Mental Health Book


Toxicology Screening

Aka: Toxicology Screening, Urine Tox Screen, Urine Drug Screen
  1. Precautions
    1. Urine toxicology utility has been markedly reduced by the growing use of synthetics
      1. Synthetic Cannabinoids
      2. Psychoactive Bath Salts
    2. Urine toxicology misses many standard substances
      1. Does not detect the most frequently used Benzodiazepines (Alprazolam, Clonazepam, Lorazepam)
      2. Variable detection of MDMA (Ecstasy)
      3. Does not detect semi-synthetic and synthetic Opioids
  2. Protocol: Assess validity of real urine sample
    1. Urine Temperature (within 4 minutes of voiding): 90 F (32.2 C) to 100 F (37.7 C)
    2. Urine pH: 4.5 to 8.5 (some facilities use pH 3.0-11.0)
    3. Urine Creatinine: 20 mg/dl or greater (otherwise artificially diluted)
    4. Nitrite concentration <500 mg/dl (<4.2 mmol/L)
    5. Sample size 30 ml or more
  3. Protocol: Prevent urine sample tampering
    1. Remove outer clothing (jackets, sweatshirts, hat)
    2. Remove any items in urine collection area that could be used to tamper with sample (bleach, vinegar, soap, ammonia, salt)
    3. Remove any items from pockets
    4. Do not allow briefcases, backpacks, purses and other similar items in collection area
    5. Patient should wash and dry hands with liquid soap under observation
    6. Add bluing agent to toilet and turn off water to the testing area
    7. Observe the actual collection and use chain of custody forms to accompany the sample
    8. Consider split sample collections with tamper resistant containers
  4. Preparations: Sedatives and Hypnotics
    1. Alcohol (Ethanol)
      1. Detection Positive: 3 to 10 hours
    2. Barbiturates
      1. Detection
        1. Short-Actings agents: 1-2 days
        2. Long-acting agents (e.g. phenobarbital): 21 days
      2. Causes: False positive tests
        1. Ibuprofen
        2. Naproxen
    3. Benzodiazepines
      1. Many hospital-based Urine Drug Screens only detect Oxazepam at its precursors (Diazepam and Chlordiazepoxide or Librium)
        1. These Urine Drug Screens miss Alprazolam, Clonazepam, Lorazepam, Flunitrazepam (Rohypnol)
      2. Detection
        1. Short-acting agents (e.g. Lorazepam, Alprazolam): 3-5 days
        2. Long acting agents (Clonazepam, Diazepam): 30 days
      3. Causes: False positive tests
        1. Oxaprozin (Daypro)
        2. Sertraline (Zoloft)
  5. Preparations: Stimulants - Cocaine
    1. Detection Direct: 5 hours
    2. Detection Metabolite (Benzoylecgonine): 2-4 days (may persist as long as 8 days with heavy use)
  6. Preparations: Stimulants - Amphetamine or Methamphetamine
    1. Positive: 2 to 4 days
    2. Detects Amphetamine at 500 ng/ml in Urine Drug Screen (and 250 ng/ml in confirmatory testing)
    3. Detects Methamphetamine at 250 ng/ml in Urine Drug Screen
    4. May also detect MDMA
    5. Causes: False positive tests
      1. Amantadine
      2. Brompheniramine
      3. Bupropion (Wellbutrin)
      4. Chlorpromazine
      5. Chloroquine
      6. Desipramine
      7. Doxepin
      8. Fluoxetine (Prozac)
      9. Labetalol
      10. Methylphenidate (Ritalin)
      11. Phentermine
      12. Phenylephrine
      13. Phenylpropanolamine
      14. Promethazine (Phenergan)
      15. Pseudoephedrine
      16. Ranitidine (Zantac)
      17. Selegiline
      18. Thioridazine
      19. Trazodone
      20. Trimethobenzamide
      21. Venlafaxine
      22. Vicks Inhaler
  7. Preparations: Opioids
    1. Tests
      1. Gas chromatography: Detects all Opioids
      2. Enzyme linked assays:
        1. Reliably detects naturally occurring Opiates (Opioid subset)
          1. Morphine
          2. Codeine
          3. Morphine metabolites (Heroin)
        2. Misses semi-synthetic Opioids (structurally similar to Opiates)
          1. Hydrocodone
          2. Oxycodone
          3. Hydromorphone
          4. Oxymorphone
          5. Fentanyl
        3. Misses synthetic Opioids
          1. Methadone
          2. Buprenorphine
          3. Meperidine
          4. Tramadol
    2. Preparations
      1. Codeine
        1. Detection Positive: 1 to 2 days
        2. May be detected as Morphine (metabolite)
      2. Heroin (detected as Morphine on less specific testing)
        1. Detection Positive: 2 days
      3. Hydromorphone (Dilaudid)
        1. Detection Positive: 2 to 4 days
      4. Methadone (Dolophine)
        1. Detection Positive: 2 to 3 days
      5. Propoxyphene (Darvon)
        1. Detection
          1. Direct: 6 hours
          2. Metabolites: 6 to 48 hours
      6. Fentanyl
        1. Detection positive: 1 to 4 days
      7. Hydrocodone (e.g. Vicodin)
        1. Dectection positive: 1 to 2 days
        2. May be detected as Hydromorphone (metabolite)
      8. Oxycodone (e.g. Percocet)
        1. Detection positive: 1 to 4 days
      9. Morphine
        1. Detection Positive: 2-3 days
    3. False positives
      1. Chlorpromazine (Methadone)
      2. Clomipramine (Methadone)
      3. Dextromethorphan (Codeine or Morphine)
      4. Diphenhydramine (Methadone)
      5. Doxylamine (Methadone)
      6. Fluoroquinolones (esp. Ofloxacin, Levofloxacin positive for Codeine or Morphine)
      7. Poppy seeds (requires high concentration)
      8. Quetiapine (Methadone)
      9. Quinine (Codeine or Morphine)
      10. Rifampin (Codeine or Morphine)
      11. Thioridazine (Methadone)
      12. Verapamil (Methadone)
  8. Preparations: Hallucinogenics - PCP (Phencyclidine)
    1. Detection
      1. Positive: 2 to 8 days (may persist as long as 14-28 days in some cases of chronic use)
    2. Causes: False positive tests
      1. Dextromethorphan
      2. Diphenhydramine
      3. Ibuprofen
      4. Imipramine
      5. Ketamine
      6. Meperidine
      7. Synthetic Cathinones (Bath Salts)
      8. Thioridazine
      9. Tramadol
      10. Venlafaxine
  9. Preparations: Marijuana (THC metabolite)
    1. General
      1. Marijuana is lipophilic and is detectable for long periods after last use
      2. Synthetic Marijuanas are not positive on Urine Drug Screens
      3. Second hand Marijuana smoke does not cause a positive result (50 ng/ml or more)
    2. Detection
      1. Positive Urine
        1. Single use: 3-7 days
        2. Use 3-4 times per week: 5-7 days (may persist for 14 days)
        3. Used Daily: 10-15 days
        4. Long-term, heavy use: 4-6 weeks
      2. Positive Blood: 8 hours
    3. Causes: False positive tests
      1. Dronabinol (Marinol)
      2. NSAIDS (especially Ibuprofen, Naproxen, sulindac)
      3. Proton Pump Inhibitors (e.g. Pantoprazole)
      4. Effavirenz
  10. Preparations: Miscellaneous Agents
    1. Methaqualone (Quaalude)
      1. Positive: 2 weeks
    2. Rohypnol
      1. Positive: 72 hours
    3. GHB
      1. Positive: 6-12 hours
    4. Soma
      1. Detected as Meprobamate (metabolite)
  11. References
    1. (2014) PL Detail-Document, Urine Drug Testing, Prescriber's Letter
    2. Jaffee (2007) J Subst Abuse Treat 33(1): 33-42 [PubMed]
    3. Moeller (2008) Mayo Clin Proc 83(1): 66-76 [PubMed]
    4. Standridge (2010) Am Fam Physician 81(5): 635-40 [PubMed]

