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Center for Substance Abuse Treatment. (2012) Clinical drug testing in primary care. Rockville, MD: Substance Abuse and Mental Health Services Administration. Technical assistance publication (TAP) series 32. Publication no. SMA12-4668.

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Chapter 1—Introduction
• Audience for the TAP
• Organization of the TAP
• Reasons To Use Clinical Drug Testing in Primary Care
• Primary Care and Substance Use Disorders
• Development of Drug Testing
• Workplace Drug Testing
• Drug Testing in Substance Abuse Treatment and Healthcare Settings
• Differences Between Federal Workplace Drug Testing and Clinical Drug Testing
• Caution

Chapter 2—Terminology and Essential
Concepts in Drug Testing
• Drug Screening and Confirmatory Testing
• Testing Methods
• Test Reliability
• Window of Detection
• Cutoff Concentrations
• Cross-Reactivity
• Drug Test Panels
• Test Matrix
• Point-of-Care Tests
• Adulterants
• Specimen Validity Tests
• Clinical Drug Testing in Primary Care

Chapter 3—Preparing for Drug Testing
• Deciding Which Drugs To Screen and Test For
• Choosing a Matrix
• Specimen Availability
• Oral Fluid
• Sweat
• Blood
• Hair
• Breath
• Meconium
• Selecting the Initial Testing Site: Laboratory or Point-of-Care
• Collection Devices
• Laboratory Tests
• Advantages and Disadvantages of Testing in a Laboratory
• Considerations for Selecting a Laboratory
• Point-of-Care Tests
• Advantages and Disadvantages of POCTs
• Considerations for Selecting POCT Devices
• Implementing Point-of-Care Testing
• Preparing Clinical and Office Staffs for Testing
• Preparing a Specimen Collection Site

Chapter 4—Drug Testing in Primary Care
• Uses of Drug Testing in Primary Care
• Monitoring Prescription Medication Use
• Management of Chronic Pain With Opioids
• Evaluation of Unexplained Symptoms or Unexpected Responses to Treatment
• Patient Safety
• Pregnancy
• Psychiatric Care
• Monitoring Office-Based Pharmacotherapy for Opioid Use Disorders
• Detection of Substance Use Disorders
• Initial Assessment of a Person With a Suspected SUD
• Talking With Patients About Drug Testing
• Cultural Competency and Diversity
• Monitoring Patients
• Patients With an SUD
• Monitoring Patients Receiving Opioids for Chronic Noncancer Pain
• Ensuring Confidentiality and 42 CFR Part 2
• Preparing for Implementing Drug Testing
• Collecting Specimens
• Conducting POCTs
• Interpreting Drug Test Results
• Result: Negative Specimen
• Result: Positive Specimen
• Result: Adulterated or Substituted Specimen
• Result: Dilute Specimen
• Result: Invalid Urine Specimen
• Frequency of Testing
• Documentation and Reimbursement
• Documentation
• Reimbursement

Chapter 5—Urine Drug Testing for Specific Substances
• Window of Detection
• Specimen Collection
• Adulteration, Substitution, and Dilution
• Adulteration
• Substitution
• Dilute Specimens
• Cross-Reactivity
• Alcohol
• Amphetamines
• Barbiturates
• Benzodiazepines
• Cocaine
• Marijuana/Cannabis
• Opioids
• Other Substances of Abuse
• PCP
• Club Drugs
• LSD
• Inhalants

Appendix A—Bibliography 63
Appendix B—Laboratory Initial Drug-Testing Methods
Appendix C—Laboratory Confirmatory Drug-Testing Methods
Appendix D—Laboratory Specimen Validity-Testing Methods
Appendix E—Glossary
Appendix F—Expert Panel
Appendix G—Consultants and Field Reviewers


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