LAUSR

Mr X has been referred to the transplant center for liver transplant evaluation secondary to end-stage liver disease of unknown etiology. His medical history is significant for previous illicit opioid use after a tragic work-related accident for which he was treated with opioids for pain management during recovery. Mr X connected with his primary care provider on illicit drug use, and he was placed on methadone to manage his chronic pain, with a drug screening contract. Upon referral to the transplant center, routine intake laboratory testing was ordered, including a urine toxicology screen, which came back negative for the presence of methadone and opiates. Seeing these results, the intake counselor consults the laboratory director of toxicology since a previous urine toxicology screen was positive for methadone; he wants to understand why the results are discordant, particularly because the patient reports no change in administration schedule.