Test Id : DSM4X
Drugs of Abuse Screen 4, Chain of Custody, Meconium
Useful For
Suggests clinical disorders or settings where the test may be helpful
Identifying amphetamines (and methamphetamines) and opiates, as well as metabolites of cocaine and marijuana in meconium specimen
Chain of custody is required whenever 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. Since the evidence of illicit drug use during pregnancy can be cause for separating the baby from the mother, a complete chain of custody ensures that the test results are appropriate for legal proceedings.
Reflex Tests
Lists tests that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial tests.
| Test Id | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| COKMX | Cocaine and metabolite Conf, CoC, M | Yes | No |
| OPTMX | Opiate Confirmation, CoC, M | Yes | No |
| THCMX | Carboxy-THC Confirmation, CoC, M | Yes | No |
| AMPMX | Amphetamines Confirmation, CoC, M | Yes | No |
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 |
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
Testing begins with immunoassay screen. Positive results are confirmed and quantitated by liquid chromatography tandem mass spectrometry at an additional charge.
Method Name
A short description of the method used to perform the test
Competitive Chemiluminescent Immunoassay (CIA)
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
"J" (Jane) (Tetrahydrocannabinol)
Amphetamines
Benzoylecgonine (Cocaine Metabolite)
Cannabinoids (Tetrahydrocannabinol)
Cocaine
Codeine
Coke (Cocaine)
Crack (Cocaine)
Desoxyn (Methamphetamines)
Dilaudid (Hydromorphone)
Drugs of Abuse
Heroin (as Morphine)
Hycodan (Hydrocodone)
Hydrocodone (Hycodan, Vicodin)
Hydromorphone (Dilaudid, Vicodin)
Jane (Tetrahydrocannabinol)
Lortab (Hydromorphone)
Marijuana (Tetrahydrocannabinol)
Mary Jane (Tetrahydrocannabinol)
MDA (Methylenedioxyamphetamine) Metabolite for Methylenedioxyethylamphetamine (MDEA) and Methylenedioxymethamphetamine (MDMA)
MDMA (Methylenedioxymethamphetamine)
Meconium Drug Screen
Methamphetamines (Desoxyn)
Methylenedioxyamphetamine (MDA) Metabolite for Methylenedioxyethylamphetamine (MDEA) and Methylenedioxymethamphetamine (MDMA)
Methylenedioxymethamphetamine (MDMA)
Morphine
Opiates
Oxycodone (OxyContin, Percodan)
OxyContin (Oxycodone)
Oxycotin
Percodan (Oxycodone)
Speed (Amphetamines)
Tetrahydrocannabinol (THC)
THC (Tetrahydrocannabinol)
Vicodin (Hydrocodone)
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
Testing begins with immunoassay screen. Positive results are confirmed and quantitated by liquid chromatography tandem mass spectrometry at an additional charge.
Specimen Type
Describes the specimen type validated for testing
Meconium
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Container/Tube: Chain of Custody Meconium Kit (T653) includes the specimen containers, seals, and documentation required.
Specimen Volume: 1 g (approximately 1 teaspoon)
Collection Instructions: Collect entire random meconium specimen.
Additional Information:
1. Specimen that arrives with a broken seal does not meet the chain-of-custody requirements.
2. The laboratory recommends sending chain-of-custody specimens by overnight shipment.
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.
0.45 g (approximately 0.5 teaspoon)
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Grossly bloody | Reject, Pink OK |
| Stool Diapers | 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 |
|---|---|---|---|
| Meconium | Frozen (preferred) | 21 days | |
| Ambient | 72 hours | ||
| Refrigerated | 21 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Identifying amphetamines (and methamphetamines) and opiates, as well as metabolites of cocaine and marijuana in meconium specimen
Chain of custody is required whenever 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. Since the evidence of illicit drug use during pregnancy can be cause for separating the baby from the mother, a complete chain of custody ensures that the test results are appropriate for legal proceedings.
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
Testing begins with immunoassay screen. Positive results are confirmed and quantitated by liquid chromatography tandem mass spectrometry at an additional charge.
