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Many substances that are prescribed for pain management and other legitimate indications are found to be taken incorrectly (either inadvertently or purposefully), shared, sold, or otherwise misdirected. In addition, many substances are available for illicit use, including prescription substances (eg, opioids, Adderall, Xanax) and nonprescription drugs (eg, heroin, methamphetamines).
To ensure safe and effective therapy, current practice guidelines recommend monitoring patients for adherence to prescribed medications and abstinence from nonprescribed drugs through periodic drug tests. However, drug testing strategies and testing methods are not standardized, which adds challenges to the selection of the right test, collection of the appropriate specimen, and interpretation of test results.
Quick Answers for Clinicians
Urine is preferred because its collection is noninvasive and inexpensive, and drugs and their metabolites tend to concentrate in the urine over time. Saliva (oral fluid) is also noninvasive to collect but is associated with higher costs. Drug concentrations and the time course for detection in saliva more closely approximate concentrations and the detection window in blood than in urine. However, not all drugs are detectable in saliva, and both urine and saliva are susceptible to adulteration or substitution by the donor. Blood (serum or plasma) is the preferred specimen for correlating signs and symptoms with drug concentrations in a real-time acute setting. Blood collection is an observed procedure, which lowers the likelihood of specimen adulteration or substitution. Blood specimens are also appropriate for patients on dialysis, for suspected cases of malabsorption (eg, gastric bypass), and for evaluating other aspects of an individual patient’s pharmacokinetics. Hair specimens, meconium, and umbilical cord tissue are useful for demonstrating chronic exposure/use.
A confirmation test should be considered when a screen result is inconsistent with the expectation (eg, patient history) and when that result will impact patient care decisions. If screen results match expectations, it is not necessary to confirm results (positive or negative) or to perform other, secondary testing. Confirmation testing should also be considered if quantitative results are required to interpret the result. Most confirmation tests produce quantitative results, which are useful when evaluating abnormal patterns of results (eg, no metabolites present, an unexpected pattern of metabolites), or to verify elimination kinetics.
The duration of time for which a drug can be detected is based on the following:
- The pharmacokinetic properties of the drug itself
- The metabolism and elimination abilities of patients
- The dose and frequency of dosing
- Detection limits of the test utilized
- The quality of the specimen being tested
Most drugs are detected in urine for 24-48 hours after the last use. Some drugs are detected for shorter durations (eg, methylphenidate, some benzodiazepines) and others for much longer (eg, methadone, marijuana). Contact the laboratory for estimates on detection periods for a specific drug, or consult the Drug Plasma Half-Life and Urine Detection Window chart.
Cannabidiol (CBD) usage could possibly result in a positive tetrahydrocannabinol (THC) result, depending on the CBD product’s purity. Most CBD products are unregulated and could contain more THC than claimed on the label. A small amount of THC in a CBD product could also accumulate in the body if the CBD product is used frequently. CBD does not cross-react with the urine immunoassay (IA) used by ARUP Laboratories for the detection of cannabis.
Quantitative urine THC metabolite testing may help with the interpretation of an unexpected positive cannabis IA.
Creatinine normalization may be useful to evaluate whether a patient has abstained from new use of marijuana. If a patient has abstained from new use of marijuana, the concentrations in urine of the creatinine-normalized delta-9-tetrahydrocannabinol (THC) metabolite, THC acid (THCA), should decrease over time. To demonstrate elimination of THCA (decreasing concentration) or new use of marijuana (increasing concentration of THCA), an appropriate testing interval is no more than once per week.
Many quantitative clinical assays for detection of THC and related metabolites (including ARUP’s) do not routinely include creatinine measurement. To determine a creatinine-normalized THC concentration, creatinine testing should be ordered or performed at the same time a urine specimen is collected for THC testing. It is best if the same creatinine and THC methods are utilized for serial samples collected from the same patient. To calculate a normalized concentration, use the following formula:
[THC (ng/mL) / creatinine (mg/dL)] x 100 = ng THC per mg creatinine
Yes. It is important to investigate the active components of any drug that a patient is prescribed or has otherwise been administered when interpreting a positive drug test. There are dozens of different trade names and formulations of popular drugs that may contribute legitimately to a positive drug test. There are also some drugs that are recognized to cause analytical interference and may contribute to a false-positive drug test. For example, cyclobenzaprine can cause false-positive results in tricyclic antidepressant immunoassay (IA) screens, and phentermine can cause false-positive results in amphetamine IA screens (refer to the table, Compounds That May Produce False-Positive IA Screen Results, for more examples).
