{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:55:54Z","timestamp":1782924954732,"version":"3.54.5"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Drugs included in the urine drug screening (UDS) panel may not reflect current drug use patterns and therefore their clinical utility, particularly for drugs with low positivity rates, may be minimal. Laboratories should frequently review the components of their UDS panel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Based on clinical need and local epidemiology, the updated UDS panel included immunoassay screens for amphetamines, benzodiazepines, cocaine metabolite, fentanyl, opiates, and oxycodone. At Site 1 (June 2022), barbiturates and cannabinoids (THC) were removed, while fentanyl and oxycodone were added. At Site 2 (October 2024), THC and methadone were removed. Both sites implemented an improved assay for benzodiazepines. We determined volumes and positivity rates and assessed clinical effects pre- and post-implementation of an updated UDS panel and assessed whether clinicians ordered drug screens that were omitted from the panel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At Site 1, post-implementation, only 0.2% and 6.3% of UDS panels included a separate order for barbiturates or THC (e.g., UDS panel + THC screen), respectively. In contrast, fentanyl and oxycodone testing increased by 8- and 3-fold, respectively. At Site 2, post-implementation, only 2.8% and 7.1% of UDS panels included a separate order for methadone or THC, respectively. The positivity rate for benzodiazepines increased by 16% at both sites following implementation of an improved assay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Changes to the UDS panel aligned laboratory testing with patterns of drug use and clinical utility and standardized care within our healthcare system. Unnecessary testing was reduced; drugs removed from the panel were infrequently ordered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jalm\/jfag026","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T12:49:14Z","timestamp":1770814154000},"page":"748-757","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Optimizing Urine Drug Screening Panels at Two Academic Medical Centers"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4541-4920","authenticated-orcid":false,"given":"Grace K","family":"Mahowald","sequence":"first","affiliation":[{"name":"Department of Pathology, Mass General Brigham , Boston, MA ,","place":["United States"]},{"name":"Harvard Medical School , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Pathology, Mass General Brigham , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter R","family":"Chai","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA ,","place":["United States"]},{"name":"Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women\u2019s Hospital , Boston, MA ,","place":["United States"]},{"name":"The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology , Cambridge, MA ,","place":["United States"]},{"name":"The Fenway Institute , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy B","family":"Erickson","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA ,","place":["United States"]},{"name":"Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women\u2019s Hospital , Boston, MA ,","place":["United States"]},{"name":"Harvard Humanitarian Initiative , Cambridge, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex C","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Pathology, Mass General Brigham , Boston, MA ,","place":["United States"]},{"name":"Harvard Medical School , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole V","family":"Tolan","sequence":"additional","affiliation":[{"name":"Department of Pathology, Mass General Brigham , Boston, MA ,","place":["United States"]},{"name":"Harvard Medical School , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5190-6652","authenticated-orcid":false,"given":"Sacha","family":"Uljon","sequence":"additional","affiliation":[{"name":"Department of Pathology, Mass General Brigham , Boston, MA ,","place":["United States"]},{"name":"Harvard Medical School , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy E F","family":"Melanson","sequence":"additional","affiliation":[{"name":"Department of Pathology, Mass General Brigham , Boston, MA ,","place":["United States"]},{"name":"Harvard Medical School , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"2026070109515342400_jfag026-B1","author":"SAMHSA"},{"key":"2026070109515342400_jfag026-B2","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.cca.2013.09.039","article-title":"Utilization management in toxicology","volume":"427","author":"Zhang","year":"2014","journal-title":"Clin Chim Acta"},{"key":"2026070109515342400_jfag026-B3","doi-asserted-by":"crossref","first-page":"177","DOI":"10.5858\/arpa.2018-0562-CP","article-title":"Interpretation and utility of drug of abuse screening immunoassays: insights from laboratory drug testing proficiency surveys","volume":"144","author":"Krasowski","year":"2020","journal-title":"Arch