IMMC Drug Screening

Report
Iowa Methodist Medical Center
Drug Screening
IMMC Drug Screening
Tests available
Drug Screen, Limited, Urine
Sympathomimetic Amines
(Amphetamine/ Methamphetamine)
Ecstasy (MDMA,MDA,MDEA)
Barbiturates
Benzodiazepines
Cocaine
Opiates
Oxycodone (OxyContin, Percocet)
6-AM (Heroin)
PCP
Marijuana
Methadone
Propoxyphene
Other
X
X
X
X
X
X
X
X
X
X
X
X
Drug Screen, Urine,
Monitoring
X
X
X
X
X
X
X
X
X
X
X
Fentanyl, Buprenorphine and
Tramadol sent to MedTox
2
IMMC Drug Screening
Screening cut offs
Sympathomimetic Amines (Amphetamine/
Methamphetamine)
Screening cut off (ng/mL)
300
Ecstasy (MDMA,MDA,MDEA)
Barbiturates
Benzodiazepines
Cocaine
Opiates
Oxycodone (OxyContin, Percocet)
500
200
200
150
300
300
6-AM (Heroin)
PCP
Marijuana
Methadone
Propoxyphene
10
25
20
300
300
3
IMMC Drug Screening
Confirmation Testing
Confirmation testing
performed automatically
at IMMC
Sympathomimetic Amines (Amphetamine/
Methamphetamine)
X
Ecstasy (MDMA,MDA,MDEA)
Barbiturates
Benzodiazepines
Cocaine
Opiates
Oxycodone (OxyContin, Percocet)
6-AM (Heroin)
PCP
Marijuana
Methadone
Propoxyphene
Confirmation testing available
upon request (Sent to MedTox
Laboratory)
X
X
X
X
X
X
X
X
X
X
X
4
IMMC Drug Screening
Drug Screen, Prescription/OTC, Urine
• Performed at MedTox Laboratory
• Detection and identification of prescription
or over the counter drugs frequently found
in drug overdose or used with a suicidal
intent. This test is designed to qualitatively
identify drugs present in the specimen
5
IMMC Drug Screening
Other individually orderable tests of interest
• Methylphenidate (Ritalin®),
• Adderall
• Almost any Benzo you can think of…
6
IMMC Drug Screening
Possible causes for false positive and
negative results
Screening Assay
Commonly Detects
False Negatives
False Positives
Sympathomimetic
Amines
(Amphetamine/
Methamphetamine)
Amphetamine,
Methamphetamine
Pseudoephedrine
Phentermine
Ephedrine
l-Amphetamine
l-Methamphetamine
Ranitidine
Ecstasy
MDMA,MDA,MDEA
N/A
Diphenhydramine
Amobarbital
Butalbital
Pentobarbital
Phenobarbital
Secobarbital
Diazepam
Nordiazepam
Oxazepam
Temazepam
Barbital
Hexobarbital
Mephobarbital
Metharbital
N/A
Alprazolam
Clonazepam
Lorazepam
Oxaprozin
Barbiturates
Benzodiazepines
7
IMMC Drug Screening
Possible causes for false positive and
negative results
Screening Assay
Cocaine
Opiates
Oxycodone
6-Acetylmorphine
Commonly
False Negatives
Detects
Benzoylecgonine Cocaine
Ecgonine Methyl
Ester
Cocaethylene
Ecgonine
Morphine
Oxycodone
Codeine
Oxymorphone
Hydrocodone
Hydromorphone
False Positives
Oxymorphone
Noroxycodone
Oxycodone
N/A
6AM
N/A
Morphine,
Codeine,
Methadone
N/A
Levofloxacin
Ofloxacin
8
IMMC Drug Screening
Possible causes for false positive and
negative results
Screening Assay
PCP
Marijuana
Methadone
Commonly
Detects
PCP
Delta 9
Carboxy THC
EDDP
False Negatives
N/A
N/A
Methadone
EDMP
False
Positives
N/A
Marinol
Niflumic Acid
N/A
9
IMMC Drug Screening
DRI® Opiate Cross-Reactivity Tables
10
IMMC Drug Screening
• And many, many more
11
IMMC Drug Screening
DRI® Benzodiazepine Cross-Reactivity Tables
12
IMMC Drug Screening
What does a “positive” urine drug test result on
an immunoassay actually mean?
• the patient was compliant and took the prescribed
drug as directed.
• the patient was only partially compliant and just took 1
dose prior to collection.
• the patient could have directly spiked/added the drug
into the urine sample after collection.
• the patient took another medication that cross-reacted
with the immunoassay causing a false-positive result.
False-positive results are one of the limitations of using
an immunoassay.
13
IMMC Drug Screening
What does a “negative” urine drug test result on
an immunoassay really mean?
• the patient is not compliant with their prescribed medication
• the patient was partially compliant and maybe missed a few
doses, or took less medication.
• the patient is well hydrated and the urine is dilute or possibly
adulterated.
• the wrong test might have been ordered and the test may not
cross-react with the patient’s medications.
• the drug may actually be present, but it is below the cutoff or
detection limit of the assay leading to a false-negative result.
False-negative results can happen as easily as a false-positive
result with immunoassays. Therefore, it is important to look at
the assay cutoff or detection limit when interpreting test results.
14
IMMC Drug Screening
Other information of value
• timing between when the patient last took
their medication and when the urine
sample was collected.
• Specimen validity testing can also be used
to help determine the integrity and quality
of the patient’s sample.
15

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