Yes. Poppy seeds contain morphine and codeine. Ingesting large amounts of poppy seeds or products that contain poppy seeds (eg, cake, bagels, salad dressing) can cause a positive urine opiate test result. In order to eliminate most of the positive test results that are due to poppy seed consumption, the Substance Abuse and Mental Health Services Administration (SAMHSA) considers 2,000 ng/mL the positive cutoff for urine testing performed by immunoassay or definitive methods. Patients should abstain from consuming poppy seeds for 3 days prior to a urine drug test. Positive results would also be expected with other matrices (eg, blood) after poppy seed consumption.
The words “opioid” and “opiate” are often used interchangeably. There are, however, subtle but important differences between them. “Opiates” are chemical compounds extracted or refined from natural plant matter; examples of opiates include morphine and codeine. Note that opiates are also opioids. The term “opioids” refers to all natural, synthetic, or semisynthetic chemical compounds that interact with opioid receptors in the body and brain. Examples include hydrocodone, oxycodone, and methadone.
The interpretation of results may be complicated by several factors, including timing of sample collection and drug impurities. For more information about these challenges or for assistance with result interpretation, consider the following resources:
- Journal of Applied Laboratory Medicine (JALM) Talk podcast: 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
- Urine Drug Testing (Unexpected Results) Algorithm
- ARUP Drug Plasma Half-Life and Urine Detection Window chart
- Test Result Interpretation section
- ARUP Laboratories' Drug Hybrid Detection Testing and Interpretation section
Specimen Selection and Timing of Collection
Refer to the ARUP Drug Plasma Half-Life and Urine Detection Window chart for specific testing information, including plasma half-life, urine detection windows, drug metabolites, and common trade and street names.
Specimens
Urine and blood specimen (serum or plasma) tests are available to detect most drugs commonly prescribed for pain management and other legitimate indications, as well as many illicit substances. Urine is typically preferred for adherence and drug exposure testing; serum or plasma is an acceptable alternative. There is no evidence that drug testing in alternate specimens (eg, hair, saliva) is more effective than urine testing for monitoring adherence, such as in the management of patients with chronic noncancer pain (CNCP).
Timing of Collection
Specimens should be collected for drug testing based on the clinical scenario and routine practices. For example, specimens may be collected for testing when qualifying patients for chronic therapy with opioids or other controlled substances, enrolling patients in substance misuse disorder programs, in situations when aberrant drug behavior is suspected, and in patients who are pregnant. This testing is intended to confirm the presence of prescribed medications that are detected by the test and to detect the presence of illicit and nonprescribed drugs. ,
Commonly Used Testing Strategy (Screening and Definitive Testing)
Testing approaches are unique in terms of performance characteristics, and the best strategy for testing should align with the goals of testing. Test choices include screen only, screen and definitive confirmation (for positive results), and direct, definitive, targeted testing. The last is typically performed using mass spectrometry (MS) technology and may be quantitative or qualitative.
Initial Drug Testing Methodologies
Initial drug testing methodologies include point-of-care (POC) screening devices (eg, urine cups), laboratory immunoassays (IAs), and MS technologies.
Immunoassays
Screening by IA is a common methodology for detecting drug presence and may be qualitative or semiquantitative. IAs have several advantages as first-line screening tests, including ease of use, fast turnaround time, and lower costs; however, IAs can produce false-positive and false-negative results.
