Drugs of Abuse
Label Mnemonic: | DAU |
Epic Lab Code: | LAB500 |
Downtime Form: | A-1a Miscellaneous Request |
Chemistry
6240 RCP
356-3527
6240 RCP
356-3527
Specimen(s):
Urine
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
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:
Amphetamines, Urine Screen
Benzodiazepine, Conf, Random Urine
Benzodiazepines, Urine Screen
Cocaine Confirmation, Random Urine
Cocaine-Urine Screen, Urine
Drugs of Abuse, Urine + Confirm
Opiate, Confirmation, Random Urine
Opiates, Urine Screen
Oxycodone, Urine Screen, Random
THC (Marijuana) Confirmation, Random Urine
THC, Urine Screen + Reflexed Confirmation, Random
THC, Urine Screen, Random
Amphetamines, Urine Screen
Benzodiazepine, Conf, Random Urine
Benzodiazepines, Urine Screen
Cocaine Confirmation, Random Urine
Cocaine-Urine Screen, Urine
Drugs of Abuse, Urine + Confirm
Opiate, Confirmation, Random Urine
Opiates, Urine Screen
Oxycodone, Urine Screen, Random
THC (Marijuana) Confirmation, Random Urine
THC, Urine Screen + Reflexed Confirmation, Random
THC, Urine Screen, Random