a Department of Pathology and Laboratory Medicine , University of Rochester Medical Center , Rochester , NY , USA.
b Department of Pathology and Laboratory Medicine , Tufts Medical Center , Boston , MA , USA.
Crit Rev Clin Lab Sci. 2017 Sep;54(6):433-445. doi: 10.1080/10408363.2017.1385053. Epub 2017 Oct 9.
In recent years, the abuse of opioid drugs has resulted in greater prevalence of addiction, overdose, and deaths attributable to opioid abuse. The epidemic of opioid abuse has prompted professional and government agencies to issue practice guidelines for prescribing opioids to manage chronic pain. An important tool available to providers is the drug test for use in the initial assessment of patients for possible opioid therapy, subsequent monitoring of compliance, and documentation of suspected aberrant drug behaviors. This review discusses the issues that most affect the clinical utility of drug testing in chronic pain management with opioid therapy. It focuses on the two most commonly used specimen matrices in drug testing: urine and oral fluid. The advantages and disadvantages of urine and oral fluid in the entire testing process, from specimen collection and analytical methodologies to result interpretation are reviewed. The analytical sensitivity and specificity limitations of immunoassays used for testing are examined in detail to draw attention to how these shortcomings can affect result interpretation and influence clinical decision-making in pain management. The need for specific identification and quantitative measurement of the drugs and metabolites present to investigate suspected aberrant drug behavior or unexpected positive results is analyzed. Also presented are recent developments in optimization of test menus and testing strategies, such as the modification of the standard screen and reflexed-confirmation testing model by eliminating some of the initial immunoassay-based tests and proceeding directly to definitive testing by mass spectrometry assays.
近年来，阿片类药物的滥用导致成瘾、过量用药和与阿片类药物滥用相关的死亡人数增加。阿片类药物滥用的流行促使专业和政府机构发布了开具阿片类药物治疗慢性疼痛的实践指南。为了管理慢性疼痛而开具阿片类药物时，临床医生的一个重要工具是药物检测，可用于患者初始评估，以确定是否可能需要阿片类药物治疗，随后监测依从性，并记录疑似异常药物行为。本文综述了影响药物检测在慢性疼痛管理中应用的最重要问题，特别是在慢性疼痛管理中开具阿片类药物时。本文重点讨论了药物检测中最常用的两种标本基质：尿液和唾液。本文回顾了尿液和唾液在整个检测过程（从标本采集到分析方法再到结果解释）中的优缺点。详细检查了免疫分析法在检测中的分析灵敏度和特异性限制，以引起人们对这些缺陷如何影响结果解释和影响疼痛管理中的临床决策的关注。分析了需要对存在的药物及其代谢物进行特定鉴定和定量测量，以调查疑似异常药物行为或意外阳性结果。还介绍了最近在测试菜单和测试策略优化方面的进展，例如通过消除一些初始基于免疫测定的检测，直接进行质谱检测来修改标准筛选和反射确认检测模型。
