The traditional clinical role of urine drug testing (UDT) has been to support treatment decisions made in the urgent care setting where patients are unable or, in some cases, unwilling to provide information about the use of substances that may be harmful to them. When used effectively, however, UDT is more than just a verification tool and has many useful clinical applications in patient-centered testing. UDT is designed to assist clinicians to use a clear testing strategy to pursue UDT further in their practices as part of a balanced approach to risk management and optimal medical care when prescribing controlled substances.

The most common uses of UDT have involved forensic testing in federally regulated industries (e.g., Department of Transportation) and nonregulated forensic testing outside the federal system (e.g., pre-employment screening and workplace testing). Forensic UDT generally assumes that the majority of donors will be negative for a limited panel of specified substances that may have misuse liability. In contrast, in patient-centered UDT, the majority of donors are in fact positive for a broader range of drug(s) of interest since these are often prescribed for legitimate medical purposes. This adds to the complexity of interpretation, which will be discussed throughout the document.

The term urine drug “screening” is a misnomer since it implies screening for all drugs. In reality, it is not possible to prove the presence or absence of all drugs, and the testing process is open- ended and evolving. No “standard” UDT is suitable for all purposes and settings— rather, a multitude of options exists that health care professionals should adapt to their particular clinical needs. The 2 main types of UDT, which are often used in combination, are:

1. Immunoassay drug testing: either laboratory based or at point-of-care (POC)
2. Laboratory-based specific drug identification: e.g., gas chromatography/mass spectrometry (GC/MS) or liquid chromatography/mass spectrometry (LC/MS)

UDT typically detects the parent drug and/or its metabolite(s) and, therefore, demonstrates recent use of prescription medications, non-prescribed drugs, and illegal substances. Although other biologic specimens can be used in drug testing, urine is usually preferred for determining the presence or absence of drugs because it has a 1- to 3-day window of detection for most drugs and/or their metabolites and is currently the most extensively validated biologic specimen for drug testing.

About Elite Diagnotics

Elite Diagnostics is a Highly Complex CLIA certified Lab based in Crown Point, Indiana. We use state of the art technology coupled with rigorous quality control guidelines to provide prompt and reliable test results for physicians and their patients.