Opiates
Most available IAs do not readily detect semisynthetic opioids (oxycodone, hydrocodone, and their metabolites) and synthetic opioids (eg, fentanyl, methadone, meperidine, tramadol). ARUP Laboratories’ IA screen for opiates includes an IA designed to detect oxycodone and its metabolites. ARUP also offers separate IA screens for synthetic opioids (eg, fentanyl, methadone, tramadol, meperidine, tapentadol) and semisynthetic opioids (eg, buprenorphine).
Benzodiazepines
A large number of drugs belong to the benzodiazepines group, and an assay’s ability to detect them varies based on assay formulation and cutoff limit. Most benzodiazepines are metabolized and conjugated before elimination through urine. Therefore, the IA’s ability to detect respective metabolites also contributes to its apparent sensitivity to detect certain drugs. Most IAs would not detect designer benzodiazepines.
Amphetamines and Methamphetamines
Urine IAs are designed to detect the d-isomer (psychoactive compound) of amphetamine and methamphetamine. Nevertheless, the IAs mostly react poorly to other synthetic central nervous system (CNS) stimulants, including phentermine (moderate sensitivity), methylphenidate, methylenedioxyethylamphetamine (MDEA), methylenedioxymethamphetamine (MDMA), and methylenedioxyamphetamine (MDA). ARUP Laboratories’ IA for urine amphetamines includes two components to detect certain synthetic CNS stimulants (MDEA, MDMA, MDA) and amphetamine and methamphetamine. The IA for amphetamines and methamphetamines also often produces high false-positive result rates. Literature has reported various cases of false positivity due to different substances (refer to the table, Compounds That May Produce False-Positive IA Screen Results). It is recommended that all IA screen results be confirmed by a definitive methodology (gas chromatography [GC], or liquid chromatography-tandem MS [LC/MS/MS]) if a clinical decision is to be made on the basis of the drug testing results.
False-Positive Immunoassay Results
Many different compounds can contribute to false-positive immunoassay screen results. The table below provides examples.
Definitive Testing
First-line definitive testing (qualitative or quantitative) is preferred for monitoring the use of relevant over-the-counter medications, prescribed and nonprescribed drugs, and illicit substances, when the service requirements for testing are well aligned with clinical needs.
Definitive testing is also recommended for any IA (laboratory based or POC) result that is not consistent with the clinical expectations, and for opiates/oxycodone and/or benzodiazepines (regardless of the screen result) if the patient is prescribed those drugs.
Targeted tests for specific drugs or drug classes are available as individually orderable tests that are useful for confirming results obtained at the client site or when only select drugs or drug classes are of interest.
Quantitative vs Qualitative Testing
Quantitative definitive urine testing is not more useful at detecting outcomes in a clinical context compared with qualitative definitive urine testing; quantitative definitive urine testing should not be used to evaluate dosage of administered drug or adherence to a prescribed dosage regimen.
Quantitative definitive urine testing can be used to:
- Identify variant drug metabolism
- Detect pharmaceutical impurities
- Detect metabolism through minor routes
The following testing guide for ARUP Laboratories' drug panels includes IA drug/class, confirmation test name and number, and drugs/metabolites included in the test.
