September 13, 2024

Warde Medical Laboratory has updated toxicology test descriptions with additional information to assist in choosing which assay is most applicable to a particular clinical situation. The analytes tested in each panel are indicated as bullet points, and clarifying information is also provided (for example, whether the test is qualitative or quantitative, whether confirmatory follow-up testing is performed, and important drugs that are not included on limited panels).

Warde receives many questions about which assay is most appropriate as a general purpose urine drug screen, since there are many options available. The Pain Management Drug Screen Panel PN03C includes a broad array of abused substances, yet remains appropriate in scope for routine use rather than exhaustive evaluation of unconscious patients. Here is additional information and answers to frequently asked questions:

PN03C:

• Contains an opiate screen (covering morphine, codeine, hydrocodone, hydromorphone)
• Plus specific screens for opioids and opioid metabolites
  (These are not sufficiently cross-reactive in an opiate immunoassay):
  • oxycodone/oxymorphone
  • methadone
  • fentanyl/norfentanyl
  • tramadol/O-desmethyl tramadol
  • meperidine/normeperidine
• It also includes other drugs of abuse as well:
  • amphetamines
  • barbiturates
  • benzodiazepines
  • buprenorphine
  • cocaine metabolite (benzoylecgonine)
  • ethanol
  • phencyclidine (PCP)
  • propoxyphene
  • cannabis (THC)

Is PN03C appropriate for monitoring compliance with a prescribed control substance, while also checking to make sure the patient is not violating their agreement not to take unprescribed drugs of abuse?

Yes. Note that PN03C performs confirmation of positive screen results, while PN03A reports immunoassay screen results without mass spectrometry confirmation (except PCP or amphetamines, which are confirmed in both assay formats).

What are the differences between PN03C and CD03C, and how do they affect suitability of each assay for monitoring controlled substance agreements?

If you only need to know about opiates, cocaine, and THC, then CD03C is a smaller panel that might suit your needs, but many street and abused prescription drugs INCLUDING OPIOIDS will be missed. For example, you will not catch fentanyl, other opioids, PCP, or benzodiazepines. PN03C will cover opioids (including fentanyl), PCP, and benzodiazepines.

What are the differences between PN03C and UDS01, and how do they affect suitability of each assay for monitoring controlled substance agreements?

Despite the tempting name (UDS01:Urine Comprehensive Drug Screen), USD01 is NOT intended for outpatient screening, pain management, addiction treatment/monitoring, or most non-emergency settings. Its purpose is detection of a large number of pharmaceutical compounds potentially ingested by a patient who is unconscious, poisoned, or has attempted suicide. Since it includes acetaminophen, caffeine, cotinine, ibuprofen, salicylates, and other compounds, it likely represents significant overtesting as a general drug screen in most scenarios involving conscious patients. PN03C is limited to relevant drugs rather than including additional toxic substances.

So if an emergency room provider wants to test urine from an unconscious, suicidal, or altered mental status patient who may have ingested street, prescription, and or over-the-counter drugs,

then yes, UDS01 would catch street drugs, prescription painkillers, and OTC medications like Tylenol.