Drug Testing Methods in the Clinical Toxicology Laboratory

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Author: Robert E. Moore, MLS(ASCP)CM, SCCM, TC(NRCC);
Reviewer: Kevin F. Foley PhD, MT, DABCC

This course presents the screening techniques utilized in drug testing and details the appropriate confirmatory techniques used in the clinical toxicology laboratory. It is important to understand the various factors that contribute to the interpretation of drug testing results. These factors, including drug half-life, are discussed in detail.

Continuing Education Credits

Objectives

  • Identify the specimens commonly utilized for testing in the clinical toxicology laboratory.
  • Distinguish between qualitative and quantitative drug testing methods.
  • Recognize initial screening techniques utilized in drug testing.
  • Determine appropriate confirmatory techniques used in the clinical toxicology laboratory.
  • Understands the various factors that contribute to the interpretation of drug testing results.

Course Outline

  • Drug Testing
      • Drug Testing
      • Urine is the preferred sample for drug testing for a number of reasons. Which of the statements below regarding urine is FALSE?
      • Drug Testing: Screening and Confirmation
  • Initial Screening Methods
      • Screening: Point of Care Drug Tests
      • Screening: Immunoassays
      • Immunoassay Techniques Used in Drug Test Screening: Enzyme Multiplied Immunoassay Technique (EMIT)
      • Immunoassay Techniques Used in Drug Test Screening: Cloned Enzyme Donor Immunoassay (CEDIA)
      • Immunoassay Techniques Used in Drug Test Screening: Enzyme-linked Immunosorbent Assay (ELISA)
      • Immunoassay Techniques, continued
      • Immunoassay Techniques: Cross-Reactivity
      • Immunoassay Cross-Reactivity continued
      • Which of the following scenarios is most likely to give a false negative result?
  • Confirmatory Methods
      • Confirmatory Testing
      • Gas Chromatography/Mass Spectrometry (GC/MS)
      • Gas Chromatography cont.
      • Electron Ionization (EI)
      • Mass Analyzer
      • Scanning Modes
      • Liquid Chromatography with Tandem Mass Spectrometry (LC/MS/MS)
      • A toxicology laboratory decides to develop an opiate method to be performed by LC/MS/MS. Why would they choose LC/MS/MS over GC/MS?
      • Liquid Chromatography
      • Electrospray Ionization (ESI)
      • Mass Analysis
      • Multiple Reaction Monitoring (MRM)
      • An immunoassay drug screen in a clinical laboratory yields a result that is above the cutoff for Cocaine. Which of the following is the most appropria...
  • Drug Half-Life and Interpretation of Results
      • Interpretation of Drug Tests in the Clinical Laboratory
      • Amphetamine
      • Methamphetamine
      • Codeine
      • MDMA
      • Cocaine
      • Marijuana
      • 6-AM
      • Morphine
      • Hydrocodone
      • Hydromorphone
      • Oxycodone
      • Oxymorphone
      • Benzodiazepines
      • Barbiturates
      • Hydrolysis
      • Ever-expanding testing...
  • References
      • References

Additional Information

Level of Instruction: Intermediate
Intended Audience: Medical laboratory scientists, medical laboratory technicians, pathology residents, MLS students, and other health care personnel who have an interest in this subject matter. 
Author Information: Robert E. Moore, MLS(ASCP)CM, SCCM, TC(NRCC) is the lead technologist in the toxicology laboratory at Kaiser Permanente in Portland, Oregon where his responsibilities include methods development and validation, review of QC data, instrument troubleshooting, and employee training/competency assessment. In his career as a medical laboratory scientist, he has been a chemistry supervisor, toxicology supervisor, and laboratory director. He holds a bachelor's degree in Biology from Marshall University. 
Reviewer Information: Kevin F. Foley, PhD, DABCC, MT, SC is the director of clinical pathology for the Kaiser Permanente Northwest region. He also teaches clinical chemistry at Oregon Health Sciences University. Dr. Foley earned his PhD in clinical pharmacology and toxicology at the East Carolina School of Medicine in North Carolina. He received a PhD in clinical pharmacology and toxicology from Brody School of Medicine, Greenville, NC. He has been working in laboratory medicine for over 15 years, starting his career as a medical technologist. 

This course is part of:
Structural Similarity
Substrates of Cytochrome P450 Enzymes
THC Metabolism
poc
drug test (shutterstock 139897918)