Urine drug screening (C0202274)

Concepts Laboratory Procedure (T059)
SnomedCT 310627008
LNC 12286-1
Dutch urine geneesmiddelscreening
French Dépistage urinaire de drogues
German Drogenscreening im Urin
Italian Ricerca di farmaco/droga nelle urine
Portuguese Teste de fármacos na urina
Spanish Analítica toxicológica urinaria, cribaje mediante la detección de fármacos en orina, pesquisa de fármacos en orina, rastreo mediante la detección de fármacos en orina, tscreening de fármacos en orina, tamizaje de fármacos en orina, cribado mediante la detección de fármacos en orina (procedimiento), tamizaje mediante la detección de fármacos en orina, cribado mediante la detección de fármacos en orina, detección selectiva de fármacos en orina (procedimiento), screening mediante la detección de fármacos en orina, cribado de fármacos en orina, detección selectiva de fármacos en orina, pesquisa mediante la detección de fármacos en orina
Japanese 尿中薬物スクリーニング, ニョウチュウヤクブツスクリーニング
English urine drug screens, urine drug screens (lab test), Drugs identified:Prid:Pt:Urine:Nom:Screen, Drugs identified in Urine by Screen method, Drugs Ur Scn, drug screen urine, drug screening urine, drug screens urine, urine drug screening, drugs screen urine, drugs screened urine, urine drug screen, Drugs identified:Presence or Identity:Point in time:Urine:Nominal:Screen, Urine drug screening (procedure), Urine drug screening, Urine drug screen
Czech Test moči na přítomnost léku
Hungarian Vizelet gyógyszer szűrés
Derived from the NIH UMLS (Unified Medical Language System)

Toxicology screen, general (procedure) (C0430054)

Concepts Laboratory Procedure (T059)
SnomedCT 171334006, 148548005, 69200006
LNC LP6503-9
English Poison screen, Toxicology screen, general (procedure), Toxicology screen, Screen, poisoning screening, toxicology screen, screen toxicology, screening toxicology, toxicology screening, screens toxicology, Toxicology screening (procedure), Toxicology screening, Toxicology screen, general, Poison screening, Toxicology screen, general, NOS
Spanish tamizaje de tóxicos, general, detección selectiva de tóxicos, general (procedimiento), cribado de tóxicos, general, detección selectiva de tóxicos, general
Derived from the NIH UMLS (Unified Medical Language System)

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