Oral fluid drug testing of chronic pain patients. I. Positive prevalence rates of licit and illicit drugs

Rebecca Heltsley, Anne DePriest, David L. Black, Tim Robert, Lucas Marshall, Viola M. Meadors, Yale H. Caplan, Edward J. Cone

Research output: Contribution to journalArticle

Abstract

Oral fluid compliance monitoring of chronic pain patients is an analytical challenge because of the limited specimen volume and the number of drugs that require detection. This study evaluated oral fluid for monitoring pain patients and compared results to urine studies of similar populations. Oral fluid specimens were analyzed from 6441 pain patients from 231 pain clinics in 20 states. Specimens were screened with 14 ELISA assays and nonnegative specimens were confirmed by LC-MS-MS for 40 licit and illicit drugs and metabolites. There was an 83.9% positive screening rate (n = 5401) of which 98.7% (n = 5329) were confirmed at ≥ LOQ concentrations for at least one analyte. The prevalence of confirmed positive drug groups was as follows: opiates > oxycodone > benzodiazepines > methadone ≈ carisoprodol > fentanyl > cannabinoids ≈ tramadol > cocaine > amphetamines ≈ propoxyphene ≈ buprenorphine > barbiturates > methamphetamine. Approximately 11.5% of the study population of pain patients apparently used one or more illicit drugs (cannabis, cocaine, methamphetamine and/or MDMA). Overall, the pattern of licit and illicit drugs and metabolites observed in oral fluid paralleled results reported earlier for urine, indicating that oral fluid is a viable option for use in compliance monitoring programs of chronic pain patients.

Original languageEnglish (US)
Pages (from-to)529-540
Number of pages12
JournalJournal of Analytical Toxicology
Volume35
Issue number8
DOIs
StatePublished - Oct 2011

Fingerprint

Street Drugs
Chronic Pain
drug
Fluids
Methamphetamine
fluid
Testing
Cocaine
Pain
Pharmaceutical Preparations
Compliance
Opiate Alkaloids
Metabolites
urine
Urine
Dextropropoxyphene
compliance
Oxycodone
metabolite
Amphetamines

ASJC Scopus subject areas

  • Analytical Chemistry
  • Toxicology
  • Health, Toxicology and Mutagenesis
  • Chemical Health and Safety
  • Environmental Chemistry

Cite this

Heltsley, R., DePriest, A., Black, D. L., Robert, T., Marshall, L., Meadors, V. M., ... Cone, E. J. (2011). Oral fluid drug testing of chronic pain patients. I. Positive prevalence rates of licit and illicit drugs. Journal of Analytical Toxicology, 35(8), 529-540. https://doi.org/10.1093/anatox/35.8.529

Oral fluid drug testing of chronic pain patients. I. Positive prevalence rates of licit and illicit drugs. / Heltsley, Rebecca; DePriest, Anne; Black, David L.; Robert, Tim; Marshall, Lucas; Meadors, Viola M.; Caplan, Yale H.; Cone, Edward J.

In: Journal of Analytical Toxicology, Vol. 35, No. 8, 10.2011, p. 529-540.

Research output: Contribution to journalArticle

Heltsley, R, DePriest, A, Black, DL, Robert, T, Marshall, L, Meadors, VM, Caplan, YH & Cone, EJ 2011, 'Oral fluid drug testing of chronic pain patients. I. Positive prevalence rates of licit and illicit drugs', Journal of Analytical Toxicology, vol. 35, no. 8, pp. 529-540. https://doi.org/10.1093/anatox/35.8.529
Heltsley, Rebecca ; DePriest, Anne ; Black, David L. ; Robert, Tim ; Marshall, Lucas ; Meadors, Viola M. ; Caplan, Yale H. ; Cone, Edward J. / Oral fluid drug testing of chronic pain patients. I. Positive prevalence rates of licit and illicit drugs. In: Journal of Analytical Toxicology. 2011 ; Vol. 35, No. 8. pp. 529-540.
@article{ed1fa493de69422bb485fccc7c7b3f42,
title = "Oral fluid drug testing of chronic pain patients. I. Positive prevalence rates of licit and illicit drugs",
abstract = "Oral fluid compliance monitoring of chronic pain patients is an analytical challenge because of the limited specimen volume and the number of drugs that require detection. This study evaluated oral fluid for monitoring pain patients and compared results to urine studies of similar populations. Oral fluid specimens were analyzed from 6441 pain patients from 231 pain clinics in 20 states. Specimens were screened with 14 ELISA assays and nonnegative specimens were confirmed by LC-MS-MS for 40 licit and illicit drugs and metabolites. There was an 83.9{\%} positive screening rate (n = 5401) of which 98.7{\%} (n = 5329) were confirmed at ≥ LOQ concentrations for at least one analyte. The prevalence of confirmed positive drug groups was as follows: opiates > oxycodone > benzodiazepines > methadone ≈ carisoprodol > fentanyl > cannabinoids ≈ tramadol > cocaine > amphetamines ≈ propoxyphene ≈ buprenorphine > barbiturates > methamphetamine. Approximately 11.5{\%} of the study population of pain patients apparently used one or more illicit drugs (cannabis, cocaine, methamphetamine and/or MDMA). Overall, the pattern of licit and illicit drugs and metabolites observed in oral fluid paralleled results reported earlier for urine, indicating that oral fluid is a viable option for use in compliance monitoring programs of chronic pain patients.",
author = "Rebecca Heltsley and Anne DePriest and Black, {David L.} and Tim Robert and Lucas Marshall and Meadors, {Viola M.} and Caplan, {Yale H.} and Cone, {Edward J.}",
year = "2011",
month = "10",
doi = "10.1093/anatox/35.8.529",
language = "English (US)",
volume = "35",
pages = "529--540",
journal = "Journal of Analytical Toxicology",
issn = "0146-4760",
publisher = "Preston Publications",
number = "8",

