What Labs Are Done at Intake?

Admissions said "labs" as if every building drew the same tubes. They do not. Tonight, ask which tests are drawn here, who explains a positive result, and whether opioid medication waits until every number is back. Do not stop a benzodiazepine, and do not stop heavy drinking, to make a lab slip look quieter.

If someone is seizing, will not wake, or cannot breathe, call 911. For a mental health crisis, call or text 988.

The list is written for opioid care, not for every front desk

For opioid use disorder, especially when people inject drugs, SAMHSA's medication guide recommends a pregnancy test, liver tests, and serology for hepatitis B, hepatitis C, and HIV. Pregnancy changes the medicine. It is not advisable to start naltrexone during pregnancy, and pregnant patients treated for active opioid use disorder typically receive buprenorphine or methadone. The clinician is told to refer to prenatal care or, if qualified, to provide it. Decisions in pregnancy are in rehab during pregnancy.

Liver tests, named as aspartate aminotransferase, alanine aminotransferase, and bilirubin, can guide which opioid medicine fits and can help rule out severe liver disease. A number on a portal is not a taper you invent at home. Alcohol-related liver injury is in alcohol and liver disease. The three medicines, without doses, are in medication for opioid use disorder.

A positive hepatitis test is a reason to evaluate hepatitis treatment. A positive HIV test is a reason to evaluate HIV treatment. A negative HIV test is a reason to talk about prevention, including pre-exposure prophylaxis. People sometimes delay screening because they are afraid of the diagnosis. Programs with medical staff should screen for hepatitis B and C at intake. Programs without on-site medical staff may refer you out. A referral is not the same thing as a tube drawn in the lobby. Ask who draws the blood and who treats a positive result.

Unfinished labs should not hold the medicine hostage

The 2020 ASAM guideline says the first priority is an urgent medical or psychiatric problem, including overdose, and that finishing every assessment should not delay medication for opioid use disorder. If the work is not done before treatment starts, it should be done soon after. The initial labs in that guideline are a complete blood count, liver enzymes, and tests for tuberculosis, hepatitis B, hepatitis C, and HIV. Testing for sexually transmitted infections should be strongly considered. Hepatitis A and B vaccination should be offered if appropriate. Women of childbearing potential should have a pregnancy test. A physical exam belongs in the record before medication starts, or soon after.

Ask whether this program stocks the opioid medicine. Do not start a dose at home. The exam before detox, including vital signs and whether the night is safe, is covered in medical clearance. Tuberculosis testing at admission is covered in the TB test.

Urine or oral-fluid testing is a different tool. It is useful before opioid medication begins, because it shows a baseline. The expert panel in that part of the TIP does not recommend routine universal drug testing in primary care. It does say to test before opioid medication and during treatment for monitoring. Why a negative result does not prove abstinence is in urine drug screens. Name prescribed medicines before the cup.

Stopping a benzodiazepine abruptly, or cutting it too fast, can cause seizures. A sudden stop after chronic heavy drinking can be life-threatening. Bring a medicine list, an allergy list, and the date of any test you already had. What to carry in is in bringing medications. The morning those questions become real is in day one of rehab.

Search FindTreatment.gov for a program, then ask what it draws. Call or text (800) 653-9376 if you want help asking that before you go.

Additional Resources

Sources cited on this page:

• NCBI Bookshelf: SAMHSA TIP 63, Part 2, laboratory tests for opioid use disorder
• ASAM National Practice Guideline for the Treatment of Opioid Use Disorder, 2020 Focused Update
• SAMHSA TIP 53: Addressing Viral Hepatitis in People With Substance Use Disorders
• FDA: Boxed warning on benzodiazepines
• NIAAA Core Resource: Alcohol Use Disorder, From Risk to Diagnosis to Recovery
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

Common Questions