Iowa Methodist Medical Center Drug Screening IMMC Drug

Iowa Methodist Medical Center Drug Screening

IMMC Drug Screening Tests available Sympathomimetic Amines (Amphetamine/ Methamphetamine) Ecstasy (MDMA, MDEA) Barbiturates Benzodiazepines Cocaine Opiates Oxycodone (Oxy. Contin, Percocet) 6 -AM (Heroin) PCP Marijuana Methadone Propoxyphene Other Drug Screen, Limited, Urine X Drug Screen, Urine, Monitoring X X X X X X X X Fentanyl, Buprenorphine and Tramadol sent to Med. Tox 2

IMMC Drug Screening cut offs Sympathomimetic Amines (Amphetamine/ Methamphetamine) Screening cut off (ng/m. L) 300 Ecstasy (MDMA, MDEA) Barbiturates Benzodiazepines Cocaine Opiates Oxycodone (Oxy. Contin, Percocet) 500 200 150 300 6 -AM (Heroin) PCP Marijuana Methadone Propoxyphene 10 25 20 300 3

IMMC Drug Screening Confirmation Testing Confirmation testing performed automatically at IMMC Confirmation testing available upon request (Sent to Med. Tox Laboratory) Sympathomimetic Amines (Amphetamine/ Methamphetamine) X Ecstasy (MDMA, MDEA) X Barbiturates Benzodiazepines Cocaine Opiates Oxycodone (Oxy. Contin, Percocet) X X X 6 -AM (Heroin) PCP Marijuana Methadone Propoxyphene X X X 4

IMMC Drug Screening Drug Screen, Prescription/OTC, Urine • Performed at Med. Tox 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, MDEA N/A Amobarbital Butalbital Pentobarbital Phenobarbital Secobarbital Diazepam Nordiazepam Oxazepam Temazepam Barbital Hexobarbital Mephobarbital Metharbital Diphenhydramine Buproprion Trazodone N/A Barbiturates Benzodiazepines Alprazolam Clonazepam Lorazepam Oxaprozin 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 6 AM N/A Morphine Codeine Methadone N/A Levofloxacin Oxycodone 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 Methadone EDMP False Positives Dextromethorphan 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