A primer on definitive gas and liquid chromatography drug testing: What clinicians need to know
DOI:
https://doi.org/10.5055/jom.2015.0249Keywords:
mass spectrometry, urine drug testing, monitoringAbstract
Objective: To describe the differences between mass spectrometry technologies and compare and contrast them with immunoassay techniques of urine drug testing (UDT). Highlight the potential importance of the differences among these technologies for clinicians so as to allow them make decisions in their use in patient care.
Methods: Review of mass spectrometry techniques, including gas chromatography, liquid chromatography, and time-of-flight techniques.
Results: The potential clinical implications of these technologies stemming from their scope and accuracy are presented.
Significance: UDT is an important clinical tool, though there are differences in technology and testing processes with important implications for clinical decision making. It is crucial, therefore, that clinicians have an understanding of the technologies behind the tests they order, so that their interpretation and use of results are based on an understanding of the strengths and weaknesses of the technologies used.
References
Chou R, Fanciullo GJ, Fine PG, et al.: Opioids for chronic noncancer pain: Prediction and identification of aberrant drugrelated behaviors: A review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain. 2009; 10(2): 131-146.
Fishbain DA, Cole B, Lewis J, et al.: What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain Med. 2008; 9(4): 444-459.
Federation of State Medical Boards of the United States: Model policy for the use of controlled substances for the treatment of pain. Series. House of Delegates of the Federation of State Medical Boards of the United States, Inc., 2004. Available at http://www.fsmb.org/pdf/2004_grpol_controlled_substances.pdf. Accessed May 25, 2010.
Federation of State Medical Boards of the United States: Model policy on the use of opioid analgesics in the treatment of chronic pain. Federation of State Medical Boards. Washington, DC, July 2013. Available at http://www.fsmb.org. Accessed July 11, 2014.
Gilbert JW, Wheeler GR, Mick GE, et al.: Importance of urine drug testing in the treatment of chronic noncancer pain: Implications of recent medicare policy changes in kentucky. Pain Phys. 2010; 13(2): 167-186.
Manchikanti L, Atluri S, Trescot AM, et al.: Monitoring opioid adherence in chronic pain patients: Tools, techniques, and utility. Pain Phys. 2008; 11(2): S155-S180.
Reisfield GM, Salazar E, Bertholf RL: Rational use and interpretation of urine drug testing in chronic opioid therapy. Ann Clin Lab Sci. 2007; 37(4): 301-314.
Trescot AM, Boswell MV, Atluri SL, et al.: Opioid guidelines in the management of chronic non-cancer pain. Pain Phys. 2006; 9(1): 1-40.
Feldkamp CS: Immunochemical techniques. In Kaplan LA, Pesce AJ (eds.): Clinical Chemistry: Theory, Analysis, Correlation, 5th edn. St. Louis, MO: Mosby, 2010: 162-179.
Garg U, Hammett-Stabler CA: Clinical applications of mass spectrometry: Methods and protocols. In Walker JM (ed.): Methods in Molecular Biology, 1st edn, Vol. 603. New York, NY: Humana Press, 2010.
Lehrer M: Chromatographic techniques. In Kaplan LA, Pesce AJ (eds.): Clinical Chemistry: Theory, Analysis, Correlation, 5th edn. St. Louis, MO: Mosby, 2010: 81-117.
Thompson SG: Principles for competitive-binding assays. In Kaplan LA, Pesce AJ (eds.): Clinical Chemistry: Theory, Analysis, Correlation, 5th edn. St. Louis, MO: Mosby, 2010: 180-199.
Wild D (ed.): The Immunoassay Handbook: Theory and Applications of Ligand Binding, ELISA and Related Techniques, 4th edn. Oxford, UK: Elsevier, 2013.
Passik SD, Rzetelny A, Kirsh KL, et al.: Trends in drug and illicit use from urine drug testing from addiction treatment clients. Poster session presented at International Conference on Opioids (ICOO): Basic Science, Clinical Applications & Compliance, Annual Meeting, Jun 9-11, 2013, Boston, MA.
Pesce A, Gonzales E, Almazan P, et al.: Medication and illicit substance use analyzed using liquid chromatography tandem mass spectrometry (LC-MS/MS) in a pain population. J Anal Bioanal Tech. 2012; 3(3): 1-5.
Pesce A, West C, West R, et al.: Analytical considerations when monitoring pain medications by LC-MS/MS. J Anal Bioanal Tech. 2012; S5: 1-11.
Ruppel TD: Drugs of abuse in GC/MS following SAMHSA (NIDA) Procedures. Application Note. Perkin Elmer, Minneapolis, 2008.
Siuzdak G: The Expanding Role of Mass Spectrometry in Biotechnology, 2nd edn. San Diego, CA: MCC Press, 2006.
Mikel C, Almazan P, West R, et al.: LC-MS/MS extends the range of drug analysis in pain patients. Ther Drug Monit. 2009; 31(6): 746-748.
Poklis A: Gas chromatography. In Kaplan LA, Pesce AJ (eds.): Clinical Chemistry: Theory, Analysis, Correlation, 1st edn. St. Louis, MO: Mosby, 1984: 117-135.
SAMHSA: Medical Review Officer Manual for Federal Agency Workplace Drug Testing Programs. Rockville, MD: Substance Abuse and Mental Health Services Administration (SAMHSA), Effective October 1, 2010.
Pesce A, West C, West R, et al.: Determination of medication cutoff values in a pain patient population. J Opioid Manag. 2011; 7(2): 117-122.
West R, Pesce A, Crews B, et al.: Determination of illicit drug cutoff values in a pain patient population. Clin Chim Acta. 2011; 412(17-18): 1589-1593.
Mikel C, Pesce A, West C: A tale of two drug testing technologies: GC-MS and LC-MS/MS. Pain Phys. 2010; 13(1): 91-92.
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