Drugs of Abuse

Label Mnemonic:	DAU
Epic code:	LAB500
Downtime form:	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

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*                           92

Bentazepam                           128

Bromazepam                            76

Brotiazolam                          138

Chlordiazepoxide                     109

Clobazam                              95

Clonazepam*                          103

Clonazolam                           110

Clorazepate                          189

Delorazepam                          109

Demoxepam                             76

Deschloroetizolam                     81

Diazepam                              90

Diclazepam                            99

Estazolam                             88

Etizolam                             118

Flubromazepam                        132

Flubromazolam                        105

Flunitrazepam                        113

Flurazepam                           161

Halazepam                            132

Lorazepam                            105

Lormetazepam                         107

Meclonazepam                         123

Medazepam                            138

Midazolam                            106

Nifoxipam                            129

Nimetazepam                           96

Nitrazepam                            96

Oxazepam                              89

Phenazepam                           124

Pinazepam                            110

Prazepam                             124

Pyrazolam                            103

Temazepam                             94

Tetrazepam                           116

Triazolam                            103



*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.



Assay with improved detection of glucuronidated benzodiazepines implemented 

05-21-2024.





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:

80307

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, Urine Screen, Random
THC, Urine Screen + Reflexed Confirmation, Random
THC (Marijuana) Confirmation, Random Urine