Drug Profiles, Targeted by Mass Spectrometry and Enzyme Immunoassay

Content Review: March 2023 Last Update:
  • Use to monitor medication compliance and to detect undisclosed drug/substance use in support of pain management, substance use disorders treatment, and other pharmacotherapies involving controlled substances.
  • If Drug Profile, Targeted with Interpretation (2009288) is ordered, submission of a medication history is required to optimize reporting. A faculty clinical toxicologist personally compares submitted medication information with test results to provide expert interpretation.

Urine drug testing is useful to assess for medication compliance and/or undisclosed substance use. Although quantitative testing is available, there are several preanalytic factors, such as individual metabolism and elimination, genetics, and interactions between prescribed and/or illicit substances, that can impact the concentration of target analytes in urine and, subsequently, complicate results interpretation.

In most cases, qualitative definitive testing is sufficient to determine the presence of relevant analytes, including prescription drugs, their metabolites, and illicit substances. When results are inconsistent with clinical expectations (eg, based on patient history), consultation is available to discuss results interpretation and possible secondary testing.

Test Interpretation


Analytic sensitivity: dependent on the cutoff concentrations for applicable drugs and drug classes. The concentration at which a drug or metabolite is detected varies by analyte. For a complete list of cutoff concentrations, refer to Mass Spectrometry Analysis and Immunoassay Analysis.

Mass Spectrometry Analysis

Specificity: The following list of analytes is tested by mass spectrometry, the gold-standard method for urine drug testing.

Analyte Cutoff Concentration (ng/mL) Additional Analyte Details
Gamma-aminobutyric Acid (GABA) Analogues
Gabapentin (Neurontin) 3,000
Pregabalin (Lyrica) 3,000
6-acetylmorphinea 20 Metabolite of heroin
Buprenorphine (Suboxoneb, Belbuca) 5
Codeinea 40
Fentanyl (Duragesic) 2
Hydrocodonea (Norco, Vicodin) 40 Metabolite of codeine
Hydromorphonea (Dilaudid) 20 Metabolite of morphine and hydrocodone
Morphinea (MS Contin) 20 Metabolite of 6-acetylmorphine and codeine
Naloxone (Narcan) 100
Norbuprenorphine 20 Metabolite of buprenorphine
Norfentanyl 2 Metabolite of fentanyl
Norhydrocodonea 100 Metabolite of hydrocodone
Normeperidine (Demerol) 50 Metabolite of meperidine
Noroxycodonea 100 Metabolite of oxycodone
Noroxymorphonea 100 Metabolite of noroxycodone and oxymorphone; chemically identical to nornaloxone
Oxycodonea (Percocet) 40
Oxymorphonea (Opana) 40 Metabolite of oxycodone
Tapentadol (Nucynta) 100
Tapentadol-o-sulfate 200 Metabolite of tapentadol
7-aminoclonazepam 40 Metabolite of clonazepam
Alpha-hydroxyalprazolam 20 Metabolite of alprazolam
Alpha-hydroxymidazolam 20 Metabolite of midazolam
Alprazolam (Xanax) 40
Clonazepam (Klonopin) 20
Diazepam (Valium) 50
Lorazepam (Ativan) 60
Midazolam (Versed) 20
Nordiazepamc (Nordaz) 50 Metabolite of diazepam
Oxazepamc (Serax) 50 Metabolite of nordiazepam and temazepam
Temazepamc (Restoril) 50 Metabolite of diazepam
Zolpidem (Ambien) 20
Zolpidem 4-phenyl carboxylic acid 100 Metabolite of zolpidem
3,4-methylenedioxyamphetamine (MDA) 200 Metabolite of MDEA and MDMA
3,4-methylenedioxyethylamphetamine (MDEA, Eve) 200
3,4-methylenedioxymethamphetamine (MDMA, Ecstasy, Molly) 200
Amphetamine (Vyvanse, Adderall) 50 Metabolite of methamphetamine
Methamphetamine 200
Methylphenidate (Focalin, Ritalin) 100
Phentermine (Lomaira) 100

aRefer to Opiates and Opioid Metabolism for a visual representation of the metabolic pathway for relevant opioids.

bCoformulation with Naloxone.

cRefer to Benzodiazepine Metabolism for a visual representation of the metabolic pathway for relevant sedative hypnotics.

Immunoassay Analysis

Specificity: The following list of analytes is tested by immunoassay. The included immunoassays are continuously monitored and have demonstrated low false-positive rates. Note that certain analytes may cross-react with similar substances; detected cross-reacting substances cannot be distinguished by immunoassay. When cross-reactivity is a concern, or when an immunoassay result does not correlate with the patient history, secondary testing by mass spectrometry is available. Refer to the Laboratory Test Directory for specific test offerings.

Analyte(s) Cutoff Concentrations (ng/mL) Additional Immunoassay Details
Barbiturates 200

Targets secobarbital

Cross-reacts with amobarbital, butalbital, pentobarbital, phenobarbital

Carisoprodol 100

Targets carisoprodol

Cross-reacts with major active metabolite meprobamate

Cocaine 150 Targets major metabolite benzoylecgonine
Ethyl glucuronide 500
Methadone 150

Targets methadone

Cross-reacts with major metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP)

Phencyclidine (PCP) 25
Tetrahydrocannabinol (THC) 20

Targets delta-9 THC metabolite

Cross-reacts with delta-8 THC metabolite

Tramadol 100

Targets tramadol

Cross-reacts with major metabolites O-desmethyltramadol and N-desmethyltramadol


A qualitative result is provided for each analyte in the panel. If testing with interpretation is ordered, results will be compared with the submitted patient medication list and a faculty clinical toxicologist will provide expert interpretation.

Results Reported As Interpretive Note



Indicates a specific analyte was detected above the established cutoff concentration


Not Detected

The absence of an expected drug or drug metabolite may indicate noncompliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted/adulterated urine, or limitations of testing.


  • Certain analytes tested by immunoassay may cross-react with similar substances. Refer to Immunoassay Analysis for more details.
  • Detected cross-reacting substances cannot be distinguished by immunoassay.