| Immunoassay Drug/Class | Confirmation Test(s)a | Drug(s) and/or Metabolite(s) Included |
|---|---|---|
| Amphetamines | Amphetamines (D/L Differentiation), Urine 2014043 Amphetamines, Urine, Quantitative 2010075 | Amphetamine, methamphetamine, MDA, MDMA (Ecstasy), MDEA (Eve), phentermine |
| Barbiturates | Barbiturates, Urine, Quantitative 2012213 | Butalbital, amobarbital, pentobarbital, secobarbital, phenobarbital |
| Benzodiazepines | Benzodiazepines, Urine, Quantitative 2008291 | Alprazolam, alpha-hydroxyalprazolam, chlordiazepoxide, clonazepam, 7-aminoclonazepam, diazepam, lorazepam, midazolam, alpha-hydroxymidazolam, nordiazepam, oxazepam, temazepam |
| Buprenorphine | Buprenorphine and Metabolites, Urine, Quantitative 2010092 | Buprenorphine, norbuprenorphine, buprenorphine glucuronide, norbuprenorphine glucuronide, naloxone |
| Cannabinoids | THC Metabolite, Urine, Quantitative 0090369 | 11-nor-9-carboxy-tetrahydrocannabinol (THC) |
| Carisoprodol/meprobamate | Carisoprodol and Meprobamate, Urine, Quantitative 2012219 | Carisoprodol, meprobamate |
| Cocaine | Cocaine Metabolite, Urine, Quantitative 0090359 | Benzoylecgonine |
| Ethyl glucuronide | Ethyl Glucuronide and Ethyl Sulfate, Urine, Quantitative 2007909 | Ethyl glucuronide, ethyl sulfate |
| Fentanyl | Fentanyl and Metabolite, Urine, Quantitative 0092570 | Fentanyl, norfentanyl |
| GABA analogues | Gabapentin, Urine 2012227 Pregabalin, Urine 2012229 | Gabapentin, pregabalin |
| Meperidine | Meperidine and Metabolite Quantitative, Urine 3000248 | Meperidine, normeperidine |
| Methadone | Methadone and Metabolite, Urine, Quantitative 0090362 | Methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) |
| Opiates/oxycodone | Opiates, Urine, Quantitative 0090364 | Codeine, morphine, 6-acetylmorphine, hydrocodone, norhydrocodone, hydromorphone, oxycodone, noroxycodone, oxymorphone, noroxymorphone |
| Phencyclidine (PCP) | Phencyclidine (PCP), Urine, Quantitative 2010462 | PCP |
| Tapentadol | Tapentadol, Urine, Quantitative 2003128 | Tapentadol |
| Tramadol | Tramadol and Metabolites, Urine, Quantitative 2002736 | Tramadol, O-desmethyltramadol |
| Zolpidem | Zolpidem, Urine, Quantitative 2012319 | Zolpidem |
aExtended panel includes confirmation testing, if needed. GABA, gamma aminobutyric acid | ||
Test Result Interpretation
Test results may be surprising not only when unexpected positive results are found, but also when expected positives are absent. Refer to the Urine Drug Testing (Unexpected Results) Algorithm for additional information on assessing unexpected results..
Opioid and Benzodiazepine Metabolic Pathways
Detecting the presence or absence of drug metabolites can be challenging. Refer to the following metabolic pathways to understand how select opioids and benzodiazepines are metabolized.
Opioid Metabolic Pathway
Benzodiazepine Metabolic Pathway
ARUP Laboratories' Drug Hybrid Detection Testing and Interpretation
ARUP employs two drug detection techniques, MS and IA, in its drug hybrid tests.
The following tables include interpretive information for the drugs/drug classes reported in ARUP Laboratories' drug hybrid tests (drug panel and drug screen with interpretation). Drugs detected by IA are indicated with a footnote; all other drugs are detected by MS. MS is used to qualitatively detect drugs and metabolites, whereas IA is used for a few drugs/drug classes based on the excellent analytical performance of the IA (eg, for marijuana metabolites) or the low positivity rate of the associated drug (eg, PCP).
