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Urine drug screen when prescribing drugs of dependence

Urine drug screens can be a valuable tool to address two critical questions when prescribing drugs of dependence to an individual.

  1. is there objective evidence that prescribed drugs of dependence are being consumed/taken (for example, the prescribed drugs are not being diverted).
  2. is there objective evidence that other substances are being consumed/taken which may directly impact on the safe provision of drugs of dependence?

To maximise the information you are supplied by toxicology reports please remember the more information on the request form, the more information the pathologist can provide you.

Information to include

Please consider including the following on urine drug screen request forms:

  • list the prescribed drugs of dependence
  • list any other medications which may impact on quantifying the test results, including Over-The-Counter codeine containing products and any herbal/natural products consumed. 

If the medication is a combined product please specify this as well

  • oxycodone with naloxone
  • buprenorphine with naloxone

For example Targin® (oxycodone with naloxone) Suboxone® (buprenorphine with naloxone) vs Oxycontin®, Endone® (oxycodone only) Subutex®, Temgisic® etc (buprenorphine only). This is because the naloxone component can interefere with the ‘opiate’ result.

Examples

Prescribed morphine 40mg a day, please verify the presence of morphine ?any other isolated opioid substances in sample including oxycodone. Patient is prescribed Panadeine Forte® 4 tabs per day.

Prescribed dexamphetamine 30mg a day, please verify the presence of dexamphetamine ?any other amphetamine substances in sample.

Prescribed buprenorphine [with naloxone] 16mg a day, please verify the presence of buprenorphine ?any other isolated opioid substances including heroin and oxycodone, benzodiazepine, amphetamine substances
in sample. Patient is also prescribed diazepam 10mg per day.

Oxycodone and buprenorphine

Oxycodone and buprenorphine will need to be specifically listed on the request form as they are not part of the routine urine drug screen panel if you wish to verify consumption of these drugs of dependence.

For further information on this process you may wish to contact SA Pathology or your toxicology provider. Please ensure any dual agent product is specified as naloxone can impact on the screening performed by the laboratory.

Random tests

Samples should always be provided by individuals on the day it is requested to ensure a true snapshot of a patient’s consumption of drugs of dependence and other substances.

For more information

For more information on urine drug screens, contact SA Health's Drugs of Dependence Unit.

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