More About Urine Drug Screens

[Dr. Joel Nathan]

I saw a patient today who was on percocet (oxycodone + tylenol) for chronic pain. The urine screen did not test specifically for oxycodone so he showed negative for opiates.

The take home lesson is:

The opiate urine drug screen checks for morphine based products: codeine, hydrocodone and heroin.

The totally synthetic opioids must be tested for separately. So drugs such as methadone, oxycodone or buprenorphine (suboxone or subutex) must be tested separately.

Joel

[Sledge]

I'm interested to know. Was this a lab conducted drug screen or one of the instant kits?

[Dr. Joel Nathan]

I'm interested to know. Was this a lab conducted drug screen or one of the instant kits?

The test was done as an instant kit.
That kit did not have a comprehensive panel on it.

Sometimes the test is sent to a laboratory.

Tests which are sent to a laboratory can vary by what tests the doctor orders. The laboratory sent tests may or may not include oxycodone or buprenorphine or other tests as listed below.*

The most sensitive urine tox screens are done by gas chromatography.The gas chromatography is very expensive and not used often.

*Review the Comprehensive List of Individual Drugs and Drug Classes That Are Detectable in the lab or on some more comprehensive urine test kits:

Detectable Classes/Drugs



Amphetamines
Barbiturates
Benzodiazepines
Buprenorphine/Norbuprenorphine
Cannabinoids (THC)
Cocaine/Cocaine metabolite
Ecstasy (MDMA)
Ethanol
Fentanyl/Norfentanyl
Gabapentin
Heroin metabolite (6AM)
LSD
Meperidine
Meprobamate (Soma metabolite)
Methadone/Methadone Metabolite
Opiates
Oxycodone/Oxymorphone
Phencyclidine (PCP)
Propoxyphene
Ritalinic Acid
Tramadol

Joel

[Tatyana]

While they are improving, the last time I checked, there are issues with the instant kits.

I know that medics in AE/ER in the UK would love a quick test that would allow them to determine what substance a patient has overdosed on when they come in either unconscious, incoherent or uncooperative to treat them.

Besides the factor with being inaccurate at times, there are legal issues with testing people for things they have not given consent for.

[Sledge]

Yes this is true Tats

I use them at work and none of them complies with Australian standards. We use them as an initial instant test because of our location but then the samples are sealed and sent off to a lab for analysis.