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The Pediatric Forum |

Laboratory Testing for Drug Abuse—Reply

Sharon Levy, MD, MPH; Sion Kim Harris, PhD; Lon Sherritt, MPH; Michelle Angulo, BA; John R. Knight, MD
Arch Pediatr Adolesc Med. 2006;160(8):854. doi:10.1001/archpedi.160.8.854-b.
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We agree with Drs Warner and Friedmann that the detection of illicit substances such as oxycodone and ecstasy (3,4 methylenedioxymethamphetamine) by immunoassay screens depends on the particular screen used, and indeed, some commercial products are able to detect these compounds in urine. Our study was conducted in 2004 when the preferred assays used in standard drug-testing laboratories did not reliably detect ecstasy, as noted in the footnote to Table 2, and to date, the majority of opioid screens do not include oxycodone. However, even if we discount these items from our questionnaire analysis, our conclusion that the primary care workforce is not currently prepared to support widespread implementation of urine drug testing would not change. Moreover, the variability in what is included in a “standard panel” among available urine screening products underscores the complexity of this procedure. Furthermore, prior research by our team examined Internet-based information regarding home drug-testing kits as well as product inserts. We found that the information companies provided regarding which drugs are detected by their testing products was often conflicting or incomplete.1 Therefore, physicians who use point-of-service test kits may have difficulty in determining which substances are detected even after examining the information provided. The question of whether physicians obtain consent prior to performing laboratory screening was beyond the scope of our article, which focused on the technical challenges of drug testing. Analysis of physician attitudes and practices is reported in a subsequent article.2

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