Iowa Methodist Medical Center Drug Screening

Tests available Drug Screen, Limited, Urine Drug Screen, Urine, Monitoring Sympathomimetic Amines (Amphetamine/ Methamphetamine) XX Ecstasy (MDMA,MDA,MDEA)XX BarbituratesXX BenzodiazepinesXX CocaineXX OpiatesXX Oxycodone (OxyContin, Percocet)XX 6-AM (Heroin)XX PCPXX MarijuanaXX MethadoneXX PropoxypheneX Other Fentanyl, Buprenorphine and Tramadol sent to MedTox 2 IMMC Drug Screening

Screening cut offs Screening cut off (ng/mL) Sympathomimetic Amines (Amphetamine/ Methamphetamine) 300 Ecstasy (MDMA,MDA,MDEA)500 Barbiturates200 Benzodiazepines200 Cocaine150 Opiates300 Oxycodone (OxyContin, Percocet)300 6-AM (Heroin)10 PCP25 Marijuana20 Methadone300 Propoxyphene300 3 IMMC Drug Screening

Confirmation Testing Confirmation testing performed automatically at IMMC Confirmation testing available upon request (Sent to MedTox Laboratory) Sympathomimetic Amines (Amphetamine/ Methamphetamine) X Ecstasy (MDMA,MDA,MDEA) X BarbituratesX Benzodiazepines X CocaineX Opiates X Oxycodone (OxyContin, Percocet) X 6-AM (Heroin) X PCPX MarijuanaX Methadone X Propoxyphene 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 AssayCommonly DetectsFalse NegativesFalse Positives Sympathomimetic Amines (Amphetamine/ Methamphetamine) Amphetamine, Methamphetamine Pseudoephedrine Phentermine Ephedrine l-Amphetamine l-Methamphetamine Ranitidine EcstasyMDMA,MDA,MDEAN/A Diphenhydramine Buproprion Trazodone Barbiturates Amobarbital Butalbital Pentobarbital Phenobarbital Secobarbital Barbital Hexobarbital Mephobarbital Metharbital N/A BenzodiazepinesDiazepam Nordiazepam Oxazepam Temazepam Alprazolam Clonazepam Lorazepam Oxaprozin 7 IMMC Drug Screening

Possible causes for false positive and negative results 8 IMMC Drug Screening Screening Assay Commonly Detects False NegativesFalse Positives CocaineBenzoylecgonine Cocaine Ecgonine Methyl Ester Cocaethylene Ecgonine N/A Opiates Morphine Codeine Hydrocodone Hydromorphone Oxycodone Oxymorphone Levofloxacin Ofloxacin Oxycodone Oxymorphone Noroxycodone Oxycodone N/A 6-Acetylmorphine6AMN/AMorphine Codeine Methadone

Possible causes for false positive and negative results 9 IMMC Drug Screening Screening Assay Commonly Detects False Negatives False Positives PCP N/ADextromethorphan Marijuana Delta 9 Carboxy THC N/A Marinol Niflumic Acid MethadoneEDDPMethadone EDMP N/A

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 IMMC Drug Screening