Provider Services - Understand Your Tests.

Provider Services

Our service and support tools enable our clinicians to make the best treatment decision with confidence.

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Essential Tools

A. Risk Assessment Tools for Patients Prescribed Opioids

All Patients

Risk-assessment tool, Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP®-R) or other:
Opioid Agreement
Treatment goals clearly defined
Urine or hair drug test* at first visit
Urine or oral drug tests appropriate for risk level
Check state’s Prescription Drug Monitoring Program (PDMP) before every opioid prescription
Consider medication counts

In-Office Drug Screening:

If a provider chooses to use a Point of Care Testing (POCT) cup or has an immunoassay analyzer, they should consider the following:
Sensitivity, specificity and cutoff levels
Ordering an adulterant panel or sending to a reference lab for an adulterant panel
Sending positive and unexpected results to a reference lab for confirmation on LS/MS/MS or GC/MS technology
Drug and drug classes that may not be detected with in office testing, include these:
You may want to consider sending these drugs to your reference lab for direct testing: Fentanyl, Meperedine, Gabapentin, Buprenorphine, Tramadol, Bath salts, Carisoprodol, Syools for Patients Pres Opioids

B. Drug-Testing Frequency Schedule All Patients:

Low risk: periodic (e.g. up to 2/year)
Medium risk: regular (e.g. up to 4/year)
High risk or opioid >100mg MED/d: frequent (at least 4/year, up to as frequently as every visit)
Aberrant behavior: at the time of each visit

C. Drug Screening Matrix Considerations

Urine:

2-3 Days Most widely used, but easiest to “beat.” Used for routine drug monitoring

Oral Screening:

Up to 48 Hours Detects more recent use; noninvasive sample that is difficult to adulterate and easy to collect. Ideal sample for drug monitoring in chronic opioid treatment.

Blood Hours:

Best sample for measuring pharmacologically active drug levels and provides interpretive information about drug dosing and tolerance. More invasive collection, but blood is ideally suited to periodically check steady-state drug concentrations.

D. Unexpected Results

Unexpected results can occur for a number of reasons, including PRN use of medications, forgetfulness, or breakthrough pain episodes. Always discuss results with the patient before determining results as aberrant.

Potential behavioral flags include the following: