Clinical Drug Testing in Primary Care - SAMHSA Publications

Clinical Drug Testing in Primary Care

Technical Assistance Publication Series

TAP 32

Clinical Drug Testing in Primary Care

TAP

Technical Assistance Publication Series

32

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment 1 Choke Cherry Road Rockville, MD 20857

Clinical Drug Testing in Primary Care

Acknowledgments

This publication was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), by RTI International and completed by the Knowledge Application Program (KAP), contract numbers 270-04-7049 and 270 09-0307, a Joint Venture of The CDM Group, Inc., and JBS International, Inc., with SAMHSA, U.S. Department of Health and Human Services (HHS). Christina Currier served as the Contracting Officer's Representative.

Disclaimer

The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS.

Electronic Access and Copies of Publication

This publication may be ordered from SAMHSA's Publications Ordering Web page at . Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726 4727) (English and Espa?ol). The document may be downloaded from the KAP Web site at .

Recommended Citation

Substance Abuse and Mental Health Services Administration. Clinical Drug Testing in Primary Care. Technical Assistance Publication (TAP) 32. HHS Publication No. (SMA) 12-4668. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

Public Domain Notice

All materials appearing in this publication except those taken from copyrighted sources are in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Originating Office

Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857.

HHS Publication No. (SMA) 12-4668 Printed 2012

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Contents

Chapter 1--Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Audience for the TAP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Organization of the TAP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Reasons To Use Clinical Drug Testing in Primary Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Primary Care and Substance Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Development of Drug Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Workplace Drug Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Drug Testing in Substance Abuse Treatment and Healthcare Settings . . . . . . . . . . . . . . 5

Differences Between Federal Workplace Drug Testing and Clinical Drug Testing. . . . . . 6

Caution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Chapter 2--Terminology and Essential

Concepts in Drug Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Drug Screening and Confirmatory Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Testing Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Test Reliability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Window of Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Cutoff Concentrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Cross-Reactivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Drug Test Panels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Test Matrix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Point-of-Care Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Adulterants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Specimen Validity Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

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