ASAM Drug Testing Pocket Guide

Drug Testing Pocket Guide

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10 Part 3: Additional Considerations for Drug Testing in Addiction Treatment Documentation and Confidentiality Î Addiction treatment programs should provide written drug testing procedures to patients. Procedures should be reviewed with the patient at the start of his or her treatment. Î Providers should document the rationale for the drug tests they order and the clinical decisions that are based upon drug test results. Î Providers should ask patients about and document potential sources of cross-reactivity, including various foods and current medications. Î Particular characteristics of a sample with the potential to lead to problems with interpretation (e.g., hair that has been chemically treated) should be documented at the time of collection. Î Test results should be documented. Î Test results should be kept confidential to the extent permitted by law. Providers should thoroughly explain to patients all rules regarding confidentiality, consent, and sharing test results with outside entities. Î In general, providers should use caution when sharing test results with outside entities such as justice settings or employers. When sharing test results with outside entities, it is optimal that positive results be verified with a definitive test. Practitioner Education and Expertise Table 2. Potential False Positive Sources Cocaine Typically no cross-reactive substances with modern testing. Opiates Typically no cross-reactive substances with modern testing. Note that many opioids are not detected by standard opiate assay and need separate screens (oxycodone, methadone, fentanyl, tramadol, tapentadol, buprenorphine, oxymorphone, other synthetic/ designer opioids). Note poppy seed ingestion from dietary sources (bagels, pastries) may result in both codeine and morphine (opiate) detection in the urine although not when the higher cutoff of 2000 ng/mL is utilized. THC Very limited potential for any false positives with modern screens. BZD Sertraline is cross-reactive with the clonazepam assay. Clonazepam and lorazepam may not be detected with certain benzodiazepine POC assays. ese benzodiazepines may require definitive testing or specific assays targeted to these benzodiazepines for sensitive detection. Amphetamine/ Methamphetamine Bupropion, pseudoephedrine/ephedrine. Note that methylphenidate is not detected via amphetamine assays but targeted analysis is available from many labs. PCP Dextromethorphan.

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