| Drug Name | Example Trade Name(s) | Reported Drug(s) and Metabolite(s) That Indicate Usea |
|---|---|---|
| Alprazolam | Xanax | Alprazolam, alpha-hydroxyalprazolam |
| Barbituratesb | Amytal | Butalbital,c amobarbital,c pentobarbital,c phenobarbital,csecobarbital |
| Carisoprodolb | Soma | Carisoprodol,c meprobamatec |
| Chlordiazepoxide | Librium | Nordiazepam, oxazepam |
| Clorazepate | Tranxene | Nordiazepam, oxazepam |
| Clonazepam | Clonopin, Klonopin | Clonazepam, 7-aminoclonazepam |
| Diazepam | Valium, Valrelease | Diazepam, nordiazepam, temazepam, oxazepam |
| Lorazepam | Ativan | Lorazepam |
| Midazolam | Versed | Midazolam, alpha-hydroxymidazolam |
| Oxazepam | Serax | Oxazepam |
| Temazepam | Normison, Restoril | Temazepam |
| Zolpidem | Ambien | Zolpidem |
| aListed drugs and metabolites may not all be present for each patient. bDetected by IA. cListed compounds are not individually identified. Total absorbencies for all detected compounds are used to report presence or absence. | ||
| Drug Name | Example Trade Name(s) | Reported Drug(s) and Metabolite(s) That Indicate Usea |
|---|---|---|
| Buprenorphine | Buprenex, Suboxone, Subutex | Buprenorphine, norbuprenorphine |
| Codeine | Tylenol-Codeine No. 3 | Codeine, morphine |
| Fentanyl | Actiq, Duragesic, Fentora | Fentanyl, norfentanyl |
| Heroin | n/a | Morphine, 6-acetylmorphine,b codeine |
| Hydrocodone | Anexsia, Vicodin, Lortab | Hydrocodone, norhydrocodone, hydromorphone |
| Hydromorphone | Dilaudid | Hydromorphone |
| Meperidine | Demerol, Mepergan | Meperidine metabolite (normeperidine) |
| Methadone | Methadose | Methadone,c EDDPd |
| Morphine | Astromorph, Avinza, DepoDur | Morphine, hydromorphone |
| Naloxone | Narcan, Evzio, Suboxone, Zubsolv | Naloxone, noroxymorphone (same as nornaloxone) |
| Oxycodone | Oxycontin, Percocet | Oxycodone, noroxycodone, oxymorphone, noroxymorphone |
| Oxymorphone | Numorphan, Opana | Oxymorphone, noroxymorphone |
| Tapentadol | Nucynta | Tapentadol, tapentadol-O-sulfate |
| Tramadol | Ultram | Tramadol,c O-desmethyl-tramadol,c N-desmethyl-tramadold |
aListed drugs and metabolites may not all be present for each patient. n/a, not applicable | ||
| Drug Name | Example Trade Name | Reported Drug(s) and Metabolite(s) That Indicate Use |
|---|---|---|
| Amphetamine | Adderall | Amphetamine |
| Cocaine | n/a | Cocaine,a benzoylecgonineb |
| MDMAc | Ecstasy | MDMA, MDA |
| MDEAc | Eve | MDEA, MDA |
| MDAc | n/a | MDA |
| Methamphetaminec | n/a | Methamphetamine, amphetamine |
| Methylphenidate | Ritalin | Methylphenidate |
| Phentermine | Adipex-P | Phentermine |
| aMinimal detection or not detected by the IA. bDetected by IA. cListed drugs and metabolites may not all be present for each patient. | ||
| Drug Name | Example Trade Name | Reported Drug or Metabolite That Indicates Use |
|---|---|---|
| Gabapentin | Gralise, Neurontin | Gabapentin |
| Pregabalin | Lyrica | Pregabalin |
| Drug Name | Reported Drug or Metabolite That Indicates Use |
|---|---|
| Marijuana | 9-carboxy-tetrahydrocannabinola |
| PCP | PCPa |
| aDetected by IA. | |
Additional Resources
ARUP Laboratories offers several options to further assist clients in interpreting and understanding test results.
- Toxicologist review
- 24/7 on-call service
- Medical director assistance in the selection of tests and interpretation of results
- Free CME, SAM, and CEU video lectures
Contact Client Services for information.
ARUP Laboratory Tests
Results indicate whether findings are consistent or inconsistent with supplied medication information
If medication information is not available or interpretation is not necessary, consider Drug Profile, Targeted by Tandem Mass Spectrometry and Enzyme Immunoassay, Urine (2007479)
Secondary testing is generally not indicated but is available if confirmation or quantitation is desired
Quantitative Tandem Mass Spectrometry/Qualitative Enzyme Multiplied Immunoassay Technique (EMIT)/Quantitative Spectrophotometry
For additional information, refer to the Drug Profiles, Targeted by Mass Spectrometry and Enzyme Immunoassay Test Fact Sheet.
