Test Id : AMPHX
Amphetamines Confirmation, Chain of Custody, Random, Urine
Useful For
Suggests clinical disorders or settings where the test may be helpful
Confirming drug exposure involving amphetamines such as amphetamine and methamphetamine, phentermine, pseudoephedrine/ephedrine, methylenedioxymethamphetamine, and methylenedioxyamphetamine.
Providing chain-of-custody for when the results of testing could be used in a court of law. Its purpose is to protect the rights of the individual contributing the specimen by demonstrating that it was always under the control of personnel involved with testing the specimen; this control implies that the opportunity for specimen tampering would be limited.
Additional Tests
Lists tests that are always performed, at an additional charge, with the initial tests.
| Test Id | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| COCH | Chain of Custody Processing | No | Yes |
| ADLTX | Adulterants Survey, CoC, U | Yes | Yes |
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
Adulterants testing will be performed on all chain-of-custody urine samples as per regulatory requirements.
Method Name
A short description of the method used to perform the test
Immunoassay/Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
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
Amphetamines
Ecstasy
MDA (Methylenedioxyamphetamine)
MDMA (Methylenedioxymethamphetamine)
Methamphetamines (Desoxyn)
Methylenedioxyamphetamine (MDA) Metabolite for Methylenedioxyethylamphetamine (MDEA) and Methylenedioxymetamphetamine (MDMA)
Speed (Amphetamines)
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
Adulterants testing will be performed on all chain-of-custody urine samples as per regulatory requirements.
Specimen Type
Describes the specimen type validated for testing
Urine
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Supplies: Chain of Custody Kit (T282)
Container/Tube: Chain of custody kit containing the specimen containers, seals, and documentation required
Specimen Volume: 5 mL
Collection Instructions: Collect specimen in the container provided, seal, and submit with the associated documentation to satisfy the legal requirements for chain-of-custody testing.
Additional Information: Submitting less than 5 mL will compromise the ability to perform all necessary testing.
Forms
1. Chain of Custody Request is included in the Chain of Custody Kit (T282).
2. 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.
1 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | OK |
| Gross icterus | OK |
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) | 28 days | |
| Ambient | 28 days | ||
| Frozen | 28 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Confirming drug exposure involving amphetamines such as amphetamine and methamphetamine, phentermine, pseudoephedrine/ephedrine, methylenedioxymethamphetamine, and methylenedioxyamphetamine.
Providing chain-of-custody for when the results of testing could be used in a court of law. Its purpose is to protect the rights of the individual contributing the specimen by demonstrating that it was always under the control of personnel involved with testing the specimen; this control implies that the opportunity for specimen tampering would be limited.
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
Adulterants testing will be performed on all chain-of-custody urine samples as per regulatory requirements.
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Amphetamines are sympathomimetic amines that stimulate central nervous system activity and, in part, suppress the appetite. Phentermine, amphetamine, and methamphetamine are prescription drugs for weight loss. All other amphetamines are Class I (distribution prohibited) compounds. In addition to their medical use as anorectic drugs, they are used in the treatment of narcolepsy, attention-deficit disorder/attention-deficit hyperactivity disorder, and minimal brain dysfunction.
Because of their stimulant effects, the drugs are commonly sold illicitly and abused. Physiological symptoms associated with very high amounts of ingested amphetamine or methamphetamine include elevated blood pressure, dilated pupils, hyperthermia, convulsions, and acute amphetamine psychosis.
Chain-of-custody is a record of the disposition of a specimen to document each individual who collected, handled, and performed the analysis. When a specimen is submitted in this manner, analysis will be performed in such a way that it will withstand regular court scrutiny.
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.
Negative
Positive results are reported with a quantitative result.
