Urine drug testing: Difference between revisions
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== Indications == |
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* May be used as a baseline for patients being considered for trial of opioids for chronic pain |
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* Regular testing is done for patient on [[opioid agonist therapy]] to monitor for adherence, validate patient-reported use, and detect coingested substances like benzodiazepines that may affect safety |
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==Immunoassays== |
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* Immunoassays are cheap and fast, but are subject to cross-reactivity |
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* Window of detection for most metabolites is 1 to 3 days |
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* An initial 5-panel IA tests for amphetamines, cocaine, benzodiazepines (though not clonazepam), opiates, and methadone |
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* Validity is best when the urine temperature is 90 to 100ºF (within 4 minutes of voiding), urine pH 4.5 to 8, and urinary creatinine ≥20 mg/dL (if <5 mg/dL, it's not urine) |
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=== Interpretation === |
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{| class="wikitable" |
{| class="wikitable" |
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!Substance |
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!False positives |
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|[[Alcohol]] |
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|Short-chain alcohols (e.g. [[isopropyl alcohol]]) |
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|[[Amphetamines]] |
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|[[Amantadine]], [[Benzphetamine]], [[Bupropion]], [[Chlorpomazine]], [[Clobenzorex]], [[l-Deprenyl]], [[Desipramine]], [[Dextroamphetamine]], [[Ephedrine]], [[Fenproporex]], [[Isometheptene]], [[Isoxsuprine]], [[Labetalol]], [[MDMA]], [[Methamphetamine]], [[Methylphenidate]], [[Phentermine]], [[Phenylephrine]], [[Phenylpropanolamine]], [[Protethazine]], [[Pseudoephedrine]], [[Ranitidine]], [[Ritodrine]], [[Selegiline]], [[Thioridazine]], [[Trazodone]], [[Trimethobenzamide]], [[Trimipramine]] |
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|[[Benzodiazepines]] |
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|[[Oxaprozin]], [[Setraline]] |
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|[[Cannabinoids]] |
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|[[Dronabinol]], [[Efavirenz]], [[Hemp-containing foods]], [[NSAIDs]], [[Proton pump inhibitors]], [[Tolmetin]] |
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|[[Cocaine]] |
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|[[Coca leaf tea]], Topical anesthetics containing cocaine |
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|[[Opioids]], [[opiates]], and [[heroin]] |
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|[[Dextromethorphan]], [[Diphenhydramine]], [[Heroin]], [[Opiates]] ([[codeine]], [[hydromorphone]], [[hydrocodone]], [[morphine]]), Poppy seeds, [[Quinine]], [[Quinolones]], [[Rifampin]], [[Verapamil]] and metabolites |
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|[[Phencyclidine]] |
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|[[Dextromethorphan]], [[Diphenhydramine]], [[Doxylamine]], [[Ibuprofen]], [[Imipramine]], [[Ketamine]], [[Meperidine]], [[Mesoridazine]], [[Thioridazine]], [[Tramadol]], [[Venlafaxine]] and [[desvenlafaxine]] |
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|[[TCAs]] |
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|[[Carbamazepine]], [[Cyclobenzaprine]], [[Cyproheptadine]], [[Diphenhydramine]], [[Hydroxyzine]], [[Quetiapine]] |
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[[Category: |
[[Category:Investigations]] |
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[[Category:Addiction medicine]] |
[[Category:Addiction medicine]] |
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Latest revision as of 17:13, 19 September 2024
Indications
- May be used as a baseline for patients being considered for trial of opioids for chronic pain
- Regular testing is done for patient on opioid agonist therapy to monitor for adherence, validate patient-reported use, and detect coingested substances like benzodiazepines that may affect safety
Immunoassays
- Immunoassays are cheap and fast, but are subject to cross-reactivity
- Window of detection for most metabolites is 1 to 3 days
- An initial 5-panel IA tests for amphetamines, cocaine, benzodiazepines (though not clonazepam), opiates, and methadone
- Validity is best when the urine temperature is 90 to 100ºF (within 4 minutes of voiding), urine pH 4.5 to 8, and urinary creatinine ≥20 mg/dL (if <5 mg/dL, it's not urine)