Does not provide interpretation of results; if interpretation is required, refer to Drug Profile, Targeted with Interpretation by Tandem Mass Spectrometry and Enzyme Immunoassay, Urine (2009288)
Secondary testing is generally not indicated but is available if confirmation or quantitation is desired
Qualitative Tandem Mass Spectrometry/Qualitative Enzyme Multiplied Immunoassay Technique (EMIT)/Qualitative Spectrophotometry
For additional information, refer to the Drug Profiles, Targeted by Mass Spectrometry and Enzyme Immunoassay Test Fact Sheet.
Use for general testing in contexts of compliance and/or abuse
Provides quantitative results for confirmatory positive results
Qualitative Enzyme Multiplied Immunoassay Technique (EMIT)/Quantitative Gas Chromatography-Mass Spectrometry (GC-MS)/Quantitative Gas Chromatography-Mass Spectrometry (GC-MS)/Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Use for general testing in contexts of compliance and/or abuse
Provides quantitative results for confirmatory positive results
Qualitative Enzyme Multiplied Immunoassay Technique (EMIT)/Quantitative Gas Chromatography-Mass Spectrometry (GC-MS)/Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Qualitative Enzyme Multiplied Immunoassay Technique (EMIT)/Quantitative Gas Chromatography-Flame Ionization Detection/Quantitative Gas Chromatography-Mass Spectrometry (GC-MS)/Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Use to monitor patient compliance
Provides quantitative results for confirmatory positive results
Qualitative Enzyme-Linked Immunosorbent Assay (ELISA)/Quantitative Gas Chromatography-Mass Spectrometry (GC-MS)/Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Gas Chromatography/Gas Chromatography-Mass Spectrometry (GC-MS)
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Gas Chromatography-Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
Quantitative Liquid Chromatography-Tandem Mass Spectrometry
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Marin SJ, Roberts M, Wood M, et al. Sensitive UPLC-MS-MS assay for 21 benzodiazepine drugs and metabolites, zolpidem and zopiclone in serum or plasma. J Anal Toxicol. 2012;36(7):472-476.
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Marin SJ, Sawyer JC, He X, et al. Comparison of drug detection by three quadrupole time-of-flight mass spectrometry platforms. J Anal Toxicol. 2015;39(2):89-95.
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McMillin GA, Davis R, Carlisle H , et al. Patterns of free (unconjugated) buprenorphine, norbuprenorphine, and their glucuronides in urine using liquid chromatography-tandem mass spectrometry. J Anal Toxicol. 2012;36(2):81-87.
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McMillin GA, Marin SJ, Johnson-Davis KL, et al. A hybrid approach to urine drug testing using high-resolution mass spectrometry and select immunoassays. Am J Clin Pathol. 2015;143(2):234-240.
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Moeller KE, Kissack JC, Atayee RS, et al. Clinical interpretation of urine drug tests: what clinicians need to know about urine drug screens. Mayo Clin Proc. 2017;92(5):774-796.
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Slawson MH, Johnson-Davis KL. Quantitation of carisoprodol and meprobamate in urine and plasma using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Methods Mol Biol. 2016;1383:105-114.
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Slawson MH, Johnson-Davis KL. Quantitation of ethyl glucuronide and ethyl sulfate in urine using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Methods Mol Biol. 2016;1383:167-175.
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Slawson MH, Johnson-Davis KL. Quantitation of flecainide, mexiletine, propafenone, and amiodarone in serum or plasma using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Methods Mol Biol. 2016;1383:11-19.
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Slawson MH, Johnson-Davis KL. Quantitation of haloperidol, fluphenazine, perphenazine, and thiothixene in serum or plasma using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Methods Mol Biol. 2016;1383:49-57.
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Tobin DG, Andrews R, Becker WC. Prescribing opioids in primary care: safely starting, monitoring, and stopping. Cleve Clin J Med. 2016;83(3):207-215.
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Ward MB, Hackenmueller SA, Strathmann FG. Pathology consultation on urine compliance testing and drug abuse screening. Am J Clin Pathol. 2014;142(5):586-593.
For a comprehensive list of ARUP drug testing options, refer to the Laboratory Test Directory.