Pathol Lab Med"},{"key":"2026070109515342400_jfag026-B4","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1093\/jalm\/jfae076","article-title":"Impact of COVID-19 on drug positivity rates in emergency departments in Boston and the surrounding areas","volume":"9","author":"Tolan","year":"2024","journal-title":"J Appl Lab Med"},{"key":"2026070109515342400_jfag026-B5","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1373\/49.3.357","article-title":"National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: recommendations for the use and laboratory tests to support poisoned patients who present to the emergency department","volume":"49","author":"Wu","year":"2003","journal-title":"Clin Chem"},{"key":"2026070109515342400_jfag026-B6","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1093\/jalm\/jfaf172","article-title":"ADLM guidance document on laboratory testing for drugs of misuse to support the emergency department","volume":"11","author":"Snozek","year":"2026","journal-title":"J Appl Lab Med"},{"key":"2026070109515342400_jfag026-B7","first-page":"429","volume-title":"Clinics in laboratory medicine","author":"Melanson","year":"2012"},{"key":"2026070109515342400_jfag026-B8","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1093\/jat\/bkv133","article-title":"A retrospective analysis of urine drugs of abuse immunoassay true positive rates at a national reference laboratory","volume":"40","author":"Johnson-Davis","year":"2016","journal-title":"J Anal Toxicol"},{"key":"2026070109515342400_jfag026-B9","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1093\/jat\/bku075","article-title":"False-positive interferences of common urine drug screen immunoassays: a review","volume":"38","author":"Saitman","year":"2014","journal-title":"J Anal Toxicol"},{"key":"2026070109515342400_jfag026-B10","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/bs.acc.2016.11.003","article-title":"Rapid assessment of drugs of abuse","volume":"80","author":"Wiencek","year":"2017","journal-title":"Adv Clin Chem"},{"key":"2026070109515342400_jfag026-B11","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1093\/jalm\/jfae036","article-title":"Performance of a norfentanyl immunoassay in specimens with low concentrations of fentanyl and\/or norfentanyl","volume":"9","author":"Uljon","year":"2024","journal-title":"J Appl Lab Med"},{"key":"2026070109515342400_jfag026-B12","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jmsacl.2024.06.002","article-title":"Despite the improved clinical sensitivity of the roche benzodiazepines II assay it cannot replace mass spectrometry in all patient populations","volume":"33","author":"Tolan","year":"2024","journal-title":"J Mass Spec Adv Clin Lab"},{"key":"2026070109515342400_jfag026-B13","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1080\/15563650.2023.2177552","article-title":"Cannabis positivity rates in seventeen emergency departments across the U.S. with varying degrees of marijuana legalization","volume":"61","author":"Tolan","year":"2023","journal-title":"Clin Toxicol"},{"key":"2026070109515342400_jfag026-B14","author":"Massachusetts Department of Public Health"},{"key":"2026070109515342400_jfag026-B15","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1002\/wps.20846","article-title":"The epidemic of fentanyl misuse and overdoses: challenges and strategies","volume":"20","author":"Volkow","year":"2021","journal-title":"World Psychiatry"},{"key":"2026070109515342400_jfag026-B16","first-page":"583","article-title":"Clinical benefits of direct-to-definitive testing for monitoring compliance in pain management","volume":"21","author":"Gencheva","year":"2018","journal-title":"Pain Physician"},{"key":"2026070109515342400_jfag026-B17","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1373\/jalm.2017.023341","article-title":"Executive summary AACC LMPG: using clinical laboratory tests to monitor drug therapy in pain management patients","volume":"2","author":"Jannetto","year":"2018","journal-title":"J Appl Lab Med"},{"key":"2026070109515342400_jfag026-B18","first-page":"SE1","article-title":"Immunoassay-based drug tests are inadequately sensitive for medication compliance monitoring in patients treated for chronic pain","volume":"20","author":"Snyder","year":"2017","journal-title":"Pain Physician"}],"container-title":["The Journal of Applied Laboratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jalm\/article-pdf\/11\/4\/748\/67286472\/jfag026.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jalm\/article-pdf\/11\/4\/748\/67286472\/jfag026.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:27:05Z","timestamp":1782923225000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jalm\/article\/11\/4\/748\/8512740"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,10]]},"references-count":18,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,3,10]]},"published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jalm\/jfag026","relation":{},"ISSN":["2475-7241"],"issn-type":[{"value":"2475-7241","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,3,10]]}}}