• Gwendolyn A McMillin, Stephanie J Marin, Kamisha L Johnson-Davis, Bryan G Lawlor, and Frederick G Strathmann.
• From the ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Department of Pathology, University of Utah School of Medicine, Salt Lake City; and gwen.mcmillin@aruplab.com.
• Am. J. Clin. Pathol. 2015 Feb 1;143(2):234-40.

ObjectivesThe major objective of this research was to propose a simplified approach for the evaluation of medication adherence in chronic pain management patients, using liquid chromatography time-of-flight (TOF) mass spectrometry, performed in parallel with select homogeneous enzyme immunoassays (HEIAs). We called it a "hybrid" approach to urine drug testing.MethodsThe hybrid approach was defined based on anticipated positivity rates, availability of commercial reagents for HEIAs, and assay performance, particularly analytical sensitivity and specificity for drug(s) of interest. Subsequent to implementation of the hybrid approach, time to result was compared with that observed with other urine drug testing approaches.ResultsOpioids, benzodiazepines, zolpidem, amphetamine-like stimulants, and methylphenidate metabolite were detected by TOF mass spectrometry to maximize specificity and sensitivity of these 37 drug analytes. Barbiturates, cannabinoid metabolite, carisoprodol, cocaine metabolite, ethyl glucuronide, methadone, phencyclidine, propoxyphene, and tramadol were detected by HEIAs that performed adequately and/or for which positivity rates were very low. Time to result was significantly reduced compared with the traditional approach.ConclusionsThe hybrid approach to urine drug testing provides a simplified and analytically specific testing process that minimizes the need for secondary confirmation.Copyright© by the American Society for Clinical Pathology.

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