Urine drug testing: Difference between revisions

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)

Interpretation

Substance	False positives
Alcohol	Short-chain alcohols (e.g. isopropyl alcohol)
Amphetamines	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
Benzodiazepines	Oxaprozin, Setraline
Cannabinoids	Dronabinol, Efavirenz, Hemp-containing foods, NSAIDs, Proton pump inhibitors, Tolmetin
Cocaine	Coca leaf tea, Topical anesthetics containing cocaine
Opioids, opiates, and heroin	Dextromethorphan, Diphenhydramine, Heroin, Opiates (codeine, hydromorphone, hydrocodone, morphine), Poppy seeds, Quinine, Quinolones, Rifampin, Verapamil and metabolites
Phencyclidine	Dextromethorphan, Diphenhydramine, Doxylamine, Ibuprofen, Imipramine, Ketamine, Meperidine, Mesoridazine, Thioridazine, Tramadol, Venlafaxine and desvenlafaxine
TCAs	Carbamazepine, Cyclobenzaprine, Cyproheptadine, Diphenhydramine, Hydroxyzine, Quetiapine

@@ Line 1: / Line 1: @@
-== Immunoassays ==
+== 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)
+=== Interpretation ===
 {| class="wikitable"
-! Substance
+!Substance
-! False positives
+!False positives
 |-
-| Alcohol
+|[[Alcohol]]
-| Short-chain alcohols (e.g. isopropyl alcohol)
+|Short-chain alcohols (e.g. [[isopropyl alcohol]])
 |-
-| Amphetamines
+|[[Amphetamines]]
-| Amantadine<br/>Benzphetamine<br/>Bupropion<br/>Chlorpomazine<br/>Clobenzorex<br/>l-Deprenyl<br/>Desipramine<br/>Dextroamphetamine<br/>Ephedrine<br/>Fenproporex<br/>Isometheptene<br/>Isoxsuprine<br/>Labetalol<br/>MDMA<br/>Methamphetamine<br/>Methylphenidate<br/>Phentermine<br/>Phenylephrine<br/>Phenylpropanolamine<br/>Protethazine<br/>Pseudoephedrine<br/>Ranitidine<br/>Ritodrine<br/>Selegiline<br/>Thioridazine<br/>Trazodone<br/>Trimethobenzamide<br/>Trimipramine
+|[[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]]
 |-
-| Benzodiazepines
+|[[Benzodiazepines]]
-| Oxaprozin<br/>Setraline
+|[[Oxaprozin]], [[Setraline]]
 |-
-| Cannabinoids
+|[[Cannabinoids]]
-| Dronabinol<br/>Efavirenz<br/>Hemp-containing foods<br/>NSAIDs<br/>Proton pump inhibitors<br/>Tolmetin
+|[[Dronabinol]], [[Efavirenz]], [[Hemp-containing foods]], [[NSAIDs]], [[Proton pump inhibitors]], [[Tolmetin]]
 |-
-| Cocaine
+|[[Cocaine]]
-| Coca leaf tea<br/>Topical anesthetics containing cocaine
+|[[Coca leaf tea]], Topical anesthetics containing cocaine
 |-
-| Opioids, opiates, and heroin
+|[[Opioids]], [[opiates]], and [[heroin]]
-| Dextromethorphan<br/>Diphenhydramine<br/>Heroin<br/>Opiates (codeine, hydromorphone, hydrocodone, morphine)<br/>Poppy seeds<br/>Quinine<br/>Quinolones<br/>Rifampin<br/>Verapamil and metabolites
+|[[Dextromethorphan]], [[Diphenhydramine]], [[Heroin]], [[Opiates]] ([[codeine]], [[hydromorphone]], [[hydrocodone]], [[morphine]]), Poppy seeds, [[Quinine]], [[Quinolones]], [[Rifampin]], [[Verapamil]] and metabolites
 |-
-| Phencyclidine
+|[[Phencyclidine]]
-| Dextromethorphan<br/>Diphenhydramine<br/>Doxylamine<br/>Ibuprofen<br/>Imipramine<br/>Ketamine<br/>Meperidine<br/>Mesoridazine<br/>Thioridazine<br/>Tramadol<br/>Venlafaxine and desvenlafaxine
+|[[Dextromethorphan]], [[Diphenhydramine]], [[Doxylamine]], [[Ibuprofen]], [[Imipramine]], [[Ketamine]], [[Meperidine]], [[Mesoridazine]], [[Thioridazine]], [[Tramadol]], [[Venlafaxine]] and [[desvenlafaxine]]
 |-
-| TCAs
+|[[TCAs]]
-| Carbamazepine<br/>Cyclobenzaprine<br/>Cyproheptadine<br/>Diphenhydramine<br/>Hydroxyzine<br/>Quetiapine
+|[[Carbamazepine]], [[Cyclobenzaprine]], [[Cyproheptadine]], [[Diphenhydramine]], [[Hydroxyzine]], [[Quetiapine]]
 |}