TEST CATALOG ORDERING & RESULTS SPECIMEN HANDLING CUSTOMER SERVICE EDUCATION & INSIGHTS
Test Catalog

Test ID: TOSU    
Targeted Opioid Screen, Random, Urine

Useful For Suggests clinical disorders or settings where the test may be helpful

Determining compliance or identifying illicit opioid drug use in urine specimens

 

This test is not intended for employment-related testing.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Opioids are a large class of medications commonly used to relieve acute and chronic pain or help manage opioid abuse and dependence. Medications that fall into this class include: buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, tapentadol, tramadol, and others. Opioids work by binding to the opioid receptors that are found in the brain, spinal cord, gastrointestinal tract, and other organs.

 

Common side effects include drowsiness, confusion, nausea, constipation, and in severe cases respiratory depression depending on the dose. These medications can also produce physical and psychological dependence and have a high risk for abuse and diversion, which is one of the main reasons many professional practice guidelines recommend compliance testing in patients' prescribed these medications.

 

Opioids are readily absorbed from the gastrointestinal tract, nasal mucosa, lungs, and after subcutaneous or intermuscular injection. Opioids are primarily excreted from the kidney in both free and conjugated forms. This assay doesn't hydrolyze the urine sample and looks for both parent drugs and metabolites (including glucuronide forms). The detection window for most opioids in urine is approximately 1 to 3 days with longer detection times for some compounds (ie, methadone).

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Not Detected

 

Cutoff concentrations:

Codeine: 25 ng/mL

Codeine-6-beta-glucuronide: 100 ng/mL

Morphine: 25 ng/mL

Morphine-6-beta-glucuronide: 100 ng/mL

6-monoacetylmorphine: 25 ng/mL

Hydrocodone: 25 ng/mL

Norhydrocodone: 25 ng/mL

Dihydrocodeine: 25 ng/mL

Hydromorphone: 25 ng/mL

Hydromorphone-3-beta-glucuronide: 100 ng/mL

Oxycodone: 25 ng/mL

Noroxycodone: 25 ng/mL

Oxymorphone: 25 ng/mL

Oxymorphone-3-beta-glucuronide: 100 ng/mL

Noroxymorphone: 25 ng/mL

Fentanyl: 2 ng/mL

Norfentanyl: 2 ng/mL

Meperidine: 25 ng/mL

Normeperidine: 25 ng/mL

Naloxone: 25 ng/mL

Naloxone-3-beta-glucuronide: 100 ng/mL

Methadone: 25 ng/mL

EDDP: 25 ng/mL

Propoxyphene: 25 ng/mL

Norpropoxyphene: 25 ng/mL

Tramadol: 25 ng/mL

O-desmethyltramadol: 25 ng/mL

Tapentadol: 25 ng/mL

N-desmethyltapentadol: 50 ng/mL

Tapentadol-beta-glucuronide: 100 ng/mL

Buprenorphine: 5 ng/mL

Norbuprenorphine: 5 ng/mL

Norbuprenorphine glucuronide: 20 ng/mL

Interpretation Provides information to assist in interpretation of the test results

If an opioid or its corresponding metabolites are identified (present), it indicates that the patient has used the respective opioids in the recent past. The absence of expected opioids or their metabolites may indicate noncompliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted or adulterated urine, or limitations of testing. The concentration of the drug must be greater than or equal to the cutoff to be reported as present. If a specific drug concentration is required, the laboratory must be contacted within 2 weeks of specimen collection/testing to request quantification by a second analytical technique at an additional charge.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

No significant cautionary statements

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Gutstein HB, Akil H: Opioid analgesics. In Goodman and Gilman's: The Pharmacological Basis of Therapeutics. 11th edition. Edited by LL Brunton, JS Lazo, KL Parker. McGraw-Hill Companies, Inc, 2006

2. Rovine T, Ferrero CL: American Pain Society: Chronic Pain in America: Roadblocks to Relief. The American Academy of the Pain Medicine. 1999 Feb 17. Available at www.doctordeluca.com/Library/Pain/ChronicPainRoadblocks.htm

3. Magnani B, Kwong T: Urine drug testing for pain management. Clin Lab Med 2012;32(32):379-390