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FeedbackQualitative Tandem Mass Spectrometry/Qualitative Enzyme Multiplied Immunoassay Technique (EMIT)/Qualitative Spectrophotometry
Quantitative Tandem Mass Spectrometry/Qualitative Enzyme Multiplied Immunoassay Technique (EMIT)/Quantitative Spectrophotometry
- 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
Sensitivity/Specificity
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 | — |
| Opioids | ||
| 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 |
| Sedative-Hypnotics | ||
| 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 |
| Stimulants | ||
| 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 |
Results
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 |
|---|---|---|
| Positive | Present | Indicates a specific analyte was detected above the established cutoff concentration |
| Negative | 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. |
Limitations
- 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.
References
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33636890
Jannetto PJ, Bratanow NC, Clark WA, et al. Executive Summary: American Association of Clinical Chemistry laboratory medicine practice guideline - using clinical laboratory tests to monitor drug therapy in pain management patients. J Appl Lab Med. 2018;2(4):489-526.
32875314
Yang YK, Johnson-Davis KL, Kelly BN, et al. Demand for interpretation of a urine drug testing panel reflects the changing landscape of clinical needs; opportunities for the laboratory to provide added clinical value. J Appl Lab Med. 2020;5(5):858-868.