Services

Compliance Monitoring

Urine Drug Testing

Benefits of InSource Diagnostics

  • Accurate Results
  • Comprehensive Test Menu
  • Easy to Interpret Reports
  • Rapid Turn Around Time
  • Excellent Customer Service

Urine is the most common sample type for prescription drug monitoring due to the ease of collection and well characterized drug metabolism profiles. Most offices utilize a CLIA Waived Point-of-Care (POC) device as a quick screening tool. Since the POC devices are subject to false readings, samples are sent to our lab for confirmation testing before making a final decision regarding the course of treatment.

Comprehensive Test Menu

InSource Diagnostics can analyze for over 50 different drug substances and metabolites at low part per billion (ppb) levels. Tests can be ordered for individual drug substances or as a Custom Panel depending on needs of the patients.

Click on the headers below to see the test menus.

  • Alcohol
    • Ethyl Glucuronide (EtG)
    • Ethyl Sulfate (EtS)
  • Bath Salts
    • Butylone
    • MDPV
    • Mephedrone
    • Methylone
    • Methedrone
    • Ethylone
    • Naphyrone
  • Cocaine
    • Benzoylecgonine
  • Heroin
    • 6-monoacetylmorphine (6-MAM)
  • Marijuana
    • THC 11-nor-9-Carboxy-THC
  • Stimulants
    • MDMA (Ecstasy, Adam)
    • MDEA (Eve)
    • MDA (Sally)
  • Methamphetamine
  • Phencyclidine (PCP)
  • Synthetic Cannabinoids (Spice/K2)
    • AM2201 4-Hydroxypentyl
    • JWH-018 5-pentanoic acid
    • JWH-019 6-hydroxyhexl
    • JWH-081 5-hydroxypentyl
    • JWH-073 4-Butanoic Acid
    • JWH-122 5-hydroxypentyl
    • JWH-210 5-hydroxypentyl
    • JWH-250 5-hydroxypentyl
    • MAM-2201 N pentanoic acid
    • RCS-4 4-hydroxypentyl
    • UR-144 5-Hydroxypentyl
    • XLR-11 4-Hydroxypentyl
  • Amphetamine
  • Barbiturates
    • Butalbital
    • Phenobarbital
    • Secobarbital
  • Benzodiazepines
    • 7-Aminoclonazepam
    • Alprazolam
    • Alpha-Hydroxyalprazolam
    • Clonazepam
    • Diazepam
    • Lorazepam
    • Midazolam
    • Nordiazepam
    • Oxazepam
    • Temazepam
  • Carisoprodol
    • Carisoprodol
    • Meprobamate
  • Meperidine
    • Meperidine
    • Normeperidine
  • Opiates
    • Codeine
    • Morphine
    • Hydrocodone
    • Hydromorphone
    • Norhydrocodone
    • Oxycodone
    • Oxymorphone
    • Noroxycodone
  • Opioids
    • Buprenorphine
      • Norbuprenorphine
    • Fentanyl
      • Norfentanyl
    • Methadone
      • EDDP
  • Tramadol
  • Propoxyphene
  • Tapentadol
  • Tricyclic Anti-Depressants (All)
    • Amitriptyline
    • Cyclobenzaprine
    • Desipramine
    • Imipramine
    • Nortriptyline
  • Zolpidem

Simplified Reports

You are busy, we understand. Our 2-page report summarizes our findings into three easy to interpret categories:

  • Consistent – You prescribed it, we found it
  • Inconsistent Negative – You prescribed it, but it wasn't there
  • Inconsistent Positive – It wasn't prescribed and shouldn't be there

 


State Guidelines

More and more states are adopting guidelines that require drug screening for patients undergoing long term drug therapy. Learn more with our state guidelines map.


Drug Detection Windows

This table will give you a guideline for how long you can expect to detect different drugs in urine or saliva.


Common Interferences with POCT Cups

POC devices often show false readings that are the results of cross reactivity of the antibodies. This quick reference chart lists the more common reasons for a false positive.


Drug Metabolism

Drug metabolism is quite complex and drugs are often converted to a related species by the body. These charts help with the interpretation of UDT results.


Practice Tools

InSource Diagnostics has many tools and services available to help optimize your monitoring program.

Oral Fluid Testing

Saliva testing offers a good alternative when a patient is unable to provide a urine sample. Samples are collected using a simple swab device that is placed under the patients tongue until the indicator light turns blue. Drug concentrations more closely match serum levels, so detection levels and windows are different from urine and this must be understood when ordering the test. At this time there are no CLIA waived devices for saliva drug testing.

  • Non-invasive sampling method
  • Alternative for patients that can't urinate
  • More limited drug classes and detection limits

Click on the headers below to see the test menus.

