| Blood is the preferred specimen for most therapeutic drug monitoring applications. However, therapeutic drug monitoring is not common to the clinical management of pain. Instead, drug testing in a pain management clinic is designed to verify patient compliance with drugs prescribed to control chronic pain, particularly opioids such as oxycodone. Opioid drugs are controlled substances for which it is important to identify non-compliance. Failure to comply with prescribed opioid therapy leads to concerns about inappropriate use, safety of use, and diversion. Urine is currently the specimen of choice to evaluate compliance in most pain management clinics. However, blood-based drug testing can also be very useful. In this presentation, utility of blood as a specimen for drug testing in a pain management setting will be discussed. Blood is the best specimen for detecting recent drug use, is not subject to adulteration, and can help determine a relationship between drug use and impairment. Blood is the specimen of choice for dialysis patients or other persons that do not produce urine. Blood is also the best specimen for understanding absorption, metabolism, and elimination kinetics for an individual patient. Because few commercially available drug tests meet the needs of blood-based testing, this area of laboratory support represents a good opportunity for application of mass spectrometric techniques. An overview of specifications for analytical methods that are designed to detect and quantify drugs of common interest to pain management clinics in blood, will be discussed in this presentation as well. |
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