Urine drug testing: Difference between revisions
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+ | == Indications == |
+ | * 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" |
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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:Investigation]] |
[[Category:Investigation]] |
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− | [[Category: |
+ | [[Category:Addiction medicine]] |
Latest revision as of 09:40, 28 September 2023
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)