Drugs of Abuse
Label Mnemonic: DAUR
Epic Lab Code: LAB1032
Downtime Form: A-1a Miscellaneous Request
Chemistry
6240 RCP
356-3527
Specimen(s):
Urine + Confirm
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
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* 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
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