How do I interpret unexpected screening UDT results?

Return to UDT Decision Support

Step 1: Click on available Urine Drug Test Results. (Assumes that Patient is both Prescribed AND Taking the Drug/Medication)
Step 2: Click Run.

Amphetamine
Barbiturates
Benzodiazepines
Cocaine
Codeine
Fentanyl
Methadone
Morphine
Oxycodone
PCP

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Drug Name	If Unexpected	Potential False Positives	Next Steps (What to do now)	If Problematic use Identified…	Common Detection Range
Amphetamine	Consider Misuse, Consider False positive due to other substances. Review if administration is appropriate and/or sanctioned. If use is likely, consider repeat and/or confirmatory testing.	amantadine; benzphetamine, bupropion; chlorpromazine; clobenzorex; dimethylamphetamine; dopamine; decongestants (e.g. brompheniramine, phenteramine, phenylpropanolamine); desipramine; Ephedrine; fenfluramine, fenproporex; isoxsuprine; mefenorex; mephentermine; methylphenidate; mexilitine; phenmetrazine; pseuodoephedrine; nasal promethazine; ranitadine; selegiline; SSRI's; trazadone; Vicks Vapor Spray (L-amphetamine - Psychoactive form of amphetamine is D-form: If < 80% is L-form, then Vicks cannot be sole source) .	• Review medication list for potential False Positives. • Tell patient that this medication showed up in their UDT. • Ask patient if they can provide any explanation for the result. • Ask patient if they are taking potential false positive medications that you may not be aware of. • Speak to patient to determine if false positive is possible but unexplainable, consider confirmatory testing with Gas Chromatography or Mass Spectroscopy. • Check online Prescription Monitoring Program (PMP) • Assess the severity of use of substance (COMM ; AUDIT ; DAST ) • Assess for Pseudo-addiction (Suspect Behaviors a/w suboptimal pain management plan)	Consider (Based on assessed severity): • Providing counseling • Providing referral to self-help, treatment, detox a/o treatment for addiction • Increasing refill frequency (decrease duration of pain medication prescription) • Increasing visit frequency (decrease time to next return visit) • Increasing frequency of UDT (decrease time to next UDT) • Starting random pill counts	1 to 2 days. Urine may test positive within 3 hours
Barbiturates	Consider Misuse, Consider False positive due to other substances. Review if administration is appropriate and/or sanctioned. If use is likely, consider repeat and/or confirmatory testing.	Ibuprofen; naproxyn; phenytoin	• Review medication list for potential False Positives. • Tell patient that this medication showed up in their UDT. • Ask patient if they can provide any explanation for the result. • Ask patient if they are taking potential false positive medications that you may not be aware of. • Speak to patient to determine if false positive is possible but unexplainable, consider confirmatory testing with Gas Chromatography or Mass Spectroscopy. • Check online Prescription Monitoring Program (PMP) • Assess the severity of use of substance (COMM ; AUDIT ; DAST ) • Assess for Pseudo-addiction (Suspect Behaviors a/w suboptimal pain management plan)	Consider (Based on assessed severity): • Providing counseling • Providing referral to self-help, treatment, detox a/o treatment for addiction • Increasing refill frequency (decrease duration of pain medication prescription) • Increasing visit frequency (decrease time to next return visit) • Increasing frequency of UDT (decrease time to next UDT) • Starting random pill counts	2 to 20 days depending on specific agent; Chronic use may result in longer detection times.
Benzodiazepines	Consider Misuse, Consider False positive due to other substances. Review if administration is appropriate and/or sanctioned. If use is likely, consider repeat and/or confirmatory testing.	Sertraline, oxaprozin.	• Review medication list for potential False Positives. • Tell patient that this medication showed up in their UDT. • Ask patient if they can provide any explanation for the result. • Ask patient if they are taking potential false positive medications that you may not be aware of. • Speak to patient to determine if false positive is possible but unexplainable, consider confirmatory testing with Gas Chromatography or Mass Spectroscopy. • Check online Prescription Monitoring Program (PMP) • Assess the severity of use of substance (COMM ; AUDIT ; DAST ) • Assess for Pseudo-addiction (Suspect Behaviors a/w suboptimal pain management plan)	Consider (Based on assessed severity): • Providing counseling • Providing referral to self-help, treatment, detox a/o treatment for addiction • Increasing refill frequency (decrease duration of pain medication prescription) • Increasing visit frequency (decrease time to next return visit) • Increasing frequency of UDT (decrease time to next UDT) • Starting random pill counts	1 to 14 days depending on specific agent; Chronic use may result in longer detection times
