Drugs of Abuse

Label Mnemonic:	DAU
Epic code:	LAB500
Downtime form:	A-1a Doctor/Provider Orders - Pathology Core and Specialty Care Nursery

Chemistry
6240 RCP
356-3527

Specimen(s):

Urine

Collection Medium:

Clear top tube

Alternate Collection Media:

Urine (Random)-BD Vacutainer^®, no additive yellow top

Minimum:

5 mL random urine

Rejection Criteria:

Test cannot be added to a urine sample previously utilized for urinalysis testing (LAB1160, LAB1164, LAB8379).

Testing Schedule:

24 hrs/day, 7 days a week, including holidays.

Turn Around Time:

1 hour (upon receipt in laboratory)

Reference Range:

None

Interpretive Data:

Drug of abuse screening tests are to be used for medical purposes only and not for non-medical purposes (e.g., employee, competitive athlete, or forensic testing).

Comments:

Screen includes amphetamines, benzodiazepines, cocaine, opiates, 
and oxycodone/oxymorphone. A presumptive positive result for any of 
the tested drugs indicates the possible presence of the drug or 
metabolites in the urine, but does not measure the level of 
intoxication. 

If confirmation is needed for amphetamines, benzodiazepines, cocaine, 
opiates, or oxycodone/oxymorphone, call the Laboratory at 356-3527. 
Allow up to seven days for confirmatory results. Confirmation is at an 
additional charge. 

The individual components of the drug of abuse-urine screen can also 
be ordered individually, if desired (see links at end).

Test Cut-off Concentrations (ng/mL)
-------------------------------------------------------------
Amphetamines                 1,000
Benzodiazepine                 100
Cocaine                        300
Opiate                         300
Oxycodone                      300

Additional information on approximate cut-offs for individual drugs or 
drug metabolites in the specific assays


AMPHETAMINES ASSAY
Drug                       Approximate cut-off for
                           amphetamines assay (ng/mL)
-------------------------------------------------------------
d-Amphetamine                        981
d-Methamphetamine                    998
MBDB                               1,175
MDA                                  771
MDEA                               1,553
MDMA ("Ecstasy")                     509
PMMA                                 690
PMA                                  908
Labetalol metabolite               5,116
Phendimetrazine*                 138,000
Phentermine*                     239,000
d-Pseudoephedrine*               261,000
Ephedrine*                       308,000

Abbreviations for the "designer" amphetamine and methamphetamine 
derivatives:
   MBDB - methylbenzodioxolylbutanamine ("Eden")
   MDA - 3,4-methylenedioxyamphetamine
   MDEA - 3,4-methylenedioxy-N-ethylamphetamine ("Eve")
   MDMA - 3,4-methylenedioxymethamphetamine ("Ecstasy")
   PMA - para-Methoxyamphetamine
   PMMA - para-Methoxymethamphetamine 

* The concentrations of these compounds needed to trigger a positive
  amphetamines screen are very high and likely only achievable in large
  overdose.

New amphetamines assay instituted 7/7/10.  
Unlike the assay used prior to 7/7/10, the new assay has very good 
cross-reactivity for MDMA (Ecstasy) and some designer amphetamines 
(MDA, MBDB, MDEA, PMA, PMMA).  The older assay did not cross-react 
well with amphetamines other than amphetamine and methamphetamine. The 
new assay has low cross-reactivity with non-amphetamine drugs 
(ephedrine, pseudoephedrine, phentermine, etc.).

Patients on labetalol can have a false positive amphetamines screen 
due to a metabolite of labetalol (APB, 1-Methyl-3-phenylpropylamine)
structurally resembling amphetamine. In these cases, confirmatory 
testing will be negative.


BENZODIAZEPINES ASSAY
Drug                       Approximate cut-off for
                           benzodiazepines assay (ng/mL)
-------------------------------------------------------------
Alprazolam*                          108
Bentazepam                           222
Chlordiazepoxide                     146
Clobazam                             123
Clonazepam*                          148
Clonazolam                            96
Clorazepate                          124
Demoxepam                             92
Deschloroetizolam                     89
Diazepam                             106
Diclazepam                           102
Etizolam                             133
Flubromazepam                         79
Flubromazolam                         97
Flunitrazepam                        142
Flurazepam                           165
Lorazepam*                           163
Meclonazepam                         347
Midazolam                            168
Nifoxipam                            375
Oxazepam                             122
Pyrazolam                            106
Temazepam                            145
Triazolam                            115

*In patients taking typical therapeutic doses of these
 benzodiazepines for medical purposes, the benzodiazepines
 screen can be negative due to the low concentrations of
 these drugs and their metabolites excreted in urine
 relative to the cut-offs.