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Illicit drug use during pregnancy is a major social and medical issue. Drug abuse during pregnancy is associated with significant perinatal complications, which include a high incidence of stillbirths, meconium-stained fluid, premature rupture of the membranes, maternal hemorrhage (abruption placenta or placenta praevia), and fetal distress.(1) In the neonate, the mortality rate, as well as morbidity (eg, asphyxia, prematurity, low birthweight, hyaline membrane distress, infections, aspiration pneumonia, cerebral infarction, abnormal heart rate and breathing problems, and drug withdrawal) are increased.(1)
The disposition of drug in meconium is not well understood. The proposed mechanism is that the fetus excretes drug into bile and amniotic fluid. Drug accumulates in meconium either by direct deposit from bile or through swallowing of amniotic fluid.(2) The first evidence of meconium in the fetal intestine appears at approximately the 10th to 12th week of gestation and slowly moves into the colon by the 16th week of gestation.(3) Therefore, the presence of drugs in meconium has been proposed to be indicative of in utero drug exposure up to 5 months before birth, a longer historical measure than is possible by urinalysis.(2)
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 liquid chromatography tandem mass spectrometry result.
Cutoff concentrations by competitive chemiluminescent immunoassay:
Amphetamines: 100 ng/g
Methamphetamine: 100 ng/g
Benzoylecgonine (cocaine metabolite): 100 ng/g
Opiates: 100 ng/g
Tetrahydrocannabinol carboxylic acid (marijuana metabolite): 20 ng/g
Interpretation
Provides information to assist in interpretation of the test results
A positive result indicates that the baby was exposed to the drugs indicated.
The limit of quantitation varies for each of these drug groups.
-Amphetamines: >100 ng/g
-Methamphetamines: >100 ng/g
-Cocaine and metabolite: >100 ng/g
-Opiates: >100 ng/g
-Tetrahydrocannabinol carboxylic acid: >20 ng/g
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
If heroin use is suspected, specimen must be sent frozen to prevent loss of 6-monoacetylmorphine (6MAM, heroin metabolite). When refrigerated, a significant percentage of 6MAM will convert to morphine in fewer than 24 hours.
Unless sent frozen, the cocaine metabolite, m-hydroxybenzoylecgonine, will degrade within 72 hours of collection.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Ostrea EM Jr. Understanding drug testing in the neonate and the role of meconium analysis. J Perinat Neonatal Nurs. 2001;14(4):61-82; quiz 105-106
2. Ostrea EM Jr, Brady MJ, Parks PM, Asensio DC, Naluz A. Drug screening of meconium in infants of drug-dependent mothers: an alternative to urine testing. J Pediatr. 1989;115(3):474-477
3. Ahanya SN, Lakshmanan J, Morgan BL, Ross MG. Meconium passage in utero mechanisms, consequences, and management. Obstet Gynecol Surv. 2005;60(1):45-56; quiz 73-74
4. Langman LJ, Bechtel LK, Holstege CP. Clinical toxicology. In: Rifai N, Chiu RWK, Young I, Burnham C-AD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:454-454: chap 43
5. Langman LJ, Rushton AM, Thomas D, et al. Drug testing in support of the diagnosis of neonatal abstinence syndrome: The current situation. Clin Biochem. 2023;111:1-10. doi:10.1016/j.clinbiochem.2022.11.002
6. Marin SJ, Merrell M, McMillin GA. Drugs of abuse detection in meconium: a comparison between ELISA and biochip microarray. J Anal Toxicol. 2011;35(1):40-45. doi:10.1093/anatox/35.1.40
7. Baselt RC. Disposition of Toxic Drugs and Chemical in Man. 12th ed. Biomedical Publications; 2020
Method Description
Describes how the test is performed and provides a method-specific reference
The meconium sample received is screened by competitive chemiluminescent immunoassay by Randox Evidence+ to detect the presence of any of the drugs or drugs that cross react with amphetamine, methamphetamine, cocaine metabolite, opiates, and carboxy-tetrahydrocannabinol. Meconium specimens identified as positive by this screen are analyzed using liquid chromatography tandem mass spectroscopy for the specific drug or drug class indicated.(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 Saturday
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.
80307
80324 (if appropriate)
80359 (if appropriate)
80353 (if appropriate)
80361 (if appropriate)
80365 (if appropriate)
80349 (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 |
|---|---|---|
| DSM4X | Drugs of Abuse Screen 4, CoC, M | 49046-6 |
| 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.
|
|---|---|---|
| 36172 | Amphetamine | 26895-3 |
| 36173 | Methamphetamine | 27289-8 |
| 36174 | Cocaine | 26956-3 |
| 36175 | Opiate | 29158-3 |
| 36176 | Tetrahydrocannabinol | 26893-8 |
| 36177 | Chain of Custody | 77202-0 |