Toxicology: Drug Testing in Addiction Medicine (2025-2026 Recording)-Toxicology: Drug Testing in Addiction Medicine Recording

Video Transcription

Video Summary

This didactic session, introduced by ACAM leadership, featured Dr. Valerie Correjo discussing toxicology testing and drug monitoring in addiction medicine. She began with an overview of the University of New Mexico Addiction Medicine Fellowship, then focused on the goals, history, and best practices of drug testing.<br /><br />Key themes included using testing therapeutically rather than punitively, knowing the question being asked before ordering tests, and understanding the limitations of different specimen types. She reviewed blood, breath, oral fluid, urine, sweat, and hair testing, emphasizing that urine is the most common clinical matrix but is vulnerable to tampering. She described ways to detect dilution or adulteration and practical steps to reduce sample manipulation.<br /><br />Dr. Correjo explained that screening tests are presumptive and can yield false positives or false negatives, while confirmatory tests such as GC-MS or LC-MS provide more definitive results. She highlighted common interpretation pitfalls involving opioids, benzodiazepines, fentanyl, methadone, and buprenorphine, including the importance of knowing which drug classes are included in a given assay.<br /><br />Several case examples illustrated real-world interpretation: negative hydrocodone despite prescribed use, false-positive amphetamine screens, clonazepam missed on routine benzodiazepine screening, fentanyl not detected on standard opioid screens, and buprenorphine sample tampering. She also discussed special populations, including pregnant patients and adolescents, stressing consent, confidentiality, legal variation by state, and the need to reduce stigma and disparities in testing.<br /><br />Her main message: choose tests thoughtfully, interpret results in clinical context, and use drug testing to support patient care.

Keywords

toxicology testing

drug monitoring

addiction medicine

urine drug screen

confirmatory testing

GC-MS

LC-MS

false positives

false negatives

specimen tampering

opioids

benzodiazepines

buprenorphine