Dr. Joel Nathan
03-22-2009, 09:12 PM
Urine Drug Screens
If you have questions on urine drug tests, ask here or PM me at vo2max.
The standard urine drug screen in a clinical setting is a panel of immunoassays to detect common drugs of abuse. The panel usually includes the five drugs required by federal workplace testing: amphetamines, cocaine, opiates, marijuana, and PCP.
Other drugs that are prevalent in the community can be added to the panel, including benzodiazepines (Valium, Xanax, Klonopin) and barbiturates. Generally, drugs and their metabolites are detectable in urine tests for about 3 days after use. Notable exceptions are THC (from marijuana), methadone and benzodiazepines (Valium, Xanax, etc) stay in the system for weeks after heavy use.
Here’s where some docs need some education (perhaps you can teach them a thing or two): Most immunoassays for opiates are designed to detect heroin and measure codeine, which is a byproduct of heroin and morphine metabolism. However, synthetic opioids such as oxycodone or methadone do not cross-react with most codeine immunoassays, and will produce a negative result. A negative urine drug screen for opioids might falsely lead the physician to believe that the person does not use any opioids.
The same is true for opioids agonist/antagonists: Suboxone (buprenorphine and naloxone combination), Subutex (buprenorphine), Nubain (nalbuphine) and others that are not picked up on routine opiate drug testing. There is a test for buprenorphine that can be done in the office, but few docs have this test available in the office or think of doing it, if they are inexperienced.
Ultram (tramadol) is a unique centrally acting analgesic that feels like an opiate. People can become addicted to it and need detox. This medication is also non-controlled and does not tested on urine tox screens.
False positives (test will be positive for opiates even though they are not being used) occur if someone eats an equivalent of 1-2 teaspoons of poppy seeds. This can be the amount in 2 poppy seed bagels. By the way, just being in the same room with marijuana smokers does not cause your urine drug screen to be positive for THC. Also antihistamines and decongestants do not cause false positives for amphetamines.
This thread does not cover hair follicle or saliva testing and testing for anabolic steroids. These belong in threads by themselves.
If you have questions on urine drug tests, ask here or PM me at vo2max.
The standard urine drug screen in a clinical setting is a panel of immunoassays to detect common drugs of abuse. The panel usually includes the five drugs required by federal workplace testing: amphetamines, cocaine, opiates, marijuana, and PCP.
Other drugs that are prevalent in the community can be added to the panel, including benzodiazepines (Valium, Xanax, Klonopin) and barbiturates. Generally, drugs and their metabolites are detectable in urine tests for about 3 days after use. Notable exceptions are THC (from marijuana), methadone and benzodiazepines (Valium, Xanax, etc) stay in the system for weeks after heavy use.
Here’s where some docs need some education (perhaps you can teach them a thing or two): Most immunoassays for opiates are designed to detect heroin and measure codeine, which is a byproduct of heroin and morphine metabolism. However, synthetic opioids such as oxycodone or methadone do not cross-react with most codeine immunoassays, and will produce a negative result. A negative urine drug screen for opioids might falsely lead the physician to believe that the person does not use any opioids.
The same is true for opioids agonist/antagonists: Suboxone (buprenorphine and naloxone combination), Subutex (buprenorphine), Nubain (nalbuphine) and others that are not picked up on routine opiate drug testing. There is a test for buprenorphine that can be done in the office, but few docs have this test available in the office or think of doing it, if they are inexperienced.
Ultram (tramadol) is a unique centrally acting analgesic that feels like an opiate. People can become addicted to it and need detox. This medication is also non-controlled and does not tested on urine tox screens.
False positives (test will be positive for opiates even though they are not being used) occur if someone eats an equivalent of 1-2 teaspoons of poppy seeds. This can be the amount in 2 poppy seed bagels. By the way, just being in the same room with marijuana smokers does not cause your urine drug screen to be positive for THC. Also antihistamines and decongestants do not cause false positives for amphetamines.
This thread does not cover hair follicle or saliva testing and testing for anabolic steroids. These belong in threads by themselves.