University of Texas Southwestern Medical Center, Dallas, TX, USA.
Am Fam Physician. 2019 Jan 1;99(1):33-39.
Urine drug testing is an essential component of monitoring patients who are receiving long-term opioid therapy, and it has been suggested for patients receiving long-term benzodiazepine or stimulant therapy. Family physicians should be familiar with the characteristics and capabilities of screening and confirmatory drug tests. Immunoassays are qualitative tests used for initial screening of urine samples. They can give false-positive and false-negative results, so all results are considered presumptive until confirmatory testing is performed. Immunoassays for opioids may not detect commonly prescribed semisynthetic and synthetic opioids such as methadone and fentanyl; similarly, immunoassays for benzodiazepines may not detect alprazolam or clonazepam. Immunoassays can cross-react with other medications and give false-positive results, which have important implications for a patient's pain treatment plan. False-negative results can cause missed opportunities to detect misuse. Urine samples can be adulterated with other substances to mask positive results on urine drug testing. Family physicians must be familiar with these substances, the methods to detect them, and their effects on urine drug testing.
尿液药物检测是监测长期接受阿片类药物治疗的患者的重要组成部分，也建议对长期接受苯二氮䓬类药物或兴奋剂治疗的患者进行检测。家庭医生应该熟悉筛选和确证药物检测的特点和能力。免疫测定是用于初步筛选尿液样本的定性检测。它们可能会产生假阳性和假阴性结果，因此所有结果都被视为初步结果，直到进行确证检测。用于检测阿片类药物的免疫测定可能无法检测到常用的半合成和合成阿片类药物，如美沙酮和芬太尼；同样，用于检测苯二氮䓬类药物的免疫测定可能无法检测到阿普唑仑或氯硝西泮。免疫测定可能与其他药物发生交叉反应，从而产生假阳性结果，这对患者的疼痛治疗计划有重要影响。假阴性结果可能导致错失滥用检测的机会。尿液样本可能会被其他物质掺杂，以掩盖尿液药物检测的阳性结果。家庭医生必须熟悉这些物质、检测它们的方法以及它们对尿液药物检测的影响。
