Clinical Information

The cocaine screen portion uses immunoassay screening techniques. A positive immunoassay screening result can be confirmed by gas chromatography mass spectrometry and quantitated at an additional charge.

The targeted opioid, benzodiazepine, and stimulant screen portions are performed using liquid chromatography tandem mass spectrometry, high-resolution accurate mass and are completed for all opioids, benzodiazepines, and stimulants. Opioids are a large class of medications commonly used to relieve acute and chronic pain or help manage opioid abuse and dependence. Medications that fall into this class include buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, tapentadol, tramadol, and others. Opioids work by binding to the opioid receptors that are found in the brain, spinal cord, gastrointestinal tract, and other organs. Common side effects for opioids include drowsiness, confusion, nausea, constipation, and, in severe cases, respiratory depression. These are dose dependent and vary with tolerance. These medications can also produce physical and psychological dependence and have a high risk for abuse and diversion, which is one of the main reasons many professional practice guidelines recommend compliance testing in patients prescribed these medications.

Opioids are readily absorbed from the gastrointestinal tract, nasal mucosa, lungs, and after subcutaneous or intermuscular injection. Opioids are primarily excreted from the kidney in both free and conjugated forms. This assay does not hydrolyze the urine sample and looks for both parent drugs and metabolites (including glucuronide forms). The detection window for most opioids in urine is approximately 1 to 3 days with longer detection times for some compounds (ie, methadone).

Benzodiazepines represent a large family of medications used to treat a wide range of disorders from anxiety to seizures and are also used in pain management. With a high risk for abuse and diversion, professional practice guidelines recommend compliance monitoring for these medications using urine drug tests. However, traditional benzodiazepine immunoassays suffer from a lack of cross-reactivity with all the benzodiazepines, so many compliant patients taking either clonazepam (Klonopin) or lorazepam (Ativan) may screen negative by immunoassay but are positive when confirmatory testing is done. The new targeted benzodiazepine screening test provides a more sensitive and specific test to check for compliance to all the commonly prescribed benzodiazepines and looks for both parent drugs and metabolites in the urine.

Stimulants are sympathomimetic amines that stimulate the central nervous system activity and, in part, suppress the appetite. Amphetamine and methamphetamine are also prescription drugs used in the treatment of narcolepsy and attention-deficit disorder/attention-deficit hyperactivity disorder (ADHD). Methylphenidate is another stimulant used to treat ADHD. Phentermine is indicated for the management of obesity. All other amphetamines (eg, methylenedioxymethamphetamine: MDMA) are Drug Enforcement Administration-scheduled Class I compounds. Due to their stimulant effects, the drugs are commonly sold illicitly and abused. Physiological symptoms associated with very high amounts of ingested amphetamine or methamphetamine include elevated blood pressure, dilated pupils, hyperthermia, convulsions, and acute amphetamine psychosis.

Gabapentinoids (pregabalin, gabapentin) are widely used in neurology, psychiatry, and primary care, with increasing reports of misuse. They decrease central neuronal excitability by binding to the calcium channel of hyperexcited neurons which results in a reduction in the release of excitatory molecules including glutamate and noradrenaline. Gabapentin is not metabolized or protein bound and is primarily excreted and detectable in the urine for up to four days. Pregabalin is also largely excreted unchanged in the urine and detectable for up to 6 days.

This test is intended to be used in a setting where the test results can be used to make a definitive diagnosis.