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When pain management testing calls for a consult

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Karen Titus

October 2016—Surprises might work for birthday parties—and even then they’re not everyone’s cup of tea—but not in drug screening programs.

Third of three parts. In August and September:
Painstaking process of drug monitoring” and “Mass spec up front for pain management testing

Perhaps the most common reason for doing a toxicology consultation is when a urine drug screen yields an unexpected result, either positive or negative, says Nicholas Heger, PhD, assistant director of clinical chemistry at Tufts Medical Center and assistant professor of anatomic and clinical pathology, Tufts University School of Medicine, Boston.

If a patient is prescribed morphine but only tests positive for methadone, for example, eyebrows might go up. Or perhaps a patient is taking a drug that isn’t detected well by a urine opiates immunoassay, such as fentanyl (which as a synthetic opioid goes undetected).

Dr. Heger

Dr. Heger

Another common reason is when the clinician suspects that the patient may have diverted his or her pain medications, said Dr. Heger, who spoke at and co-chaired an AACC virtual conference on drug monitoring for pain management.

The elements of a toxicology consult are straightforward, Dr. Heger said. (The template he uses is referenced in Clinical Toxicology Testing: A Guide for Laboratory Professionals, CAP Press 2012.) These pieces will become part of a patient’s medical record, and clinicians are likely to use the information to make clinical decisions about prescribing and treatment.

Among the components:

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