}

TY - JOUR

T1 - Oral fluid drug testing of chronic pain patients. I. Positive prevalence rates of licit and illicit drugs

AU - Heltsley, Rebecca

AU - DePriest, Anne

AU - Black, David L.

AU - Robert, Tim

AU - Marshall, Lucas

AU - Meadors, Viola M.

AU - Caplan, Yale H.

AU - Cone, Edward J.

PY - 2011/10

Y1 - 2011/10

N2 - Oral fluid compliance monitoring of chronic pain patients is an analytical challenge because of the limited specimen volume and the number of drugs that require detection. This study evaluated oral fluid for monitoring pain patients and compared results to urine studies of similar populations. Oral fluid specimens were analyzed from 6441 pain patients from 231 pain clinics in 20 states. Specimens were screened with 14 ELISA assays and nonnegative specimens were confirmed by LC-MS-MS for 40 licit and illicit drugs and metabolites. There was an 83.9% positive screening rate (n = 5401) of which 98.7% (n = 5329) were confirmed at ≥ LOQ concentrations for at least one analyte. The prevalence of confirmed positive drug groups was as follows: opiates > oxycodone > benzodiazepines > methadone ≈ carisoprodol > fentanyl > cannabinoids ≈ tramadol > cocaine > amphetamines ≈ propoxyphene ≈ buprenorphine > barbiturates > methamphetamine. Approximately 11.5% of the study population of pain patients apparently used one or more illicit drugs (cannabis, cocaine, methamphetamine and/or MDMA). Overall, the pattern of licit and illicit drugs and metabolites observed in oral fluid paralleled results reported earlier for urine, indicating that oral fluid is a viable option for use in compliance monitoring programs of chronic pain patients.

AB - Oral fluid compliance monitoring of chronic pain patients is an analytical challenge because of the limited specimen volume and the number of drugs that require detection. This study evaluated oral fluid for monitoring pain patients and compared results to urine studies of similar populations. Oral fluid specimens were analyzed from 6441 pain patients from 231 pain clinics in 20 states. Specimens were screened with 14 ELISA assays and nonnegative specimens were confirmed by LC-MS-MS for 40 licit and illicit drugs and metabolites. There was an 83.9% positive screening rate (n = 5401) of which 98.7% (n = 5329) were confirmed at ≥ LOQ concentrations for at least one analyte. The prevalence of confirmed positive drug groups was as follows: opiates > oxycodone > benzodiazepines > methadone ≈ carisoprodol > fentanyl > cannabinoids ≈ tramadol > cocaine > amphetamines ≈ propoxyphene ≈ buprenorphine > barbiturates > methamphetamine. Approximately 11.5% of the study population of pain patients apparently used one or more illicit drugs (cannabis, cocaine, methamphetamine and/or MDMA). Overall, the pattern of licit and illicit drugs and metabolites observed in oral fluid paralleled results reported earlier for urine, indicating that oral fluid is a viable option for use in compliance monitoring programs of chronic pain patients.

UR - http://www.scopus.com/inward/record.url?scp=82855169685&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=82855169685&partnerID=8YFLogxK

U2 - 10.1093/anatox/35.8.529

DO - 10.1093/anatox/35.8.529

M3 - Article

C2 - 22004671

AN - SCOPUS:82855169685

VL - 35

SP - 529

EP - 540

JO - Journal of Analytical Toxicology

JF - Journal of Analytical Toxicology

SN - 0146-4760

IS - 8

ER -