Drug Monitoring, Assess Panels, Quantitative, Urine
These panels are used to assess baseline medication and drug use when substance use disorder is suspected or before prescribing or changing prescribed drugs with potential for misuse. They are also used to assess drug use in follow-up testing.Test Summary
Drug Monitoring, Assess Panels, Quantitative, Urine
Test codes:
- 39989: Drug Monitoring Assess Panel, Base, Quantitative, Urine
- 39991: Drug Monitoring Assess Panel, Plus, Quantitative, Urine
- 39992: Drug Monitoring Assess Panel, Extended, Quantitative, Urine
Clinical use
- Assess baseline medication and drug use
- When substance use disorder is suspected
- Before prescribing drugs or changing prescribed drugs with potential for misuse
- Assess drug use in follow-up testing
Clinical background
Drug testing in the clinical setting can provide information that improves patient care and prompts important clinical discussions with patients.1 For example, absence of an expected drug could suggest poor adherence or diversion, whereas detection of a nonprescribed licit or illicit drug could raise concerns regarding substance misuse.
Urine drug testing provides an objective assessment of drug use. Testing can be divided into presumptive and definitive tests. Presumptive drug tests (eg, immunoassays) are used to detect possible use of many drug classes at the point of care. However, they do not necessarily determine which drug a patient is taking.
Definitive drug tests use more complex methods (eg, liquid chromatography-tandem mass spectrometry [LC-MS/MS]) to identify specific drugs and metabolites in the test specimen. They can be used to confirm presumptive test results, or as an initial screen, but require specialty laboratory expertise. Quantitative tests indicate drug levels in the urine, whereas qualitative tests indicate the presence or absence of a given drug relative to established cut-off levels.
Panel testing that simultaneously measures a broad array of drug classes using definitive mass spectrometry–based testing is a means of establishing baseline drug use (prescription and non-prescription) in some patients. However, no single panel can be used to address all clinical needs; the availability of multiple testing options allows more flexibility for the physician.2
The Drug Monitoring, Assess Panels, Quantitative, Urine (test codes 39989, 39991, and 39992) provide options for assessing the presence of different drug classes, depending on clinical needs (Table 1). Panel components may be ordered separately. In addition, medMATCH® reports (test code 39158) can be ordered for these panels to match assay results to prescription information.
Table 1. Drugs (Individual Test Codes) Included in the Panels
Base panel (test code 39989) |
Plus panel (test code 39991) |
Extended panel (test code 39992) |
The American Society for Addiction Medicine (ASAM) has guidance on the clinical need to include various drugs in panel testing.3 Panels should be based on the patient’s drug(s) of choice, prescribed medications, and drugs commonly used in the patient’s geographical location and peer group.3
In general, the frequency of testing depends on the physician’s clinical judgment based on the patient’s diagnosis and reason for drug testing.2 For outpatients and partially hospitalized patients, ASAM recommends more frequent testing during the addiction stabilization period, tapering from methadone and buprenorphine, and the period thereafter; less frequent testing is indicated during the maintenance phase of treatment.3
The Centers for Disease Control and Prevention (CDC) recommends that clinicians consider the benefits and risks of drug testing before starting opioid treatment and at least annually during opioid treatment.4
Individuals suitable for testing
- Patients being considered for opioid therapy or a change in treatment
- Patients who request a prescription for a controlled substance but
- 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 substance use disorder
Method
- LC-MS/MS
- Specimen validity testing, including creatinine with reflex to specific gravity, pH, and oxidant
Interpretive information
A "positive" result indicates that a drug or its metabolite has been definitively quantified at or above its cut-off value. A "negative" result indicates that a drug or its metabolite was not present at levels above the cut-off value.
medMATCH reports, if ordered, indicate whether a detected drug was prescribed ("consistent") or not prescribed ("inconsistent") or whether a prescribed drug was not detected ("inconsistent"). The latter result may indicate noncompliance with the treatment plan or diversion.
Quantitative values indicate drug and/or metabolite levels in the urine specimen but cannot be used to assess the drug dose because excreted drugs are extensively metabolized; many factors, including genetics, age, weight, health conditions, and other medications, may influence how the body processes drugs.
Urine specimen validity results indicating a pH outside the 4.5 to 9.0 range, creatinine <20 mg/dL with abnormal specific gravity, and/or presence of oxidants ≥200 μg/mL are considered to render the drug testing results invalid because of suspected adulteration, dilution, or both.2
These panels are 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.5
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
- American Society of Addiction Medicine (ASAM). Drug testing: a white paper of the American Society of Addiction Medicine (ASAM). American Society of Addiction Medicine (ASAM); 2013.
