Core EM - Emergency Medicine Podcast

Episode 180.0: Urine Tox Screens

Jan 12, 2021

Dr. Philip DiSalvo, an emergency physician and toxicologist, discusses the reliability and limitations of urine drug screens in emergency medicine. Topics include false positives/negatives, interference, and the need for additional testing methods. The impact of timing and drug detection duration is explored, along with the role of urine drug screens in ED management and psychiatry.

19:40

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Episode guests

Philip DiSalvo

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Quick takeaways

Urine drug screens have limited utility in the emergency department and should not be solely relied upon for diagnosing drug intoxication.

The timing of drug ingestion or exposure affects urine drug screen results, and the detection period varies for different drugs.

Deep dives

Understanding the Urine Drug Screen

The podcast episode explores the controversy surrounding urine drug screens (UTOCs) in emergency medicine. The history and development of standardized urine drug screens are discussed, highlighting the NIDA-5 panel that tests for marijuana, PCP, opiates, amphetamines, and cocaine. Variability in urine drug screen panels across different clinical sites is noted. False positives and false negatives are common with urine drug screens due to incomplete understanding and interference from other substances. Specific examples of false positives are mentioned, including poppy seeds for opiates and medications like Dextromethorphan, Quinine, bupropion, and medications containing ephedrine or pseudoephedrine for amphetamines. The podcast emphasizes that urine drug screens should not be relied upon solely for diagnosing drug intoxication, as they can lead to incorrect interpretations and have limited utility in the emergency department.

Introduction

4min

Limitations and Challenges of Urine Drug Screens

5min

Limitations of Urine Drug Screens and the Role of Quantitative Testing

4min

Timing and Duration of Drug Detection in Urine Drug Screens

2min

Urine Drug Screens on ED Management and the Role of Psychiatry

6min

We discuss the (F)utility(?) of ED Utox screens with our very own Dr. Phil DiSalvo.

Hosts:
Bree Tse, MD
Brian Gilberti, MD

Download Leave a Comment Tags: Toxicology

Show Notes

Special Thanks To:

Dr. Philip DiSalvo, MD

Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health, NYC Health + Hospitals/ Bellevue

New York City Poison Control Center

References:

Christian MR, et al. Do rapid comprehensive urine drug screens change clinical management in children? Clin Toxicol (Phila). 2017;57:977-980.

Grunbaum AM, Rainey PM (2019). Chapter 7: Laboratory Principles. In Goldfrank’s toxicologic emergencies. New York, NY: McGraw-Hill Education.

Moeller K, Kissack J, Atayee R, Lee K. Clinical Interpretation of Urine Drug Tests: What Clinicians Need to Know About Urine Drug Screens. Mayo Clinic Proceedings Review. Volume 92, Issue 5, p774-796, May 1, 2017. https://www.mayoclinicproceedings.org/article/S0025-6196(16)30825-4/fulltext

Table 2: Approximate Drug Detection Time in the Urine

Table 4: Summary of Agents Contributing to Results by Immunoassay