Test ID: PAIN
Pain Clinic Survey 10, Urine

Detecting drug use involving amphetamines, barbiturates, benzodiazepines, cocaine, methadone, opiates, phencyclidine, propoxyphene, and tetrahydrocannabinol

This test is intended to be used in a setting where the test results can be used to make a definitive diagnosis.

If immunoassay screen is positive, then gas chromatography-mass spectrometry (GC-MS) confirmation is performed. GC-MS confirmation with quantification of positives for amphetamines, barbiturates, benzodiazepines, cocaine and metabolites, methadone, phencyclidine, propoxyphene, and tetrahydrocannabinol metabolite will be performed at an additional charge.

An evaluation to detect the presence of adulterants will be performed and reported at no additional charge. See Adulterant Survey Algorithm in Special Instructions.

• Adulterant Survey Algorithm

PN_10/26320, OPATU/8473: Screened by Immunoassay and Confirmed by Gas Chromatography-Mass Spectrometry (GC-MS)

ADULT/29345: Spectrophotometry (SP)

AMPHU/8257, BARBU/80372, BENZU/80370, COKEU/9286, MTDNU/83129, MSPR/500373, PCPU/80371, THCU/8898: Gas Chromatography-Mass Spectrometry (GC-MS)

Collection Container/Tube: Plastic urine container

Submission Container/Tube: Plastic, 60-mL urine bottle

Specimen Volume: 30 mL

Collection Instructions:

1. Collect a random urine specimen.

2. Submit 30 mL in 1 plastic bottle.

3. No preservative.

Additional Information:

1. No specimen substitutions.

2. No STATS are accepted for this procedure.

3. For situations where chain-of-custody is required, a Chain-of-Custody Kit (Supply T282) is available. For chain-of-custody information, see COCH/9426 Chain-of-Custody Processing.

4. Additional drug panels and specific requests are available. Call Mayo Medical Laboratories at 800-533-1710 or 507-266-5700.

This assay was designed to test for and confirm by gas chromatography-mass spectrometry (GC-MS) the following:

-Amphetamines

-Barbiturates

-Benzodiazepines

-Cocaine

-Methadone

-Phencyclidine

-Propoxyphene

-Opiates

-Tetrahydrocannabinol

This test uses the simple screening technique described under IDOAU/8248 Drug Abuse Survey, Urine, which involves immunologic testing for drugs by class. Oxycodone is not detected well with the opiate screening assay; therefore, OPATU/8473 Opiates, Urine is included to detect this drug. All positive screening results are confirmed by GC-MS, and quantitated, before a positive result is reported.

Negative

Screening cutoff concentrations

Amphetamines: 500 ng/mL

Barbiturates: 200 ng/mL

Benzodiazepines: 200 ng/mL

Cocaine (benzoylecgonine-cocaine metabolite): 150 ng/mL

Methadone: 300 ng/mL

Opiates: 300 ng/mL

Phencyclidine: 25 ng/mL

Propoxyphene: 300 ng/mL

Tetrahydrocannabinol carboxylic acid: 20 ng/mL

This report is intended for use in clinical monitoring or management of patients. It is not intended for use in employment-related testing.

A positive result derived by this testing indicates that the patient has used 1 of the drugs detected by this technique in the recent past. See individual tests (eg, AMPHU/8257 Amphetamines, Urine) for more information.

For information about drug testing, including estimated detection times, see Drugs of Abuse Testing at http://www.mayomedicallaboratories.com/articles/drug-book/index.html

Creatinine and specific gravity are measured as indicators of specimen dilution.

Not intended for use in employment-related testing.

For situations where chain-of-custody is required, a Chain-of-Custody Kit (Supply T282) is available. See COCH/9426 Chain-of-Custody Processing.

The test does not screen for drug classes other than those listed above. More comprehensive screening is available using the serum or urine drug screens (DSS/8421 Drug Screen, Prescription/OTC, Serum or PDSU/88760 Drug Screen, Prescription/OTC, Urine).

1. Physicians Desk Reference (PDR). 60th edition. Montvale, NJ, Medical Economics Company, 2006

2. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th edition. Edited by LL Bruntman. New York, McGraw-Hill Book Company, 2006

3. Langman LJ, Bechtel L, Holstege CP: Chapter 35. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Edited by CA Burtis, ER Ashwood, DE Bruns. WB Saunders Company, 2011, pp 1109-1188

Drug classes are detected by immunoassay technique method. All positive screening results are confirmed by gas chromatography-mass spectrometry.(Armbruster DA, Schwarzhoff RH, Hubster EC, Liserio MK: Enzyme immunoassay, kinetic microparticle immunoassay, radioimmunoassay, and fluorescence polarization immunoassay compared for drugs-of-abuse screening. Clin Chem 1993;39:2137-2146; Ellis GM Jr, Mann MA, Judson BA, et al: Excretion patterns of cannabinoid metabolites after last use in a group of chronic users. Clin Pharmacol Ther 1985;38:572-578; Foerster EH, Dempsey J, Garriott JC: A gas chromatographic screening procedure for acid and neutral drugs in blood. J Anal Toxicol 1979;3:87-91; as modified to incorporate some alkaline drugs by LE Ebnet and TP Moyer, Mayo Clinic)

Monday through Friday; Varies

80104-Drug screen, qualitative, each procedure

83925-Opiates

G0431-Drug screen, qualitative, each specimen-government payers (if appropriate)

80154-Benzodiazepines (if appropriate)

80299-Tetrahydrocannabinol carboxylic acid (if appropriate)

80299 x 2-Propoxyphene (if appropriate)

82145 x 2-Amphetamines (if appropriate)

82205-Barbiturates (if appropriate)

82520-Cocaine (if appropriate)

83840-Methadone (if appropriate)

83992-Phencyclidine (if appropriate)