Lesson 293: PreAnesthetic Assessment of the Drug Abuser: Value of Urine Drug Screening Course Administration

Registration Fee: $15.00
2.0 AMA PRA Category 1 Credits^TM
available until August 31, 2012

Review Date: July, 2011

Participants who do not possess a copy of Anesthesiology News can download and print the course material in an easy to read convenient  format.  Participants must reflect on the information presented, and then register to complete the exam and course evaluation online before the availability date listed above.  (CME credit is not valid past this date).  

Click on the link below to download and print the course material and post-test exam.  Register for the exam to enter your responses to receive CME credit.  There are ten questions in the examination and you must achieve a score of 80% or better to earn CME credit.  Following successful completion, your certificate will be immediately available online.  In addition, a historical record of  completed CME courses is maintained online in an individualized profile.  This includes copies of course certificates which can be printed at any time.

The registration fee for this course is $15.00

Physicians are provided with two opportunities to successfully complete the exam presented here. 

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Nearly 9% of the population over the age of 12 report active use of at least one illicit substance. Anesthesia in the context of recent illicit drug use may lead to excess morbidity and mortality, due in part to drug interaction. Urine drug screening before surgery is one approach available for detecting recent drug abuse. However, the test itself has limitations, including the potential to generate false-positive and false-negative results. Moreover, some illicit substances are not detected in the urine. Anesthesiologists should have a basic understanding of how urine drug screening is performed in order to best use and interpret this test in clinical practice. The topic has received considerable attention in the media, and has been identified by committee as necessary information for clinical anesthesiologists.

CASE HISTORY

A 36-year-old man was scheduled for left inguinal hernia repair. His medical history was significant for hypertension, chronic low back pain, and depression. He also gave a history of illicit substance abuse, including intermittent marijuana, cocaine, and heroin. He had smoked approximately one pack of cigarettes per day since age 17, but denied using alcohol. His current prescription medications included metoprolol and bupropion. In the preoperative area, the patient appeared somewhat anxious, but was otherwise alert and appropriate. His vital signs were blood pressure, 130/82 mm Hg; heart rate, 76 beats per minute; respiratory rate, 10 breaths per minute; oxygen saturation, 99% on room air; temperature, 37.2°C. The surgical resident informed the anesthesiologist that a urine drug screen, ordered for the morning of surgery, was positive for amphetamines, cannabinoids, and cocaine. Upon questioning, the patient admitted to smoking marijuana daily, but otherwise insisted he had been taking only his prescribed medications. He said he stopped using IV drugs more than 13 months previously, and had never abused amphetamines.

LEARNING OBJECTIVES

At the end of this activity, the participant should be able to:

1. Discuss the epidemiology of substance abuse in the United States.
2. Explain the general purpose and performance characteristics of a screening or diagnostic test.
3. Describe the methodology of urine drug screening, and the drugs typically screened.
4. Identify circumstances that may lead to false-positive or false-negative results from a urine drug screen.
5. Interpret the positive results of a urine drug screen with respect to the timing of most recent drug ingestion.
6. List methods by which urine samples may be adulterated in order to interfere with the accuracy of drug screening.
7. Describe how to validate a urine specimen to identify suspected adulteration.
8. Identify methods available for confirming the results of an initial urine drug test.
9. Summarize the potential risks of administering anesthetics to a patient who admits acute drug abuse.
10. Develop an informed approach to the use of urine drug screening, preoperatively.

TARGET AUDIENCE:  Anesthesiologists

Accreditation Statement

Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation: The Mount Sinai School of Medicine designates each educational activity for a maximum of 2 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

It is the policy of Mount Sinai School of Medicine to ensure objectivity, balance, independence, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices.

Disclosures

The author, the reviewer, and the editor have no relation-ships with pharmaceutical companies or manufacturers of products to disclose. This educational activity may contain discussion of published and/or investigational uses of agents for the treatment of disease. Some uses of these agents have not been approved by the FDA. Please refer to the official prescribing information for each product for approved indications, contraindications, and warnings.

CONTACT INFORMATION

Questions regarding course content may be directed to Dr. Elizabeth Frost: ElzFrost@aol.com.

If you require technical assistance with completing this course, please contact Continuing Education Online Customer Service at 718-648-8080 or send e-mail to ceo.contact7@proceo.com.

CALL FOR WRITERS

If you would like to write a CME lesson in Anesthesiology News, please send an e-mail to Elizabeth A.M. Frost, MD, at ElzFrost@aol.com