Drugs of Abuse
Label Mnemonic: | DAUR |
Epic code: | LAB1032 |
Downtime form: | Doctor/Provider Orders - Pathology Core and Specialty Care Nursery |
Chemistry
6240 RCP
356-3527
6240 RCP
356-3527
Specimen(s):
Urine + Confirm
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. Confirmation is automatically sent to a commercial laboratory for amphetamines, cocaine, opiates, and oxycodone/oxymorphone, except for patients in the ETC. Confirmation for benzodiazepines and opiates and oxycodone/oxymorphone is also NOT automatic for any inpatient units due to the high prevalence of use of benzodiazepines and opiates in the inpatient and ETC setting. Confirmation of any test is accomplished by the ordering physician calling Specimen Control at 356-3527, upon receipt of a positive screening result. The samples are maintained in the laboratory frozen for 30 days post screening. Confirmation is at an additional charge. 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
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
Amphetamines, Urine Screen
Benzodiazepine, Conf, Random Urine
Benzodiazepines, Urine Screen
Cocaine Confirmation, Random Urine
Cocaine-Urine Screen, Urine
Drugs of Abuse, Urine
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