Waived Urine Drug Screens in Physician Office Practice

I'd love to learn any answers you get to your questions! Here is what I know: but I have not implemented this test (yet) - I'm sure I will in the future because the request comes up about once a year.

The common reason for requesting that I've had - is for patients on pain contracts in order to get a renewed prescription for certain controlled substances/medications. Or in our addiction clinic - the providers want to reward the patient for only taking the medications they are prescribed and they want to be able to provide that reward for a good urine drug screen test in real time versus waiting for the results to come back from the lab and calling the patient.      

When I scoped this, all of the package inserts for kits I looked at said that confirmatory testing of positive results via gas chromatography is required. I reached out to my State CLIA agency and they said since these clinics only care about the results being negative to give a reward ....they are okay to not have us perform confirmatory testing of positive results. They said if it would make us more comfortable as laboratorians we could report positives as "preliminary positive".   That answer still makes me feel uncomfortable! 

We asked our requestors what tests they wanted to ensure were on the drug screen test and used that to start looking at different kits. We wanted to have some adulterant testing built into the kit we choose.  We primarily looked at the Abbott iScreen, Abbott iCUP, and UScreen.

One of the reasons that has prevented us from implementing thus far is there isn't an interfaced urine drug screen test that is waived (that I can find!) and manually entering 10+ results into each patient's EMR and the time to audit those for correctness etc. felt too risky.