The Toxicology Laboratory's Role in Pain Management: Testing for Opiates

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

This course will provide an overview of general drugs of abuse testing with an emphasis on urine testing for opiates and other narcotics used in the practice of pain management.

Continuing Education Credits


  • List the common drugs of abuse that are tested on a routine urine drug screen.
  • Describe the advantages of urine testing versus serum testing in the context of drugs of abuse testing.
  • Describe testing methods used in the clinical toxicology laboratory.
  • Define pain management in a clinical context and explain the lab's role in this practice.
  • Identify parent and metabolite compounds of common opiate medications.
  • Interpret urine drug screen and confirmation results and decide if the result is consistent with the patient's history and current prescriptions.

Course Outline

  • Laboratory Testing Methods For Drugs of Abuse
      • Course Introduction
      • Drugs of Abuse (DOA) Screening Tests
      • Drugs of Abuse (DOA) Screening Tests, continued
      • Cutoff Concentrations for DOA Screening Tests
      • Confirmation of Positives
      • Mass Spectrometry (MS)
      • False-Positive Opiate Results
      • Laboratory Samples for DOA
      • Adulterants
      • Which of the following is the best example of adulteration of a urine sample that could result in a false negative result?
  • The Use of Opiates For Pain Management and the Problem of Drug Abuse
      • Pain Management Contracts
      • Opiates
      • Opiates, continued
      • Opiate Abuse
      • Other Drugs of Interest
      • Pain Management: The Problem
      • The Problem, continued
      • Dependence versus Addiction
      • Diversion is:
      • The Goal of Pain Management (PM)
      • Testing the Pain Management (PM) Patient
      • Which statement below is true?
      • Which of the following drugs is a synthetic opioid with a very long duration of action and is used to help wean patients from opiate dependency?
      • Which of the following is true?
      • In the practice of pain management, the absence of a compound in the urine is often just as significant as the presence of a compound.
      • True or false: The goal of pain management is to have the patient live pain-free.
  • Interpretation of Drugs of Abuse Testing in Pain Management
      • Pain Management Drug Screen Interpretation Competencies
      • Adulterants and Urine Samples Collected for Prescription Drug Monitoring
      • Opiate Metabolites
      • The Problem with Oxycodone and Oxymorphone (Oxys) In Immunoassay Methods
      • Cross-Reactivities
      • Common Pain Management (PM) Drugs and Trade Names
      • Morphine is a metabolite of codeine.
      • Half-Lives and Windows
      • Which of the following drugs is a metabolite of another opiate but is also itself available as a prescription drug?
      • Frequently Asked Questions (FAQs) To the Toxicology Laboratory
      • Scenario 1A patient with a urine creatinine of 25 mg/dL who has reportedly been taking codeine has codeine present in her urine but no morphine presen...
      • Scenario 2A clinician calls and says the laboratory made an error on a general opiate drug screen he had ordered for one of his patients to detect met...
      • Scenario 3A clinician has a patient taking Vicodin 750-7.5 mg daily (the numbers refer to 750 mg acetaminophen and 7.5 mg hydrocodone per tablet). The...
      • Summary
      • A patient with hydrocodone, hydromorphone, codeine, and morphine in his/her urine would likely be taking which of the following drug combinations?
  • References
      • References

Additional Information

Level of instruction: Intermediate

Target audience: Medical laboratory scientists, medical laboratory technicians, and MLS students. This course may also be of interest to other health care professionals who are involved in pain management.
Author information: Kevin F. Foley, PhD, DABCC, MT, SC is the Northwest chemistry, toxicology, immunology and POC director for Kaiser Permanente. He also teaches pharmacology, clinical chemistry, immunology and medicinal chemistry at Oregon Health Sciences University. Dr. Foley earned his PhD in clinical pharmacology and toxicology at East Carolina School of Medicine in North Carolina. His research areas include cardiovascular risk and inflammation markers as well as the neuropharmacology of amphetamine-like compounds. He is a frequent contributor to several clinical laboratory publications and is active in the American Association of Clinical Chemistry.

Reviewer 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 review of QC data, instrument troubleshooting, and employee training and competency assessment. In his career as a medical laboratory scientist, he has held the positions of chemistry supervisor, toxicology supervisor, and laboratory director.
Content information: This course will provide an overview of general drugs of abuse testing with an emphasis on urine testing for opiates and other narcotics used in the practice of pain management. 

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