Buprenorphine
Cocaine	Consider Misuse, Consider False positive due to other substances. Review if administration is appropriate and/or sanctioned. If use is likely, consider repeat and/or confirmatory testing.	Local anesthetics (TAC: Tetracaine, Adrenaline, & Ccaine HCL). Not found in Lidocaine, Benzocaine,Mepivacaine)	• Review medication list for potential False Positives. • Tell patient that this medication showed up in their UDT. • Ask patient if they can provide any explanation for the result. • Ask patient if they are taking potential false positive medications that you may not be aware of. • Speak to patient to determine if false positive is possible but unexplainable, consider confirmatory testing with Gas Chromatography or Mass Spectroscopy. • Check online Prescription Monitoring Program (PMP) • Assess the severity of use of substance (COMM ; AUDIT ; DAST ) • Assess for Pseudo-addiction (Suspect Behaviors a/w suboptimal pain management plan)	Consider (Based on assessed severity): • Providing counseling • Providing referral to self-help, treatment, detox a/o treatment for addiction • Increasing refill frequency (decrease duration of pain medication prescription) • Increasing visit frequency (decrease time to next return visit) • Increasing frequency of UDT (decrease time to next UDT) • Starting random pill counts	Usually positive up to 48 to 72 hours; Chronic use may result in longer detection times.
Codeine	Consider Misuse, Consider False positive due to other substances. Review if administration is appropriate and/or sanctioned. If use is likely, consider repeat and/or confirmatory testing.	Poppy seeds ; dextromethorophan; dipnehydramine; fluoroquinolones; quinine, rifampin.	• Review medication list for potential False Positives. • Tell patient that this medication showed up in their UDT. • Ask patient if they can provide any explanation for the result. • Ask patient if they are taking potential false positive medications that you may not be aware of. • Speak to patient to determine if false positive is possible but unexplainable, consider confirmatory testing with Gas Chromatography or Mass Spectroscopy. • Check online Prescription Monitoring Program (PMP) • Assess the severity of use of substance (COMM ; AUDIT ; DAST ) • Assess for Pseudo-addiction (Suspect Behaviors a/w suboptimal pain management plan)	Consider (Based on assessed severity): • Providing counseling • Providing referral to self-help, treatment, detox a/o treatment for addiction • Increasing refill frequency (decrease duration of pain medication prescription) • Increasing visit frequency (decrease time to next return visit) • Increasing frequency of UDT (decrease time to next UDT) • Starting random pill counts	2 to 4 days
Fentanyl	Consider Misuse, Consider False positive due to other substances. Review if administration is appropriate and/or sanctioned. If use is likely, consider repeat and/or confirmatory testing.	False positives are highly unlikely.	• Review medication list for potential False Positives. • Tell patient that this medication showed up in their UDT. • Ask patient if they can provide any explanation for the result. • Ask patient if they are taking potential false positive medications that you may not be aware of. • Speak to patient to determine if false positive is possible but unexplainable, consider confirmatory testing with Gas Chromatography or Mass Spectroscopy. • Check online Prescription Monitoring Program (PMP) • Assess the severity of use of substance (COMM ; AUDIT ; DAST ) • Assess for Pseudo-addiction (Suspect Behaviors a/w suboptimal pain management plan)	Consider (Based on assessed severity): • Providing counseling • Providing referral to self-help, treatment, detox a/o treatment for addiction • Increasing refill frequency (decrease duration of pain medication prescription) • Increasing visit frequency (decrease time to next return visit) • Increasing frequency of UDT (decrease time to next UDT) • Starting random pill counts	24 Hours
Heroin-MAM6
Hydrocodone
Hydromorphone
Meperidine
Methadone	Consider Misuse, Consider False positive due to other substances. Review if administration is appropriate and/or sanctioned. If use is likely, consider repeat and/or confirmatory testing.	Diphenhydramine; doxylamine; clomipramine; chlorpromazine; ibuprofen; quitiapine; thioridazine; tramadol; verapamil.	• Review medication list for potential False Positives. • Tell patient that this medication showed up in their UDT. • Ask patient if they can provide any explanation for the result. • Ask patient if they are taking potential false positive medications that you may not be aware of. • Speak to patient to determine if false positive is possible but unexplainable, consider confirmatory testing with Gas Chromatography or Mass Spectroscopy. • Check online Prescription Monitoring Program (PMP) • Assess the severity of use of substance (COMM ; AUDIT ; DAST ) • Assess for Pseudo-addiction (Suspect Behaviors a/w suboptimal pain management plan)	Consider (Based on assessed severity): • Providing counseling • Providing referral to self-help, treatment, detox a/o treatment for addiction • Increasing refill frequency (decrease duration of pain medication prescription) • Increasing visit frequency (decrease time to next return visit) • Increasing frequency of UDT (decrease time to next UDT) • Starting random pill counts	1 to 3 days; Chronic use may result in longer detection times.