- Substance Abuse Mental Health Services Administration. Clinical drug testing in primary care: technical assistance publication series (TAP) 32. HHS Publication (SMA); 2012.
- Jarvis M, Williams J, Hurford M, et al. Appropriate use of drug testing in clinical addiction medicine. J Addict Med. 2017;11(3):163-173. doi:10.1097/ADM.0000000000000323
- 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
- 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 9/2025
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39393 - Drug Monitoring, Fentanyl, Quantitative, Urine
Fentanyl is an opioid analgesic with a potency approximately 80 times that of morphine. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of fentanyl is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39991 - Drug Monitoring Assess Panel, Plus, Quantitative, Urine
A single direct to definitive panel with the ability to identify multiple specific drugs and metabolites across drug classes facilitates enhanced patient care. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39989 - Drug Monitoring Assess Panel, Base, Quantitative, Urine
A single direct to definitive panel with the ability to identify multiple specific drugs and metabolites across drug classes facilitates enhanced patient care. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39435 - Drug Monitoring, Zolpidem, Quantitative, Urine
Zolpidem is used to treat patients with insomnia. This test is used to detect the presence of the drug as a therapeutic drug monitoring and to aide clinicians with the drug's dosage effectiveness.
39405 - Drug Monitoring, Tapentadol, Quantitative, Urine
Tapentadol is approved for the treatment of moderate to severe acute pain. Due to its dual mechanism of action as an opioid agonist and norepinephrine reuptake inhibitor, there is potential for ON LABEL for chronic pain. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of tapentadol is important for ensuring compliance to treatment strategies. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39391 - Drug Monitoring, Buprenorphine and Naloxone, Quantitative, Urine
This test measures levels of buprenorphine and its metabolite norbuprenorphine in urine. Buprenorphine and norbuprenorphine are biomarkers for monitoring possible use or non-use of buprenorphine. The test is a definitive drug assay using the liquid chromatography/mass spectrometry (LC/MS-MS) method of analysis.
Buprenorphine is an opioid analgesic used for moderate to moderately severe pain. Formulated with naloxone, buprenorphine is used to treat opioid substance use disorders. Less than 11% of the dose is excreted as free and conjugated unchanged drug, while less than 14% is excreted as free and conjugated metabolites [1].
According to the American Association for Clinical Chemistry (AACC), testing drugs/drug metabolites is recommended and effective for detecting the use of relevant over-the-counter, prescribed, and nonprescribed drugs, as well as illicit substances in pain-management patients [2]. Laboratory testing is more effective than other physician tools for the detection of these substances and is useful for routine monitoring of adherence. Instances where unchanged drug is detected, but metabolite(s) is not, may be indicative of drug added to the specimen after collection (eg, pill shaving, drug spiking) [2].
Note: 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.
Urine drug test results equal to or greater than cutoff are reported as quantitative values and results less than cutoff are reported as negative. Quantitative values cannot be used to assess the drug dose because the drug is extensively metabolized and excreted in the urine.
References
1. Suboxone® [package insert]. Vacaville, CA: ALZA Corp; 2018.
2. AACC. Using clinical laboratory tests to monitor drug therapy in pain management patients. November 2017.
https://www.aacc.org/-/media/Files/Science-and-Practice/Practice-Guidelines/Pain-Management/LMPGPain-Management20171220.pdf. Accessed November 21, 2019.
Buprenorphine is an opioid analgesic used for moderate to moderately severe pain. Formulated with naloxone, buprenorphine is used to treat opioid substance use disorders. Less than 11% of the dose is excreted as free and conjugated unchanged drug, while less than 14% is excreted as free and conjugated metabolites [1].
According to the American Association for Clinical Chemistry (AACC), testing drugs/drug metabolites is recommended and effective for detecting the use of relevant over-the-counter, prescribed, and nonprescribed drugs, as well as illicit substances in pain-management patients [2]. Laboratory testing is more effective than other physician tools for the detection of these substances and is useful for routine monitoring of adherence. Instances where unchanged drug is detected, but metabolite(s) is not, may be indicative of drug added to the specimen after collection (eg, pill shaving, drug spiking) [2].
Note: 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.
Urine drug test results equal to or greater than cutoff are reported as quantitative values and results less than cutoff are reported as negative. Quantitative values cannot be used to assess the drug dose because the drug is extensively metabolized and excreted in the urine.
References
1. Suboxone® [package insert]. Vacaville, CA: ALZA Corp; 2018.
2. AACC. Using clinical laboratory tests to monitor drug therapy in pain management patients. November 2017.
https://www.aacc.org/-/media/Files/Science-and-Practice/Practice-Guidelines/Pain-Management/LMPGPain-Management20171220.pdf. Accessed November 21, 2019.
