Drug Monitoring

Drug monitoring uses laboratory testing to check medication adherence, substance use, or abstinence over time. It is widely used in pain management, addiction treatment (MAT), workplace and safety programs, and clinical care. A proactive plan starts with a clear goal (adherence, recent use, long-term pattern), chooses the right specimen (urine, oral fluid, blood, hair), and pairs a rapid screen with definitive confirmation when results are non-negative or policy requires it.

Screening immunoassays are fast and cost-effective, but they can cross-react. LC-MS/MS or GC-MS confirmation identifies the specific drug and metabolite at set cutoffs. Metabolite patterns (for example, 6-MAM for heroin; norfentanyl for fentanyl; EDDP for methadone; norbuprenorphine for buprenorphine) add clarity. Specimen validity checks help detect dilution or adulteration. Lab results inform clinical or program decisions but do not, by themselves, determine impairment or intent.

Signs, Situations & Related Needs

• Pain management / MAT: verify adherence, detect undisclosed substances, support treatment adjustments

• Workplace / safety-sensitive roles: pre-employment, random, return-to-duty, post-incident testing

• Clinical care: unexpected behaviors, medication interactions, high-risk prescriptions (e.g., opioids, benzodiazepines)

• Legal / compliance: court-ordered monitoring, child custody, probation requirements

• When to seek urgent care: suspected overdose, severe sedation, chest pain, suicidal ideation, or rapidly worsening symptoms
  All testing should be interpreted by a qualified clinician, Medical Review Officer (MRO), or program administrator.

Why These Tests Matter

What monitoring can do

• Verify presence or absence of target drugs and confirm specific compounds with metabolites

• Differentiate adherence vs. non-adherence and identify undisclosed substances

• Provide objective trends over time to guide frequency, counseling, or program steps

What monitoring cannot do

• Prove impairment, exact dose, or time of ingestion

• Replace clinical judgment, chain-of-custody, or program policies

• Explain intent—results require context

What These Tests Measure (at a glance)

• Opioids & semisynthetics: morphine, codeine, 6-MAM (heroin), hydrocodone/hydromorphone, oxycodone/oxymorphone, fentanyl/norfentanyl, methadone/EDDP, buprenorphine/norbuprenorphine

  • Use: adherence (MAT/pain), diversion concerns, undisclosed opioid exposure

• Stimulants: amphetamine/methamphetamine (option for D/L isomer), MDMA/MDA, methylphenidate metabolites

  • Use: clarify screen cross-reactivity; confirm specific stimulant

• Cocaine: benzoylecgonine, ecgonine methyl ester

  • Use: definitive cocaine exposure

• Cannabinoids: THC-COOH (urine), parent THC (blood/oral fluid)

  • Use: recent vs. residual pattern by matrix

• Benzodiazepines: alprazolam/α-hydroxyalprazolam, lorazepam, oxazepam, temazepam, clonazepam/7-aminoclonazepam

  • Use: detect glucuronidated benzos that screens may miss

• Other classes (as ordered): barbiturates, PCP, synthetic opioids/novel psychoactives, etc.

• Specimen validity: urine creatinine, specific gravity, pH, oxidants/nitrites

  • Use: detect dilution, substitution, or adulteration

Detection windows (typical; vary by dose/use/cutoff)

• Urine: ~1–3 days for many drugs; longer for THC with frequent use

• Oral fluid: hours to ~1–2 days (recent use)

• Blood: hours to ~1 day (current presence)

• Hair: weeks to months (long-term pattern; not impairment)

How the Testing Process Works

1. Define the goal & policy: adherence, abstinence, recent use, or long-term pattern; confirm matrix and any chain-of-custody needs

2. Collect the specimen: urine/oral fluid/blood/hair per instructions; add specimen validity for urine when required

3. Screen, then confirm: run immunoassay screen; LC-MS/MS or GC-MS confirmation for non-negative or policy-directed classes

4. Review & document: receive a secure report with analytes, metabolites, levels (and validity metrics when applicable)

5. Trend over time: set an interval for repeat testing to document change, adherence, or relapse prevention

Interpreting Results (General Guidance)

• Confirmed positive: target analyte(s) at/above cutoff; evaluate metabolite profile (e.g., oxycodone with oxymorphone, fentanyl with norfentanyl) and prescriptions

• Negative / below cutoff: analyte not detected or under threshold; does not exclude use outside the detection window

• Special markers: 6-MAM (heroin), norfentanyl (fentanyl), EDDP (methadone metabolism), norbuprenorphine(buprenorphine metabolism) strengthen interpretation

• Matrix matters: oral fluid/blood reflect recent use; urine reflects clearance window; hair shows long-term patterns
  Always interpret alongside medications, timing, clinical findings, and program rules.

Choosing Panels vs. Individual Tests

• Pain management / MAT: targeted opioid benzodiazepine panels with metabolite confirmation and urine validity

• Workplace / safety programs: standard multi-drug panels (DOT/non-DOT) with confirmation as required

• Clinical surprises (unexpected screen): broaden to LC-MS/MS confirmation panel; consider isomer testing for amphetamines

• Long-term pattern monitoring: hair panels; pair with periodic urine/oral fluid for near-term checks

• Suspected tampering: add specimen validity to urine panels

FAQs

What’s the difference between screening and confirmation?
Screening is a rapid yes/no immunoassay; confirmation uses mass spectrometry to precisely identify and quantify drugs/metabolites.

Can prescription meds trigger a positive screen?
Yes. That is why confirmation is used to separate cross-reactivity from true positives.

Does a positive mean I was impaired?
No. Results show presence above a cutoff, not impairment or exact timing.

Which specimen should I choose?
Match the test to the goal: blood (now), oral fluid (recent), urine (recent/clearance), hair (weeks–months pattern).

How do metabolite patterns help?
They verify biologic processing (e.g., 6-MAM for heroin) and help distinguish adherence from non-prescribed use.

What if I suspect dilution or adulteration?
Order specimen validity (creatinine, specific gravity, pH, oxidants) and follow collection policy.

Internal Links & Cross-References

• Drug & Alcohol Tests Hub

• Employment & Compliance Testing

•  Pain Management Monitoring

• Drug & Alcohol Tests Hub

• Drug Screening

• Drug Confirmation Test

• Drug Monitoring

• Drug Toxicology Monitoring

• Alcohol

• Key Lab Tests: LC-MS/MS Multi-Drug Panel (Urine) • Oral Fluid Drug Panel • Hair Drug Panel • Opioid/Benzodiazepine Targeted Confirmation • Fentanyl/Norfentanyl Confirmation • Specimen Validity

References

1. Substance Abuse and Mental Health Services Administration (SAMHSA). Drug testing guidance and cutoffs.

2. U.S. Department of Transportation (DOT). Drug Testing Program regulations.

3. American Society of Addiction Medicine (ASAM). Appropriate use of drug testing in clinical addiction medicine.

4. American Association for Clinical Chemistry (AACC). Laboratory best practices for definitive drug testing.

5. College of American Pathologists (CAP). Toxicology and mass spectrometry standards.

6. Centers for Disease Control and Prevention (CDC). Opioid prescribing and risk mitigation—monitoring considerations.

7. ARUP Consult/clinical toxicology compendia. Detection windows, metabolite interpretation, and specimen validity.

Available Tests & Panels

Your drug monitoring menu is pre-populated in the Ulta Lab Tests system. Select the matrix and panel that match your goal and policy, pair screening with confirmatory LC/GC-MS when required, and include specimen validity for urine. Review all results with your clinician, MRO, or program administrator.