Morphine	Consider Misuse, Consider False positive due to other substances. Review if administration is appropriate and/or sanctioned. If use is likely, consider repeat and/or confirmatory testing.	Diphenhydramine; doxylamine; clomipramine; chlorpromazine; ibuprofen; quitiapine; thioridazine; tramadol; verapamil.	• Review medication list for potential False Positives. • Tell patient that this medication showed up in their UDT. • Ask patient if they can provide any explanation for the result. • Ask patient if they are taking potential false positive medications that you may not be aware of. • Speak to patient to determine if false positive is possible but unexplainable, consider confirmatory testing with Gas Chromatography or Mass Spectroscopy. • Check online Prescription Monitoring Program (PMP) • Assess the severity of use of substance (COMM ; AUDIT ; DAST ) • Assess for Pseudo-addiction (Suspect Behaviors a/w suboptimal pain management plan)	Consider (Based on assessed severity): • Providing counseling • Providing referral to self-help, treatment, detox a/o treatment for addiction • Increasing refill frequency (decrease duration of pain medication prescription) • Increasing visit frequency (decrease time to next return visit) • Increasing frequency of UDT (decrease time to next UDT) • Starting random pill counts	1 to 3 days; Chronic use may result in longer detection times.
Oxycodone	Consider Misuse, Consider False positive due to other substances. Review if administration is appropriate and/or sanctioned. If use is likely, consider repeat and/or confirmatory testing.	Poppy seeds ; dextromethorophan; dipnehydramine; fluoroquinolones; quinine, rifampin.	• Review medication list for potential False Positives. • Tell patient that this medication showed up in their UDT. • Ask patient if they can provide any explanation for the result. • Ask patient if they are taking potential false positive medications that you may not be aware of. • Speak to patient to determine if false positive is possible but unexplainable, consider confirmatory testing with Gas Chromatography or Mass Spectroscopy. • Check online Prescription Monitoring Program (PMP) • Assess the severity of use of substance (COMM ; AUDIT ; DAST ) • Assess for Pseudo-addiction (Suspect Behaviors a/w suboptimal pain management plan)	Consider (Based on assessed severity): • Providing counseling • Providing referral to self-help, treatment, detox a/o treatment for addiction • Increasing refill frequency (decrease duration of pain medication prescription) • Increasing visit frequency (decrease time to next return visit) • Increasing frequency of UDT (decrease time to next UDT) • Starting random pill counts	1 to 4 days
Oxymorphone
PCP	Consider Misuse, Consider False positive due to other substances. Review if administration is appropriate and/or sanctioned. If use is likely, consider repeat and/or confirmatory testing.	Dextromethorophan; dipnehydramine; ibuprofen; tramadol; venlafaxine.	• Review medication list for potential False Positives. • Tell patient that this medication showed up in their UDT. • Ask patient if they can provide any explanation for the result. • Ask patient if they are taking potential false positive medications that you may not be aware of. • Speak to patient to determine if false positive is possible but unexplainable, consider confirmatory testing with Gas Chromatography or Mass Spectroscopy. • Check online Prescription Monitoring Program (PMP) • Assess the severity of use of substance (COMM ; AUDIT ; DAST ) • Assess for Pseudo-addiction (Suspect Behaviors a/w suboptimal pain management plan)	Consider (Based on assessed severity): • Providing counseling • Providing referral to self-help, treatment, detox a/o treatment for addiction • Increasing refill frequency (decrease duration of pain medication prescription) • Increasing visit frequency (decrease time to next return visit) • Increasing frequency of UDT (decrease time to next UDT) • Starting random pill counts	1 to 3 days

Return to UDT Decision Support

For Prescribers

Starting Opiods
Continuing Opioids
Stopping Opioids

For Pharmacists

When to Call the Prescriber
Message Board
Talking to Patients about Opioid Therapy
Pharmacist's Manual from U.S. Drug Enforcement Agency

For Patients

An Informational Form on Opioids for Patients
Drug Abuse Addiction Information Facts