Urine Drug of Abuse testing & interpretation - AAEM

This survey is intended to assess knowledge of current topics related to prescription and illicit drug use, to identify what gaps exist and where education can most effectively be targeted to improve patient care. If taking this survey on a mobile phone, you may have to scroll to see all 4 answers for each question.

To make this education effective, PLEASE answer questions as best you can based on your own knowledge (i.e., don't look up answers).

Question Title

A patient with history of a substance use disorder is positive on urine immunoassay screen for amphetamines. She denies illicit drug use but said she took pseudoephedrine for a cold. What is the best next step?

Subject the urine to confirmation testing by mass spectrometry

Refer the patient to drug treatment; pseudoephedrine does not cross-react on amphetamine screens

Disregard the result as a false positive

Re-administer a urine drug screen at the next visit

Question Title

A patient with BMI >40 was told to cease his regular marijuana habit before surgery. Urine confirmation is positive for THC metabolites, 2 weeks after he claims to have stopped. What is the most likely explanation?

THC metabolites are detectable for several months after last use

Testing was within the THC detection window for an obese patient

THC metabolites cannot be detected 2 weeks, so he is still using

Obese users clear THC and metabolites rapidly, so he is still using

Question Title

An ED patient arrived with miosis and respiratory depression, waking after several doses of Narcan (naloxone). An immunoassay drug screen was only positive for fentanyl. However, confirmation was negative for fentanyl and norfentanyl. What is the most likely reason?

Patient did not use an opioid

Patient used fentanyl

Patient used a fentanyl analog(s)

The naloxone caused a false positive

Question Title

A patient prescribed Suboxone (buprenorphine/naloxone) has urine confirmation results (in ng/mL): 10,000 buprenorphine, 50 norbuprenorphine, 2,500 naloxone. What is the best interpretation?

The patient is smoking the Suboxone sublingual film

Norbuprenorphine to buprenorphine ratio indicates compliance

The patient is compliant but is a poor metabolizer

The patient adulterated the sample with Suboxone to simulate compliance

Question Title

Your patient is prescribed Valium (diazepam). His urine confirmation test is positive for nordiazepam, temazepam and oxazepam. What is the most likely interpretation?

Non-compliant: these metabolites indicate use of Restoril (temazepam)

Non-compliant: these metabolites indicate use of Serax (oxazepam)

Non-compliant: these metabolites indicate use of Librium (chlordiazepoxide)

Compliant: these metabolites indicate use of Valium (diazepam)

Question Title

Which of the following can generally be detected using a urine opiate immunoassay screen?

Tramadol

Fentanyl

Hydrocodone

Meperidine

Question Title

How much experience/training do you have with performing or interpreting urine drug testing?

None

A little

Moderate

Extensive

Question Title

How confident are you in your ability to interpret urine drug test results?

Not at all

Somewhat

Generally

Extremely

Question Title

What is your main specialty area?

Medical or clinical toxicology

Family medicine

Primary care

Occupational medicine

Internal medicine

Pain management

Addiction medicine

Emergency medicine

Pediatrics

OB/GYN

Psychiatry

Transplant

Palliative Care

Oncology

Other (please specify)

Question Title

Which of these best describes your role?

Social work

Nursing

Advanced practice professional

Attending MD or equivalent

Pharmacist

MD resident or fellow

Other (please specify)

Question Title

If you had a question about urine drug testing, where are you most likely to seek information?

Another provider in my same specialty

Specialist provider (e.g., addiction medicine, medical toxicology)

Testing laboratory

Internet search

None of the above

Urine Drug of Abuse testing & interpretation - AAEM

Question Title

* A patient with history of a substance use disorder is positive on urine immunoassay screen for amphetamines. She denies illicit drug use but said she took pseudoephedrine for a cold. What is the best next step?

Question Title

* A patient with BMI >40 was told to cease his regular marijuana habit before surgery. Urine confirmation is positive for THC metabolites, 2 weeks after he claims to have stopped. What is the most likely explanation?

Question Title

* An ED patient arrived with miosis and respiratory depression, waking after several doses of Narcan (naloxone). An immunoassay drug screen was only positive for fentanyl. However, confirmation was negative for fentanyl and norfentanyl. What is the most likely reason?

Question Title

* A patient prescribed Suboxone (buprenorphine/naloxone) has urine confirmation results (in ng/mL): 10,000 buprenorphine, 50 norbuprenorphine, 2,500 naloxone. What is the best interpretation?

Question Title

* Your patient is prescribed Valium (diazepam). His urine confirmation test is positive for nordiazepam, temazepam and oxazepam. What is the most likely interpretation?

Question Title

* Which of the following can generally be detected using a urine opiate immunoassay screen?

Question Title

* How much experience/training do you have with performing or interpreting urine drug testing?

Question Title

* How confident are you in your ability to interpret urine drug test results?

Question Title

* What is your main specialty area?

Question Title

* Which of these best describes your role?

Question Title

* If you had a question about urine drug testing, where are you most likely to seek information?

A patient with history of a substance use disorder is positive on urine immunoassay screen for amphetamines. She denies illicit drug use but said she took pseudoephedrine for a cold. What is the best next step?

A patient with BMI >40 was told to cease his regular marijuana habit before surgery. Urine confirmation is positive for THC metabolites, 2 weeks after he claims to have stopped. What is the most likely explanation?

An ED patient arrived with miosis and respiratory depression, waking after several doses of Narcan (naloxone). An immunoassay drug screen was only positive for fentanyl. However, confirmation was negative for fentanyl and norfentanyl. What is the most likely reason?

A patient prescribed Suboxone (buprenorphine/naloxone) has urine confirmation results (in ng/mL): 10,000 buprenorphine, 50 norbuprenorphine, 2,500 naloxone. What is the best interpretation?

Your patient is prescribed Valium (diazepam). His urine confirmation test is positive for nordiazepam, temazepam and oxazepam. What is the most likely interpretation?

Which of the following can generally be detected using a urine opiate immunoassay screen?

How much experience/training do you have with performing or interpreting urine drug testing?

How confident are you in your ability to interpret urine drug test results?

What is your main specialty area?

Which of these best describes your role?

If you had a question about urine drug testing, where are you most likely to seek information?