39407 - Drug Monitoring, Gabapentin, Quantitative, Urine
Gabapentin is used as an anticonvulsant in the management of neuropathic pain in adults and as adjunctive therapy in the treatment of partial seizures in patients with epilepsy. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of gabapentin is important for ensuring compliance to treatment strategies. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39385 - Drug Monitoring, Amphetamines, Quantitative, Urine
The amphetamine class of drugs are traditionally classified as stimulants. Some members of the class (amphetamine) are prescribed for treatment of attention-deficit hyperactivity disorder (ADHD), to suppress appetite, and for narcolepsy. Other members of the class are considered drugs of abuse (methamphetamine, MDMA) with no accepted medical uses. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of the amphetamines and their metabolites is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
11831 - Drug Monitoring, Ketamine, Quantitative, Urine
Ketamine is a potent dissociative anesthetic and hallucinogenic. Traditionally, used as a veterinary tranquilizer. Esketamine (Spravato®) Nasal Spray FDA-approved for Treatment Resistant Depression in Humans Depressive Symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or actions. Misuse and abuse occur due to the desired detachment and hallucinogenic effects associated with Ketamine.
The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39401 - Drug Monitoring, Phencyclidine, Quantitative, Urine
Phencyclidine (PCP, "angel dust") is an illicit psychotropic drug that causes anxiety, disorientation, and acute confusion resembling schizophrenia. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of PCP is important for ensuring compliance to treatment strategies. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39431 - Drug Monitoring, Mitragynine, Quantitative, Urine
Monitoring of Mitragynine in urine, the results of this test are used in specific treatment programs to determine compliance with prescribed dosing schedules.
39992 - Drug Monitoring Assess Panel, Extended, Quantitative, Urine
A single direct to definitive panel with the ability to identify multiple specific drugs and metabolites across drug classes facilitates enhanced patient care. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39399 - Drug Monitoring, Opiates Expanded, Quantitative, Urine
Opiates possess exceptional analgesic properties and have become the mainstay of pain management therapies. Being both psychologically and physically addictive, the monitoring of opiate use and abuse is a major component of any treatment program. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of the opiates is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39392 - Drug Monitoring, Cocaine Metabolite, Quantitative, Urine
Cocaine is sometimes used clinically as a local anesthetic. More commonly however, it is used illicitly. Identification and verification of cocaine's metabolite benzoylecgonine in urine is most often used to show illicit use. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of the cocaine is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39403 - Drug Monitoring, Carisoprodol Metabolite, Quantitative, Urine
Carisoprodol is used clinically as a muscle relaxant and sedative. Carisoprodol's metabolite, Meprobamate, is commonly accepted as the primary urinary metabolite in man. Detection of this metabolite is indicative of ingestion of carisoprodol. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of propoxyphene is important for ensuring compliance to treatment strategies. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39398 - Drug Monitoring, Methadone Metabolite, Quantitative, Urine
Methadone is prescribed to patients for the alleviation of opioid addiction withdrawal symptoms and analgesic purposes. The methadone and metabolite test is a definitive drug assay using the liquid chromatography/mass spectrometry (LC/MS-MS) method of analysis. Therapeutic urine drug monitoring of methadone and its metabolite EDDP is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes strategies. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39394 - Drug Monitoring, Heroin Metabolite, Quantitative, Urine
6-Monoacetylmorphine is the primary metabolite of heroin. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of 6-Monoacetylmorphine is important for ensuring compliance to treatment strategies. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39397 - Drug Monitoring, MDMA/MDA, Quantitative, Urine
3,4-Methylenedioxymethamphetamine (MDMA, aka Ecstasy, Molly) is a stimulant that is hallucinogenic in large does. The test is a definitive assay using a specific and sensitive liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of MDMA is important for ensuring compliance to treatment strategies. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39389 - Drug Monitoring, Benzodiazepines, Quantitative, Urine
The benzodiazepine class of drugs are traditionally classified as depressants. They are used therapeutically to produce sedation, induce sleep, relieve anxiety, treat muscle spasms, and to prevent seizures. In general, benzodiazepines act as hypnotics in high doses, anxiolytics in moderate doses, and sedatives in low doses. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of the benzodiazepines is important for ensuring compliance to treatment strategies, as well as ensuring non-diversion for illicit purposes. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39406 - Drug Monitoring, Tramadol, Quantitative, Urine
This test measures levels of tramadol and its metabolite desmethyltramadol in urine. Tramadol and desmethyltramadol are biomarkers for monitoring possible use or non-use of tramadol. The test is a definitive drug assay using the liquid chromatography/mass spectrometry (LC/MS-MS) method of analysis.
