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 using urine specimens
This test is not intended for employment-related testing.
Highlights
This test uses high-resolution accurate mass spectrometry to identify 33 different opioids and metabolites where immunoassays are not adequate.
This test offers lower detection limits than previous Mayo Clinic Laboratories-offered screens.
This test has the ability to detect "spiked" samples.
Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.
| Test Id | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| LPPO | List prescribed opioids | No | Yes |
| TOPSU | Targeted Opioid Screen, U | No | Yes |
Method Name
A short description of the method used to perform the test
Liquid Chromatography Tandem Mass Spectrometry, High-Resolution Accurate Mass (LC-MS/MS HRAM)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
6-monoacetylmorphine (heroin metabolite)
Buprenorphine (Buprenex, Suboxone)
Codeine (Tylenol #3)
Codeine-6-beta-glucuronide (codeine metabolite)
Dihydrocodeine(hydrocodone metabolite)
EDDP (Methadone metabolite)
Fentanyl (Actiq, Duragesic, Fentora)
Heroin
Hydrocodone (Lortab, Norco, Vicodin)
Hydromorphone (Dilaudid, Exalgo)
Hydromorphone-3-beta-glucuronide (hydromorphone metabolite)
Meperidine (Demerol)
Methadone (Dolophine)
Methadone metabolite (EDDP)
Morphine (Avinza, Kadian, MS Contin)
Morphine-6-beta-glucuronide (morphine metabolite
N-desmethyltapentadol (Tapentadol metabolite)
Naloxone (Narcan)
Naloxone-3-beta-glucuronide (Naloxone metabolite)
Norbuprenorphine (Buprenorphine metabolite)
Norbuprenorphine glucuronide (Buprenorphine metabolite)
Norfentanyl (fentanyl metabolite)
Norhydrocodone (hydrocodone metabolite)
Normeperidine (Meperidine metabolite)
Noroxycodone (oxycodone metabolite)
Noroxymorphone (Oxymorphone metabolite)
Norpropoxyphene (propoxyphene metabolite)
O-desmethyltramadol (Tramadol metabolite)
Opiates
Oxycodone (Endocet, Percocet, Oxycontin)
Oxymorphone (Numorphan, Opana)
Oxymorphone-3-beta-glucuronide (Oxymorphone metabolite)
Propoxyphene (Darvon, Darvocet)
Tapentadol (Nucynta)
Tapentadol-beta-glucuronide (Tapentadol metabolite)
Tramadol (Tradol, Ultram, Ultracet)
Specimen Type
Describes the specimen type validated for testing
Urine
Additional Testing Requirements
In most cases, no additional testing is needed after the qualitative targeted opioid test is performed if the parent drug or metabolites found are consistent with the patient's prescribed medications. However, if an unexpected opioid parent drug or metabolites are found, confirmatory testing can be requested at an additional charge.
ORDER QUESTIONS AND ANSWERS
| Question ID | Description | Answers |
|---|---|---|
| LPPO | List prescribed opioids |
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube: Plastic urine container
Submission Container/Tube: Plastic, 5-mL tube
Specimen Volume: 1 mL
Collection Instructions:
1. Collect a random urine specimen.
2. No preservative
Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
0.5 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | Reject |
| Gross icterus | Reject |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 14 days | |
| Ambient | 72 hours | ||
| Frozen | 28 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Determining compliance or identifying illicit opioid drug use using 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 of opioids include drowsiness, confusion, nausea, constipation, and, in severe cases, respiratory depression. These are dose dependent and vary with tolerance. 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 does not 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 (Positive results are reported with qualitative "Present" results)
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
2-Ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (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 is identified (present), it indicates that the patient has used the respective opioid 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: Brunton LL, Lazo JS, Parker KL, eds. Goodman and Gilman's: The Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill; 2006:chap 21
2. Rovine T, Ferrero CL, American Pain Society. Chronic Pain in America: Roadblocks to Relief. Roper Starch Worldwide, Inc; 1999. Updated October 2, 2001. Accessed December 13, 2024. Available at http://accurateclinic.com/wp-content/uploads/2016/04/Chronic-Pain-In-America-Roadblocks-To-Relief-1999.pdf
3. Magnani B, Kwong T. Urine drug testing for pain management. Clin Lab Med. 2012;32(32):379-390
4. Langman LJ, Bechtel LK, Holstege CP. Clinical toxicology. In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. St Louis, MO: Elsevier; 2023:chap 43
5. Jannetto PJ, Bratanow NC, Clark WA, et al. Executive Summary: American Association of Clinical Chemistry Laboratory Medicine Practice Guideline-using clinical laboratory tests to monitor drug therapy in pain management patients. J Appl Lab Med. 2018;2(4):489-526
Method Description
Describes how the test is performed and provides a method-specific reference
The urine sample is diluted with internal standard and then analyzed by liquid chromatography tandem mass spectrometry using a high resolution-accurate mass orbi-trap detector.(Unpublished Mayo method)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Sunday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
G0480
80364 (if appropriate for select payers)
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| TOSU | Targeted Opioid Screen, U | 95796-9 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| 42323 | Codeine | 19411-8 |
| 42324 | Codeine-6-beta-glucuronide | 89310-7 |
| 42325 | Morphine | 19597-4 |
| 42326 | Morphine-6-beta-glucuronide | 89308-1 |
| 42327 | 6-monoacetylmorphine | 19321-9 |
| 42328 | Hydrocodone | 19482-9 |
| 42329 | Norhydrocodone | 89304-0 |
| 42330 | Dihydrocodeine | 19446-4 |
| 42331 | Hydromorphone | 19486-0 |
| 42332 | Hydromorphone-3-beta-glucuronide | 89309-9 |
| 42333 | Oxycodone | 19642-8 |
| 42334 | Noroxycodone | 89303-2 |
| 42335 | Oxymorphone | 19646-9 |
| 42336 | Oxymorphone-3-beta-glucuronide | 89301-6 |
| 42337 | Noroxymorphone | 89302-4 |
| 42338 | Fentanyl | 59673-4 |
| 42339 | Norfentanyl | 43199-9 |
| 42340 | Meperidine | 19532-1 |
| 42341 | Normeperidine | 27920-8 |
| 42342 | Naloxone | 42618-9 |
| 42343 | Naloxone-3-beta-glucuronide | 89307-3 |
| 42344 | Methadone | 19550-3 |
| 42345 | EDDP | 93495-0 |
| 42346 | Propoxyphene | 19429-0 |
| 42347 | Norpropoxyphene | 19632-9 |
| 42348 | Tramadol | 19710-3 |
| 42349 | O-desmethyltramadol | 86453-8 |
| 42350 | Tapentadol | 72485-6 |
| 42351 | N-desmethyltapentadol | 89306-5 |
| 42352 | Tapentadol-beta-glucuronide | 89300-8 |
| 42353 | Buprenorphine | 93494-3 |
| 42354 | Norbuprenorphine | 82371-6 |
| 42355 | Norbuprenorphine glucuronide | 89305-7 |
| 65059 | Opioid Interpretation | 69050-3 |
| LPPO | List prescribed opioids | 29305-0 |