Test Summary
Drug Monitoring Assess Panel, Comprehensive, Qualitative Urine
Test code: 11878
Clinical use
- Assess presence or absence of licit or illicit drugs in patients who present with signs and symptoms of poisoning, intoxication, and/or overdose in an emergency care setting
- Assess baseline medication and drug use (1) when substance use disorder (SUD) is suspected or (2) before prescribing (or changing a prescription for) drugs with potential for misuse
Clinical background
Urine drug testing may be used in combination with patient history and clinical presentation to identify causes of poisoning, intoxication, and overdose in patients presenting in the emergency room. In addition, SUDs can be identified in patients experiencing an overdose or, with patient consent, in those who have become acutely ill or injured because of substance misuse.1,2 Awareness of SUDs may prompt a change in behavior or a referral to recovery programs.1,2 Children presenting with signs of intoxication can be evaluated for exposure to drugs, which may prompt conversations on safe drug storage or the need for referral to Child Protective Services.3 In addition, urine drug testing can be used as a toxicological screen to help establish base-line drug use; the Centers for Disease Control and Prevention (CDC) recommends that urine drug testing be considered and discussed with the patient before starting opioid drug therapy.4
Understanding the strengths and limitations of the specific drug testing regimen (ie, presumptive vs definitive) is important, as inaccurate results or misinterpretation of results can lead to neglect of other etiologies, inappropriate legal actions, or continued misuse or child endangerment.5 Presumptive drug tests (eg, immunoassays including urinary strip tests) are used to detect possible use of many drug classes but do not determine which drug a patient is taking. Presumptive tests also fail to detect some new or novel “designer drugs.” Definitive drug tests (eg, mass spectrometry assays) identify specific drugs and metabolites in the test specimen. They can be used to confirm presumptive test results, or they can be used as the initial test.
Using a large panel of definitive drug tests has advantages over other drug screening strategies. Presumptive drug tests are much less specific and sensitive than definitive tests and can lead to more false-positive and false-negative results.6 Standard panels detect far fewer drugs and provide a less complete profile of drug use.
Quest Diagnostics offers Drug Monitoring, Assess Panel, Comprehensive, Qualitative, Urine (test code 11878) as an initial, definitive, mass spectrometry-based drug screening test. It can be used to assess the presence or absence of licit or illicit drugs in an emergency care setting or to establish baseline drug use before prescribing opioids. The panel includes 113 drugs that are definitively identified at or above specified cutoff concentrations in urine (Table).
The panel has some limitations. An indeterminate ("Interference") result may be caused by interference observed as suppression or enhancement around the cutoffs of one or more analytes due to high levels of certain drugs the patient is taking.7 In addition, this panel cannot resolve the cannabinoid isomers Δ8-THC-COOH (generally legal under federal law) and Δ9-THC-COOH (illegal under federal law). Because parameters are optimized to simultaneously detect 113 analytes, cutoffs may not be optimal for all prescription compliance situations compared to quantitative standalone tests or smaller panels.
Quest also offers smaller panels and tests for individual analytes from this panel, both quantitative and qualitative. For a full list of drug monitoring options, see https://testdirectory.questdiagnostics.com/test/home.
Individuals suitable for testing
- Patients experiencing signs or symptoms consistent with drug-induced toxicity
- Patients who have an acute illness or injury that may be related to the influence of drugs and provide informed consent
- Patients being considered for opioid therapy or a change in treatment
- Patients requesting a prescription for a controlled substance but who8
- Resist a full evaluation for their stated medical condition
- Arrive toward the end of, or after, office hours
- Repeatedly report losing prescriptions
- Are reluctant to change medications
- Do not adhere to the treatment plan
- Patients suspected of diversion
- Patients who need advocacy to verify their abstinence
- Patients in recovery from SUD
Methods
- Liquid chromatography-tandem mass spectrometry
- Qualitative, analyte results reported as "positive," "negative," or "interference"
- Individual analyte cutoffs: 10 to 3,000 ng/mL
- No clinically significant interferences observed between the 113 analytes within the panel or from 51 additional related substances at commonly observed or normal therapeutic concentration ranges
Interpretive information
A “positive” result indicates that a drug or its metabolite has been definitively detected at or above its cutoff value. A “negative” result indicates that a drug or its metabolite was not detected at levels at or above the cutoff value. “Interference” indicates that the presence or absence of the drug or its metabolite cannot be determined because of interfering substances.
This drug test is for medical treatment only. Analysis is performed as non-forensic testing and these results should be used only by healthcare providers to render diagnosis or treatment or to monitor progress of medical conditions.
This panel is not designed to determine clinical impairment. For example, assessment of clinical impairment due to opioid misuse should be based on behavior, cognitive function, motor performance, and somnolence, independent of the presence of an opioid or its metabolite.9
No single monitoring approach provides adequate information about the pattern or dose of patient drug use. Safest prescribing habits should include a combination of tools and laboratory test results to correctly detect drug-use patterns.
References
- Hawk K, D’Onofrio G. Emergency department screening and interventions for substance use disorders. Addict Sci Clin Pr. 2018;13(1):18. doi:10.1186/s13722-018-0117-1
- Swimmer KR, Sandelich S. Substance use disorder. Emerg Med Clin North Am. 2024;42(1):53-67. doi:10.1016/j.emc.2023.06.023
- Lynch KL. A case series evaluation of comprehensive drug testing in the pediatric acute care setting. J Mass Spectrom Adv Clin Lab. 2023;28:75-79. doi:10.1016/j.jmsacl.2023.02.011
- Dowell D, Ragan KR, Jones CM, et al. CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. MMWR Recomm Rep. 2022;71(3):1-95. doi:10.15585/mmwr.rr7103a1
- Tesfazghi MT, Bardelmeier R, Saunders AN, et al. Development and implementation of one-step, broad-spectrum, high-sensitivity drug screening by tandem mass spectrometry in a pediatric population. J Appl Lab Med. 2022;7(2):409-420. doi:10.1093/jalm/jfab157
- Stellpflug SJ, Cole JB, Greller HA. Urine drug screens in the emergency department: the best test may be no test at all. J Emerg Nurs. 2020;46(6):923-931. doi:10.1016/j.jen.2020.06.003
- Bechtel L, Holstege CP. Utilizing the toxicology laboratory in the poisoned patient. Emerg Med Clin North Am. 2022;40(2):431-441. doi:10.1016/j.emc.2022.01.003
- Substance Abuse Mental Health Services Administration. Clinical Drug Testing in Primary Care: Technical Assistance Publication Series (TAP) 32. HHS Publication (SMA); 2012.
- Stolbach A, Connors N, Nelson L, et al. ACMT position statement: interpretation of urine opiate and opioid tests. J Med Toxicol. 2022;18(2):176-179. doi:10.1007/s13181-021-00864-1
Content reviewed 08/2024
11878 - Drug Monitoring Assess Panel, Comprehensive, Qualitative, Urine
Reference ranges are provided as general guidance only. To interpret test results use the reference range in the laboratory report.
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