Tramadol is an opioid-like analgesic used to treat moderate to moderately severe pain. Approximately 30% of the dose is excreted as unchanged drug, while 60% is excreted as metabolites [1,2].
According to the American Association for Clinical Chemistry (AACC), testing drugs/drug metabolites is recommended and effective for detecting the use of relevant over-the-counter, prescribed, and nonprescribed drugs, as well as illicit substances in pain-management patients [3].
Laboratory testing is more effective than other physician tools for the detection of these substances in pain-management patients and is useful for routine monitoring of adherence. Instances where unchanged drug is detected, but metabolite(s) is not, may be indicative of drug added to the specimen after collection (eg, pill shaving, drug spiking) [3].
Note: 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.
Urine drug test results equal to or greater than cutoff are reported as quantitative values and results less than cutoff are reported as negative. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
References
1. Ultram [package insert]. Raritan, NJ: Ortho-McNeil Pharmaceutical, Inc; 2003.
2. Vazzana M, et al. Biomed Pharmacother. 2015;70:234-238.
3. AACC. Using clinical laboratory tests to monitor drug therapy in pain management patients. November 2017. https://www.aacc.org/-/media/Files/Science-and-Practice/Practice-Guidelines/Pain-Management/LMPGPain-Management20171220.pdf?la=en&hash=19670524407619F78999AB60731A24CB4901939D. Accessed November 21, 2019.
Tramadol is an opioid-like analgesic used to treat moderate to moderately severe pain. Approximately 30% of the dose is excreted as unchanged drug, while 60% is excreted as metabolites [1,2].
According to the American Association for Clinical Chemistry (AACC), testing drugs/drug metabolites is recommended and effective for detecting the use of relevant over-the-counter, prescribed, and nonprescribed drugs, as well as illicit substances in pain-management patients [3].
Laboratory testing is more effective than other physician tools for the detection of these substances in pain-management patients and is useful for routine monitoring of adherence. Instances where unchanged drug is detected, but metabolite(s) is not, may be indicative of drug added to the specimen after collection (eg, pill shaving, drug spiking) [3].
Note: 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.
Urine drug test results equal to or greater than cutoff are reported as quantitative values and results less than cutoff are reported as negative. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
References
1. Ultram [package insert]. Raritan, NJ: Ortho-McNeil Pharmaceutical, Inc; 2003.
2. Vazzana M, et al. Biomed Pharmacother. 2015;70:234-238.
3. AACC. Using clinical laboratory tests to monitor drug therapy in pain management patients. November 2017. https://www.aacc.org/-/media/Files/Science-and-Practice/Practice-Guidelines/Pain-Management/LMPGPain-Management20171220.pdf?la=en&hash=19670524407619F78999AB60731A24CB4901939D. Accessed November 21, 2019.
39409 - Drug Monitoring, Methylphenidate Metabolite, Quantitative, Urine
Methylphenidate is a mild CNS stimulant used to control symptoms of attention deficit hyperactivity disorder (ADHD) in adults and children. Ritalin acid is the metabolite of methylphenidate, and its detection is indicative of ingestion of methylphenidate. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of methylphenidate is important for ensuring compliance to treatment strategies. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39414 - Drug Monitoring, Naltrexone, Quantitative, Urine
Naltrexone (opioid antagonist) is used to treat alcohol and opioid dependence. This new test provides an option for compliance monitoring for naltrexone use.
39410 - Drug Monitoring, Pregabalin, Quantitative, Urine
Pregabalin is used as an adjunct therapy for partial seizures, for the treatment of generalized anxiety disorder, neuropathic pain and fibromyalgia. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of pregabalin is important for ensuring compliance to treatment strategies. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
39411 - Drug Monitoring, Tricyclic Antidepressants, Quantitative, Urine
Amitriptyline and nortriptyline are used to treat various forms of depression and chronic neuropathic pain. The test is a definitive assay using liquid chromatography mass spectroscopy (LC/MS/MS) methodology. Therapeutic urine drug monitoring of these drugs is important for ensuring compliance to treatment strategies. Urine or oral fluid are the specimens of choice for routine monitoring of patients taking prescription drugs. Use of serum/plasma should be limited to anuretic patients, or where a patient's clinical appearance does not coincide with their prescribed medications. 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. Quantitative values cannot be used to assess the drug dose, because the drug is extensively metabolized and excreted in the urine.
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