Wellness Center atWaters Place, 1510Waters Place, Bronx, NY 10461, USA.
J Addict Dis. 2010 Oct;29(4):436-48. doi: 10.1080/10550887.2010.509277.
Urine toxicology screening testing is an important standard of care in the addiction and pain treatment setting, offering a reproducible, unbiased, and accurate laboratory test to monitor patients and provide objective support for clinical observations. It has been shown that physicians do not have proficiency in the ordering or interpretation of these tests. This article is an attempt to respond to that need. Current antibody-based enzymatic immunoassays (EIAs) used for urine toxicology screening are useful to detect classes of drugs (ex., opiate) but cannot determine which specific drug (ex., morphine) is present. Gas chromatography and mass spectroscopy can determine exactly which drugs are present, allowing prescribed (or illicit) opiates and benzodiazepines to be identified. This article will discuss principles and details of opiate and benzodiazepine EIA and gas chromatography and mass spectroscopy urine toxicology testing. The approach to detecting patients attributing positive opiate EIAs to prescription opiates who are using heroin or other opioids will be reviewed. Cases of controlled prescription drugs that do not produce the expected positive urine tests (ex., oxycodone producing negative opiate screening tests) will be discussed. How to differentiate codeine from heroin and the role of poppy seeds in toxicology will be examined. The case of an anti-depressant drug that produces false-positive benzodiazepine results and antibiotics that cause positive opiate urine toxicology results will be reviewed. Common benzodiazepines (ex., clonazepam and lorazepam) that do not reliably produce positive benzodiazepine EIAs will be discussed. The approach to detection and management of all these types of toxicology cases will be reviewed, and it is hoped that the analyses presented will impart an adequate information base to medical providers and staff members of drug treatment and pain centers, enabling them to order and interpret these tests in the clinic more effectively as an integrated part of whole patient care.
尿液毒理学筛查检测是成瘾和疼痛治疗领域的重要护理标准，提供了一种可重复、无偏倚和准确的实验室检测方法，用于监测患者并为临床观察提供客观支持。已经表明，医生在这些测试的订购或解释方面没有足够的专业知识。本文旨在满足这一需求。目前用于尿液毒理学筛查的基于抗体的酶免疫分析（EIA）可用于检测药物类别（例如阿片类药物），但无法确定存在哪种特定药物（例如吗啡）。气相色谱和质谱分析可准确确定存在哪些药物，从而可以识别处方（或非法）阿片类药物和苯二氮䓬类药物。本文将讨论阿片类药物和苯二氮䓬类药物 EIA 以及气相色谱和质谱尿液毒理学检测的原理和细节。将审查检测归因于使用海洛因或其他阿片类药物的患者的阳性阿片类 EIA 的患者的方法。将讨论不产生预期阳性尿液检测结果的受控处方药物的案例（例如，产生阴性阿片类药物筛选测试的羟考酮）。将研究如何区分可待因和海洛因以及罂粟籽在毒理学中的作用。将审查一种抗抑郁药产生假阳性苯二氮䓬结果和抗生素导致阳性阿片类药物尿液毒理学结果的案例。将讨论不会可靠地产生阳性苯二氮䓬 EIA 的常见苯二氮䓬类药物（例如，氯硝西泮和劳拉西泮）。将审查所有这些类型的毒理学案例的检测和管理方法，希望所提出的分析将为医疗提供者和药物治疗和疼痛中心的工作人员提供足够的信息基础，使他们能够在临床实践中更有效地订购和解释这些测试，作为整体患者护理的一个组成部分。
