The Patient Scenario
A patient is prescribed transdermal fentanyl therapy for chronic pain. In a follow-up visit, the patient has complained of activity-related pain which she would like treated. Specifically, she requests oxycodone to ease this episodic pain. The physician wonders if the patient is demonstrating drug-related aberrant behavior and obtains an onsite urine drug test that includes opiates in its drug panel profile.
Point of Collection/Care (POC) Immunoassay Testing for Opiates
The Test Results
The test is negative for opiates.
Synthetic opioids such as fentanyl and meperidine will not be detected by routine opiate immunoassays.
The Physician’s Next Steps
A call to the reference lab for advice provides important information. The sample is retested at the lab specifically for nor-fentanyl using comprehensive testing, and results are positive for fentanyl.
After discussing the latest urine test results with the patient, the physician is reassured that the patient is in fact continuing to use her prescribed fentanyl patches. On further examination, the patient indicates that due to the loss of insurance coverage, she has been changing patches not every 3 days but rather every 4 or 5 days to save money. She explains to the doctor that she asked for the oxycodone because it is less expensive than the transdermal fentanyl patch and she thought she could combine use of each to ease her pain while saving money. Unfortunately, she is experiencing an increase in pain in response to her ‘economically driven solution.’
The Patient-Physician Communication
With any unexpected laboratory result, communication with the patient and the lab may help to clarify the clinical significance of the result.
The Final Outcome
The physician suggests and the patient agrees that rotation from transdermal fentanyl to a less expensive but effective analgesic agent is warranted.