  • Cocaine
    • Benzoylecgonine
  • Heroin
    • 6-monoacetylmorphine (6-MAM)
  • Marijuana
    • THC 11-nor-9-Carboxy-THC
  • Stimulants
    • MDMA (Ecstasy, Adam)
    • MDEA (Eve)
    • MDA (Sally)
  • Methamphetamine
  • Phencyclidine (PCP)
  • Amphetamine
  • Barbiturates
    • Butalbital
    • Phenobarbital
    • Secobarbital
  • Benzodiazepines
    • 7-Aminoclonazepam
    • Alprazolam
    • Alpha-Hydroxyalprazolam
    • Clonazepam
    • Diazepam
    • Lorazepam
    • Midazolam
    • Nordiazepam
    • Oxazepam
    • Temazepam
  • Carisoprodol
    • Carisoprodol
    • Meprobamate
  • Meperidine
    • Meperidine
    • Normeperidine
  • Opiates
    • Codeine
    • Morphine
    • Hydrocodone
    • Hydromorphone
    • Norhydrocodone
    • Oxycodone
    • Oxymorphone
    • Noroxycodone
  • Opioids
    • Buprenorphine
      • Norbuprenorphine
    • Fentanyl
      • Norfentanyl
    • Methadone
      • EDDP
  • Tramadol
  • Propoxyphene
  • Tapentadol
  • Tricyclic Anti-Depressants (All)
    • Amitriptyline
    • Cyclobenzaprine
    • Desipramine
    • Imipramine
    • Nortriptyline
  • Zolpidem

New to Testing?

If you are new to compliance monitoring, you probably have a lot of questions about how the process works. Our specially trained representatives can help you with everything from work flow optimization to billing/coding questions.


Point-of-Care (POC) Testing

  • Provides real time information about drugs in the patients system
  • The physician can bill for the Interpretation of the POC device
  • Customizable drug panels

In-office POC devices allow the clinician to asses what drugs are in a patients system while they are still in the office. You can customize the drug panels that are included to test for a variety of common pharmaceuticals and drugs of abuse. Many offices elect to use CLIA Waived devices that allow them to bill a small amount for interpretation of the cup, while reimbursements vary offices report an average of $10-$30 per cup.

*Important Note: In order to bill for the POC devices, the office must first obtain a CLIA Waiver license. Don't have one? No problem, let us help you understand how easy it can be to obtain one!

Confirmation Testing

The quality and reliability of POC devices varies and it is important for clinicians to understand that false POSTIVES and false NEGATIVES are very common. it is strongly recommended that any result be confirmed using a more sophisticated technique such as LC/MS/MS.

Point-of-Care (POC) Device Chart

Point-of-Care (POC) Device Chart

When to Test?

In most states there is no required frequency, only general guidelines to help you determine what is right for your practice. Any testing policy should be clearly defined and documented in your records.

Elements of Compliance Monitoring

  • Controlled Substance Contract (aka Opioid Contract)
  • Risk Assessment Tools (e.g. SOAPP-R, ORT)
  • Checks Against the National and State Prescription Drug Monitoring Program Database (PDMP)
  • Randomized Drug Testing

Testing Objectives

  1. Assessment based on risk factors
  2. Drug testing at baseline for all new patients
  3. Regular testing to ensure compliance
  4. Random testing to identify potential abuse or diversion
  5. Testing when aberrant behavior is identified

Risk Assessment Correlation to Testing Frequency

Many organizations suggest there should be a correlation between the risk of abuse and the frequency of testing. There are several models for risk assessment. Please ask your InSource Diagnostics representative for more information and templates your office can use to set up its own risk assessment program.

Risk Assessment1 Testing Frequency2
Low Risk Responsible alcohol and medication use, no history of abuse, and no psychological conditions Infrequent
Randomly for Compliance
Moderate Risk Family history of abuse, depression, anxiety, reliance on medication, or history of non-compliance with other meds Periodic
Quarterly
High Risk History of abuse, discharged from a previous physician, or regular non-compliance Frequent
At Every Visit
Aberrant
Behavior
Lost prescriptions, requests for early refill, change in dosage, or apparent intoxication During Visit
1A patients risk should be re-evaluated on a continual basis
2Testing frequency taken from the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). These are guidelines only and the testing frequency should be based on your own medical judgment

Limitations of Screening Techniques

  • Specially designed antibodies are used to detect drugs or metabolites
  • Identification is generally for a drug class, not a specific drug compound
  • Results are qualitative only (positive/negative)
  • Potential for false positive and false negative results
  • Results should be confirmed by LC/MS/MS before reporting to a patient


High Complexity Immunoassay Screening

Limitation of Screening Technologies

  • Specific to a drug class only (e.g. opiates), cannot provide the specific drug substance detected
  • Low sensitivity for some drugs (false negatives) – especially true for drug metabolites
  • Results are qualitative only (positive/negative)
  • False positives for structurally related compounds

False Positives

The POC would indicate a positive result, but the patient was in fact compliant.

Methamphetamine

Pseudoephedrine

Pseudoephedrine is a common component of cough and cold medications, and can often result in a false positive for methamphetamine.

False Negatives

The cup results would indicate a negative result, which could lead you to believe the patient was compliant when they were not.

Concentrations (ng/mL) of Opiate Compounds that Produce a Result Approximately Equivalent to the 300 ng/mL Cutoff
Compound Concentration (ng/mL) at 300 ng/mL Cutoff
Codeine 102-306
Dihydrocodeine 291
Hydrocodone 247
Hydromorphone 498
Levallorphan >5000*
Levorphanol 1048
Meperidine >15000
6-Acetylmorphine 435
Morphine-3-Glucuronide 626
Nalorphine 5540*
Naloxone 360000
Oxycodone 1500
Oxymorphone 9300

* Therapeutic or toxic urinary levels of levallorphan and nalorphine are not reported in the literature.

Meperidine urinary concentrations of 15000 ng/mL have been measured in cases of fatal meperidine overdosage.