The Urine Drug Screen Is Abnormal—Now What? (SA524)

Abstract

1.Discuss the indications for and implications of obtaining a urine drug screen.2.Discuss the metabolism of substances and techniques for analyzing specimens that influence the reported results of drug screening.3.Describe and incorporate techniques for discussing urine drug screening results with patients and developing an appropriate safety plan. With increasing concerns about abuse of opioids and other controlled substances, palliative care clinicians are being urged to screen for substance abuse and diversion. Urine drug screens (UDS) are often recommended when patients are at high risk for misuse of prescribed medications. A thorough history and the use of screening tools and state prescription drug monitoring programs (where available) can help uncover such patients. If we are to use the UDS effectively, we must know when to order one and how to interpret the results. Understanding the results requires knowing the type of drug screen to order, what metabolites to expect from which drugs, and when false positives and negatives might occur. Palliative care and hospice clinicians need to know what to do when the UDS uncovers evidence of use of unprescribed medications, illegal substances such as cocaine or marijuana, or lack of prescribed medications, as well as the medical and legal implications of prescribing to patients with substance abuse. Concerns about the legal implications of the UDS, especially in an increasingly harsh regulatory environment, are not trivial, but it is important to distinguish between the use of the UDS for medical purposes and those used for legal proceedings (such as for parolees, or for employment). Finally, although palliative care clinicians are well trained in communicating difficult news, they are rarely trained in discussing addiction or negotiating a plan for treating at risk patients with severe cancer-associated pain. In this concurrent session, we will discuss the clinical utility of the UDS, including patient and test selection; review drug metabolism, testing techniques, and their effect on test interpretation; discuss legal implications of screening; and provide role-play examples of model patient interactions following aberrant test results.