title: Optimizing urine drug testing for monitoring medication compliance in pain management.
abstract: BACKGROUND
  It can be challenging to successfully monitor medication compliance in pain management. Clinicians and laboratorians need to collaborate to optimize patient care and maximize operational efficiency. The test menu, assay cutoffs, and testing algorithms utilized in the urine drug testing panels should be periodically reviewed and tailored to the patient population to effectively assess compliance and avoid unnecessary testing and cost to the patient.
  
  
  OBJECTIVE
  Pain management and pathology collaborated on an important quality improvement initiative to optimize urine drug testing for monitoring medication compliance in pain management.
  
  
  METHODS
  We retrospectively reviewed 18 months of data from our pain management center. We gathered data on test volumes, positivity rates, and the frequency of false positive results. We also reviewed the clinical utility of our testing algorithms, assay cutoffs, and adulterant panel. In addition, the cost of each component was calculated.
  
  
  RESULTS
  The positivity rate for ethanol and 3,4-methylenedioxymethamphetamine were <1% so we eliminated this testing from our panel. We also lowered the screening cutoff for cocaine to meet the clinical needs of the pain management center. In addition, we changed our testing algorithm for 6-acetylmorphine, benzodiazepines, and methadone. For example, due the high rate of false negative results using our immunoassay-based benzodiazepine screen, we removed the screening portion of the algorithm and now perform benzodiazepine confirmation up front in all specimens by liquid chromatography-tandem mass spectrometry.
  
  
  CONCLUSIONS
  Conducting an interdisciplinary quality improvement project allowed us to optimize our testing panel for monitoring medication compliance in pain management and reduce cost.
authors.affiliation: Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Stacy E F
authors.initials: SE
authors.lastname: Melanson
authors.forename: Adam S
authors.initials: AS
authors.lastname: Ptolemy
authors.forename: Ajay D
authors.initials: AD
authors.lastname: Wasan
mesh_terms: D000700:Analgesics / Q000652:urine*; D006801:Humans; D055118:Medication Adherence; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D012189:Retrospective Studies; D015813:Substance Abuse Detection / Q000379:methods*
chemical_list: D000700:Analgesics
keywords: Chronic Pain; Opioids; Pain Management; Quality Improvement; Urine Drug Testing