Updated Guidance for Emergency Department Drug Testing released by ADLM

WASHINGTON, Jan. 5, 2026 – The Association for Diagnostics & Laboratory Medicine (ADLM) has released updated expert guidance for urine drug testing in emergency departments (EDs). This guidance aims to help laboratory medicine professionals and clinicians collaborate effectively to select the most appropriate drug tests, ultimately leading to more personalized and effective patient care.

The evolving Landscape of Drug Testing

Drug testing is a critical component of care for patients presenting to the ED with potential drug overdose or altered mental status. Accurate testing can guide treatment decisions, perhaps preventing unnecessary medical procedures – such as MRIs in pediatric cases – and informing interventions like involving child protective services when appropriate. Given the rapidly changing patterns of drug use and advancements in testing technologies, staying current with best practices is essential.

The original ADLM guidance was first published in 2003.Since than, the drug landscape has undergone a dramatic transformation. Around 2013, the emergence of synthetic opioids, especially fentanyl, considerably altered the illicit drug supply. Moreover, new psychoactive substances, frequently enough designed to circumvent legal restrictions, are continually being created. Conversely, the use of some older drugs, like tricyclic antidepressants, has declined to the point where routine testing is no longer warranted.

Alongside these shifts in drug use, testing methodologies have also advanced.Immunoassay technology has improved in sensitivity and specificity, and access to mass spectrometry – a more powerful, but also more complex, testing method – has become more widespread.

Key Recommendations from the Updated Guidance

Developed by a group of experts from ADLM’s Academy of Diagnostics & Laboratory Medicine, the updated guidance focuses on several key areas:

• Collaboration is Crucial: Laboratory experts and ED clinicians should work together to ensure drug tests are used appropriately for both adult and pediatric patients. Laboratories should proactively educate clinicians about the performance characteristics and limitations of different tests and be available to assist with result interpretation.
• Regular Test Menu Review: clinical laboratories and EDs should periodically review their drug test menus and protocols to align with local drug use trends. Testing should be focused on substances that will directly impact patient management.
• Consider Mass Spectrometry: while more expensive and complex, mass spectrometry should be considered for specific populations, such as pediatric patients, and in cases where immunoassay results are inconclusive or insufficient to guide 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,” stated Drs. Christine L.H. Snozek, Matthew D. Krasowski, Jennifer M. colby, Kamisha L. Johnson-Davis, rebecca E. Bruccoleri, and Stacy E. Melanson, the authors of the document. They further emphasized the importance of ongoing education for clinical staff regarding assay performance and limitations, and also collaborative discussions to optimize testing strategies.

About the Association for Diagnostics & Laboratory Medicine (ADLM)

ADLM is a global association dedicated to advancing health through laboratory medicine. With a community of over 70,000 professionals in 110 countries, ADLM fosters scientific collaboration, knowledge sharing, and the development of innovative solutions in areas such as clinical chemistry, molecular diagnostics, and mass spectrometry. Founded in 1948, ADLM continues to champion the vital role of the laboratory in improving health outcomes. More information can be found at www.myadlm.org.

Contact:

christine DeLong
ADLM
Director, Editorial and Media Relations
(p) 202.835.8722
cdeLong@adlm.org

Bill Malone
ADLM
Senior Director, strategic Communications
(p) 202.835.8756
bmalone@adlm.org

SOURCE Association for Diagnostics & Laboratory Medicine (ADLM)