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Learn More. The objective of this analysis was to determine the diagnostic utility of oral fluid testing collected with the Intercept oral fluid collection device.
Opioids opiates or narcotics are a class of drugs derived from the opium poppy plant that typically relieve pain and produce a euphoric feeling. Methadone is a long-acting synthetic opioid used to treat opioid dependence and chronic pain. It prevents symptoms of opioid withdrawal, reduces opioid cravings and blocks the euphoric effects of short-acting opioids such as heroin and morphine.
Opioid dependence is associated with harms including an increased risk of exposure to Human Immunodeficiency Virus and Hepatitis C as well as other health, social and psychological crises. The goal of methadone treatment is harm reduction. Treatment with methadone for opioid dependence is often a long-term therapy.
The Ontario College of Physicians and Surgeons estimates that there are currently physicians qualified to prescribe methadone, and 15, people in methadone maintenance programs across Ontario. Drug testing is a clinical tool whose purpose is to provide objective meaningful information, which will reinforce positive behavioral changes in patients and guide further treatment needs.
Such information includes knowledge of whether the patient is taking their methadone as prescribed and reducing or abstaining from using opioid and other drugs of abuse use. The of drug testing can be used with behavior modification techniques contingency management techniques where positive reinforcements such as increased methadone take-home privileges, sustained employment or parole are granted for drug screens negative for opioid use, and negative reinforcement including loss of these privileges for drug screens positive for opioid used. Body fluids including blood, oral fluid, often referred to as saliva, and urine may contain metabolites and the parent drug of both methadone and drugs of abuse and provide a means for drug testing.
Compared with blood which has a widow of detection of several hours, urine has a wider window of detection, approximately 1 to 3 days, and is therefore considered more useful than blood for drug testing. Because of this, and the fact that obtaining a urine specimen is relatively easy, urine drug screening is considered the criterion measure gold standard for methadone maintenance monitoring.
However, 2 main concerns exist with urine specimens: the possibility of sample tampering by the patient and the necessity for observed urine collection. Urine specimens may be tampered with in 3 ways: dilution, adulteration contamination with chemicals, and substitution patient submits another persons urine specimen.
To circumvent sample tampering the supervised collection of urine specimens is a common and recommended practice. However, it has been suggested that this practice may have negative effects including humiliation experienced by patient and staff, and may discourage patients from staying in treatment. Supervised urine specimen collection may also present an operational problem as staff must be available to provide same-sex supervision. Oral fluid testing has been proposed as a replacement for urine because it can be collected easily under direct supervision without infringement of privacy and reduces the likelihood of sample tampering.
Generally, the of oral fluid drug testing are similar to urine drug testing but there are some differences, such as lower concentrations of substances in oral fluid than urine, and some drugs remain detectable for longer periods of time in urine than oral fluid. The pad is coated with common salts. The absorbent pad is inserted into the mouth and placed between the cheek and gums for 3 minutes on average. The pad absorbs the oral fluid. After 3 minutes range 2min-5 min the collection device is removed from the mouth and the absorbent pad is placed in a small vial which contains 0.
It is recommended that the person undergoing oral fluid drug testing have nothing to eat or drink for a minute period before the oral fluid specimen is collected. This will remove opportunity for adulteration. Likewise, it is recommended that the person be observed for the duration of the collection period to prevent adulteration of the specimen. An average of 0. The specimen may be stored at 4C to 37C and tested within 21 days of collection or within 6 weeks if frozen. The oral fluid specimen must be analyzed in a laboratory setting.
There is no point-of-care POC oral fluid test kit for drugs of abuse other than for alcohol. In the laboratory the oral fluid is extracted from the vial after centrifugation and a screening test is completed to eliminate negative specimens.
Similar to urinalysis, oral fluid specimens are analyzed first by enzyme immunoassay with positive specimens sent for confirmatory testing. Comparable cut-off values to urinalysis by enzyme immunoassay have been developed for oral fluids. What is the diagnostic utility of the Intercept oral specimen device?
Studies evaluating paired urine and oral fluid specimens from the same individual with the Intercept oral fluid collection device. Sensitivity and Specificity of oral fluid testing compared to urinalysis for methadone methadone metaboliteopiates, cocaine, benzodiazepines, and alcohol. The Grading of Recommendations Assessment, Development and Evaluation GRADE system was used to evaluate the overall quality of the body of evidence defined as 1 or more studies supporting the research questions explored in this systematic review.
A total of potential citations were retrieved. After reviewing titles and abstracts, 2 met the inclusion and exclusion criteria. Two other relevant studies were found after corresponding with the author of the 2 studies retrieved from the literature search. Therefore a total of 4 published studies are included in this analysis. All 4 studies carried out by the same investigator meet the definition of Medical Advisory Secretariat level III not a-randomized controlled trial with contemporaneous controls study de.
