Dr. Raouf is a former PGY-1 Pharmacy Resident at the VA Tennessee Valley Healthcare System Nashville. Dr. Bettinger is a PGY-1 Pharmacy Resident, and Dr. Fudin is Residency Program Director for Pharmacy Pain and Palliative Care, both at Stratton VA Medical Center in Albany, New York. Dr. Fudin also is the CEO/CMO at Remitigate and Adjunct Associate Professor at both Albany College of Pharmacy and Health Sciences and Western New England University College of Pharmacy in Springfield, Massachusetts. Correspondence: Dr. Raouf (menaraouf92@gmail.com)
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
Urine drug monitoring is an important tool for substance misuse or abuse and adherence to the prescribed regimen. The most commonly used test is UDM by IA due to its low cost and quick results. However, it comes with an array of false-positive and false-negative results. Clinicians should seek definitive results by confirmatory testing prior to making changes that alter patient care, and all results should include discussions with the patient.
Clinical pharmacy specialists are generally an excellent and often untapped resource to provide guidance for interpretation of both IA and chromatographic testing. Clinical pharmacy specialists have an excellent understanding of the physical and medicinal chemistry properties of laboratory testing, a vast understanding of drug metabolites and interactions that might increase or decrease drug concentrations might account for possible false positives and false negatives, and they can help decipher unexpected results.
Finally, it is important to consider that UDM is done for patients and not to patients, with the ultimate goal of improving the safety of the patient and the public. Unexpected results should be discussed with patients to identify the underlying reasons, which may then warrant further intervention, such as definitive testing and ultimate referral to a substance abuse treatment program. Simply sending a discharge or medication discontinuation letter to a patient can create a confrontational situation rather than an educational opportunity for both patient and provider.