COCAINE ASSAY
Drug or drug metabolite    Approximate cut-off for
                           cocaine assay (ng/mL)
-------------------------------------------------------------
Benzoylecgonine (metabolite)             300
Cocaine                               18,132
Cocaethylene                          34,900
Ecogine                             >100,000
Ecgonine methyl ester               >100,000
Norcocaine                          >100,00
Lidocaine               No cross-reactivity*
Procaine                No cross-reactivity*

*In general, local anesthetics do not cross-react with the
 cocaine immunoassay.


OPIATES ASSAY
Drug or drug metabolite    Approximate cut-off for
                           opiates assay (ng/mL)
-------------------------------------------------------------
Buprenorphine           No cross-reactivity
Codeine                                 224
6-Acetylmorphine (heroin metabolite)    386
Fentanyl                No cross-reactivity
Heroin                                  366
Hydrocodone                           1,086
Hydromorphone                         1,425
Meperidine                        > 100,000
Methadone               No cross-reactivity
Morphine                                300
Oxycodone                          > 75,000*

*Therapeutic use of oxycodone in the absence of any other
 opiates is unlikely to result in a positive opiates screen.


OXYCODONE ASSAY*
Drug                       Approximate cut-off for
                           oxycodone assay (ng/mL)
-------------------------------------------------------------
Oxycodone                             300
Oxymorphone                           291

*The oxycodone assay does not cross-react with opiates other than
 oxycodone or oxymorphone (e.g., codeine, heroin, hydrocodone,
 hydromorphone, morphine) or with synthetic opioids (e.g., fentanyl,
 meperidine, methadone, propoxyphene).


References:

Belson MG, Simon HK, Sullivan K, Geller RJ.  The Utility of 
Toxicologic Analysis in Children with Suspected Ingestion.  Pediatr 
Emerg Care 1999;15:383-387.

Bast RP, Helmer SD, Henderson SR, Rogers MA, Shapiro WM, Smith RS.  
Limited Utility of Routine Drug Screening in Trauma Patients.  South 
Med J 2000;93:397-399.

Hammett-Stabler CA, Pesce AJ, Cannon DJ.  Urine Drug Screening in the 
Medical Setting.  Clinica Chimica Acta 2002;315:125-135.

Schiller MJ, Shumway M, Batki SL.  Utility of Routine Drug Screening 
in a Psychiatric Emergency Setting.  Psychiatric Services 2000;51:474-
478.

Sugarman JM, Rodgers GC, Paul RI.  Utility of Toxicology Screening in 
a Pediatric Emergency Department.  Pediatric Emergency Care.  
Pediatric Emergency Care 1997;13(3):194-197.

Test Limitations:

There is the possibility that other substances and/or factors may interfere with the test and cause erroneous results (e.g., technical or procedural errors). Call the lab at 319-356-3527 for additional information.

Methodology:

All assays except oxycodone are based on the kinetic interaction of microparticles in a solution (KIMS) as measured by changes in light transmission. The oxycodone screen is based on the competition between a drug labeled with glucose-6-phosphate dehydrogenase (G6PDH), and free drug from the urine sample for a fixed amount of specific antibody binding sites. In the absence of free drug from the sample, the specific antibody binds the drug labeled with G6PDH and causes a decrease in enzyme activity. This phenomenon creates a direct relationship between the drug concentration in urine and enzyme activity. The enzyme activity is determined spectrophotometrically at 340 nm by measuring the conversion of nicotinamide adenine dinucleotide (NAD) to NADH.

CPT Code:

80301

See also:
Benzodiazepine, Conf, Random Urine
Cocaine Confirmation, Random Urine
THC (Marijuana) Confirmation, Random Urine
Drugs of Abuse, Urine + Confirm
Opiate, Confirmation, Random Urine
Amphetamines, Urine Screen
Benzodiazepines, Urine Screen
Cocaine-Urine Screen, Urine
Opiates, Urine Screen
Oxycodone, Urine Screen, Random
THC, Urine Screen + Reflexed Confirmation, Random
THC, Urine Screen, Random