In each of the studies, paired urine and oral fluid specimens where obtained from drug users. Urine collection was not observed in the studies however, laboratory tests for pH and creatinine were used to determine the reliability of the specimen.
Urine specimens thought to be diluted and unreliable were removed from the evaluation. Urinalysis was used as the criterion measurement for which to determine the sensitivity and specificity of oral fluid testing by the Intercept oral fluid device for opiates, benzodiazepines, cocaine and marijuana. Alcohol was not tested in any of the 4 studies. From these 4 studies, the following conclusions were drawn:. The evidence indicates that oral fluid testing with the Intercept oral fluid device has better specificity than sensitivity for opiates, benzodiazepines, cocaine and marijuana.
The consequences of opiate false-negatives by oral fluid testing with the Intercept oral fluid device need to be weighed against the disadvantages of urine testing, including invasion of privacy issues and adulteration and substitution of the urine specimen. The window of detection is narrower for oral fluid drug testing than urinalysis and because of this oral fluid testing may best be applied in situations where there is suspected frequent drug use.
When drug use is thought to be less frequent or remote, urinalysis may offer a wider hours more than oral fluids window of detection. The narrow window of detection for oral fluid testing may mean more frequent testing is needed compared to urinalysis.
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This may increase the expense for drug testing in general. POC oral fluid testing is not yet available and may limit the practical utility of this drug testing methodology.
POC urinalysis by immunoassay is available. Because of its narrow window of detection compared to urinalysis oral fluid testing may best be used during periods of suspected frequent or recent drug use within 24 hours of drug testing.
How long does methadone stay in your body?
This is not to say that oral fluid testing is superior to urinalysis during these time periods. In situations where an observed urine specimen is difficult to obtain.
When the health of the patient would make urine testing unreliable e,g. As an alternative drug testing method when urine specimen tampering practices are suspected to be affecting the reliability of the urinalysis test.
Advantages of opioid use disorder treatment with methadone
No oral fluid POC test equivalent to onsite urine dips or POC analyzer reducing immediacy of for patient care. Currently, physicians get reimbursed directly for POC urinalysis. Oral fluid must be analyzed in a lab setting removing physician reimbursement, which is a source of program funding for many methadone clinics.
Small amount of oral fluid specimen obtained; repeat testing on same sample will be difficult. Reliability of positive oral fluid methadone parent drug may decrease because of possible contamination of oral cavity after ingestion of dose. Therefore high methadone levels may not be indicative of compliance with treatment. Oral fluid does not as yet test for methadone metabolite. There currently is no d provincial laboratory that analyses oral fluid specimens.
Drug testing is a clinical tool whose purpose is to provide objective meaningful information to guide treatment. Opioids opiates or narcotics are a class of drugs that are derived from the opium poppy plant. They can also be produced synthetically. Some specific opioids include morphine, heroin, and codeine. Most opioid drugs typically relieve pain and produce a euphoric feeling. Methadone is a long-acting synthetic opioid used to treat opioid dependence.
It is also used to manage chronic pain. As a treatment for opioid dependence, methadone prevents symptoms of withdrawal, reduces opioid cravings and blocks the euphoric effects of short acting opioids such as heroin and morphine. The goal of methadone treatment is essentially harm reduction. Persons with opioid dependence have an increased risk of exposure to Human Immunodeficiency Virus and Hepatitis C as well as experiencing other health, social and psychological crises.
Before treatment with methadone is initiated, clinicians need objective evidence to confirm opiate dependence. Currently, laboratory analysis of urine urinalysis for drugs of abuse is the gold standard for objective patient monitoring.
The of a urine drug test may be used with behavior modification techniques contingency management techniques where positive reinforcements such as methadone take-home privileges or continued employment may be granted for negative drug screens indicating no illicit or licit opiates use and negative reinforcement such as decreased privileges for positive screens indicating continued opiate use. Compared with blood which has a widow of detection of several hours, urine has a wider window of detection of approximately 1 to 3 days for most drugs and is therefore considered more useful than blood as a test medium.
Urine specimens may be tampered in 3 ways: dilution, contamination and substitution. Dilution of the urine specimen may occur directly by adding water to the specimen or indirectly by drinking an excessive amount of fluid before providing the urine specimen.
Contaminating the urine specimen with chemicals such as bleach will disrupt the laboratory assay making metabolites undetectable. To circumvent specimen tampering, the supervised collection of urine specimens is a common and recommended practice. However, it has been suggested that this practice is humiliating for patients and staff and may discourage patients from staying in treatment. Saliva testing has been proposed as a replacement for urine because it can be collected easily under direct supervision reducing the likelihood of sample tampering.
The collection process also does not constitute an infringement of privacy. Generally, the of oral fluid drug testing are similar to urine drug testing but there are some differences such as lower concentrations of substances in oral fluid than urine, and some drugs remain detectable for longer periods of time in urine than oral fluid.