positives, false-negatives, influence of other drugs, and demographic characteristics.
  
  
  BACKGROUND
  NCT 01052155.
authors.affiliation: Pain Management Center of Paducah, Paducah, KY, USA. drlm@thepainmd.com
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Malla
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Wargo
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Cash
authors.forename: Vidyasagar
authors.initials: V
authors.lastname: Pampati
authors.forename: Kim S
authors.initials: KS
authors.lastname: Damron
authors.forename: Carla D
authors.initials: CD
authors.lastname: McManus
authors.forename: Doris E
authors.initials: DE
authors.lastname: Brandon
mesh_terms: D000700:Analgesics / Q000009:adverse effects / Q000652:urine*; D002853:Chromatography, Liquid / Q000379:methods / Q000592:standards*; D002908:Chronic Disease / Q000188:drug therapy; D019411:Clinical Laboratory Techniques; D003951:Diagnostic Errors / Q000517:prevention & control; D003955:Diagnostic Tests, Routine; D016903:Drug Monitoring / Q000379:methods / Q000592:standards; D004335:Drug and Narcotic Control; D005189:False Positive Reactions; D006801:Humans; D007118:Immunoassay / Q000379:methods / Q000592:standards*; D008137:Longitudinal Studies; D055118:Medication Adherence; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000652:urine; D010146:Pain / Q000188:drug therapy; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012107:Research Design; D015813:Substance Abuse Detection / Q000379:methods / Q000592:standards*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000652:urine; D053719:Tandem Mass Spectrometry / Q000592:standards*; D014481:United States; D016482:Urinalysis / Q000379:methods / Q000592:standards*
chemical_list: D000700:Analgesics