Cutoff concentrations:
Immunoassay screen: 500 ng/mL
Liquid chromatography tandem mass spectrometry:
Amphetamine: 25 ng/mL
Methamphetamine: 25 ng/mL
Phentermine: 25 ng/mL
Methylenedioxyamphetamine: 25 ng/mL
Methylenedioxymethamphetamine: 25 ng/mL
Pseudoephedrine/ephedrine: 25 ng/mL reported as negative
Interpretation
Provides information to assist in interpretation of the test results
The presence of amphetamines in urine is a strong indicator that the patient has used these drugs within the past 3 days.
Methamphetamine has a half-life of 9 to 24 hours and is metabolized by hepatic demethylation to amphetamines. Consequently, a sample containing methamphetamine usually also contains amphetamine. Amphetamine has a half-life of 4 to 24 hours.
Amphetamine is not metabolized to methamphetamine; absence of methamphetamine in the presence of amphetamine indicates the primary drug of abuse is amphetamine. However, trace amounts of methamphetamine can be detected in amphetamine-based prescription drugs (eg, Adderall), but the concentrations are typically less than 1% of the amphetamine concentrations.
3,4-Methylenedioxymethamphetamine (Ecstasy, MDMA) is metabolized to 3,4-methylenedioxyamphetamine (MDA).
Methylenedioxyethylamphetamine is also metabolized to MDA.
The detection interval in urine for amphetamine type stimulants is typically to 3 to 5 days after last ingestion.
This test will produce true-positive results for urine specimens collected from patients who are administered Adderall and Benzedrine (contain amphetamine); Desoxyn and Vicks Inhaler (contain methamphetamine); Selegiline, and famprofazone (metabolized to methamphetamine and amphetamine); and clobenzorex, fenethylline, fenproporex, and mefenorex, which are amphetamine pro-drugs and metabolized to amphetamine.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Over-the-counter sympathomimetics such as ephedrine and phenylpropanolamine are occasionally detected in the screening immunoassay.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Baselt RC. Disposition of Toxic Drugs and Chemicals in Man. 10th ed. Biomedical Publications; 2014
2. 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. Elsevier; 2023:chap 43
3. Principles of Forensic Toxicology. 2nd ed. AACC Press; 2003:385
Method Description
Describes how the test is performed and provides a method-specific reference
Urine is preliminarily screened for the presence of amphetamine-type stimulants by immunoassay technique.
The amphetamine assay is based on the kinetic interaction of microparticles in a solution as measured by changes in light transmission. In the absence of sample drug, soluble drug conjugates bind to antibody-bound microparticles causing the formation of particle aggregates. As the aggregation reaction proceeds in the absence of sample drug, the absorbance increases. When a urine sample contains the drug in question, this drug competes with the drug derivative conjugate for microparticle-bound antibody. Antibody bound to sample drug is no longer available to promote particle aggregation, and subsequent particle lattice formation is inhibited. The presence of sample drug diminishes the increasing absorbance in proportion to the concentration of drug in the sample. Sample drug content is determined relative to the value obtained for a known cutoff concentration of drug.(Package insert: AMPS2. Roche Diagnostics; 06/2020)
The specimen is then diluted and then analyzed by liquid chromatography tandem mass spectrometry.(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 Friday
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.
80325
80359
G0480 (if appropriate)
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 |
|---|---|---|
| AMPHX | Amphetamines Confirmation, CoC, U | 97161-4 |
| 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.
|
|---|---|---|
| 6538 | Amphetamines Immunoassay Screen | 19261-7 |
| 36128 | Amphetamine-by LC-MS/MS | 20410-7 |
| 36129 | Phentermine-by LC-MS/MS | 20557-5 |
| 36130 | Methamphetamine-by LC-MS/MS | 16235-4 |
| 36131 | Pseudoephedrine/Ephedrine-by LC-MS/MS | 58707-1 |
| 36132 | MDA (Ecstasy metabolite)-by LC-MS/MS | 20545-0 |
| 36133 | MDMA (Ecstasy)-by LC-MS/MS | 18358-2 |
| 36134 | Amphetamines Interpretation | 69050-3 |
| 36135 | Chain of Custody | 77202-0 |