ADLM publishes updated guidance to help healthcare professionals navigate drug testing for patients in the emergency department

WASHINGTON, Jan. 5, 2026 /PRNewswire/ -- The Association for Diagnostics & Laboratory Medicine (ADLM) has released updated expert guidance on urine drug testing for patients in the emergency department (ED). As drug misuse and testing methods continue to evolve, this guidance will help laboratory medicine professionals and clinicians to collaborate on selecting the most appropriate tests for drug detection, which in turn will help patients receive more personalized care.

Read the guidance document here: https://myadlm.org/science-and-research/academy-guidance/testing-for-drugs-of-misuse-to-support-the-emergency-department

Drug testing plays a vital role in the care of patients who arrive at the ED with signs of a drug overdose or altered mental status. For example, if a pediatric patient with altered mental status tests positive for a drug of misuse, this could prevent an unnecessary MRI and could also alert healthcare providers to involve child protective services. It is therefore essential that laboratory medicine professionals and emergency clinicians have the most up-to-date information on drug use trends and testing.

To meet this need, ADLM first released guidance for ED drug testing in 2003. Since then, however, the drug testing landscape has transformed dramatically. Around 2013, synthetic opioids, including fentanyl, began flooding the illegal drug supply. New designer recreational drugs are now created every year in an effort to circumvent drug laws. And on the flipside, the use of certain drugs, such as tricyclic antidepressants, has declined since the early 2000s to the point that it no longer makes sense to routinely test for them.

Alongside these changes in drug use, testing technology also has advanced: Immunoassays — the standard drug testing method — have improved. And more healthcare institutions have gained access to mass spectrometry, a powerful method that can detect drugs in cases where immunoassays can't. 

With all of these factors in mind, a group of experts formed by ADLM's Academy of Diagnostics & Laboratory Medicine has updated the association's 2003 guidance. Major recommendations from the document include the following:

• Laboratory experts and ED clinicians should collaborate to ensure that drug tests are used appropriately for both pediatric and adult patients. In particular, labs should educate ED and other specialty providers about the performance and limitations of drug tests and should be available to assist with test interpretation.
• The clinical laboratory and ED should periodically review their institution's drug test menu and protocols and update them to reflect local drug use patterns. The lab and ED should also make sure that their test menu only includes tests whose results will actually guide patient management.
• Although mass spectrometry is more costly and complex than immunoassays, the clinical laboratory and ED should consider using this method for special populations such as pediatric patients and in cases where an immunoassay would be insufficient and the test result would inform the patient's care.

"Regardless of the method(s) offered, all laboratories should collaborate with ED leadership … to ensure test menus are up to date and reasonable for the patient population," wrote the document authors Drs. Christine L.H. Snozek, Matthew D. Krasowski, Jennifer M. Colby, Kamisha L. Johnson-Davis, Rebecca E. Bruccoleri, and Stacy E. Melanson. Additionally, "laboratories and EDs should collaborate on education of clinical staff regarding assay performance and limitations and regularly discuss optimal strategies to meet clinical needs."

About the Association for Diagnostics & Laboratory Medicine (ADLM)
Dedicated to achieving better health for all through laboratory medicine, ADLM unites more than 70,000 clinical laboratory professionals, physicians, research scientists, and business leaders from 110 countries around the world. Our community is at the forefront of laboratory medicine's diverse subdisciplines, including clinical chemistry, molecular diagnostics, mass spectrometry, clinical microbiology, and data science, and is comprised of individuals holding the spectrum of lab-related professional degrees, certifications, and credentials. Since 1948, ADLM has championed the advancement of laboratory medicine by fostering scientific collaboration, knowledge sharing, and the development of innovative solutions that enhance health outcomes. For more information, visit www.myadlm.org.

Christine DeLong
ADLM
Director, Editorial and Media Relations
(p) 202.835.8722
[email protected]

Bill Malone
ADLM
Senior Director, Strategic Communications
(p) 202.835.8756
[email protected]

SOURCE Association for Diagnostics & Laboratory Medicine (ADLM)