Identifying amphetamines (and methamphetamines), opiates, as well as metabolites of cocaine and marijuana in meconium specimens
Test Id | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
AMPHM | Amphetamines, Confirmation, M | Yes | No |
COKEM | Cocaine and Metabolites, Confirm, M | Yes | No |
OPATM | Opiate Confirmation, M | Yes | No |
THCM | Carboxy-THC Confirmation, M | Yes | No |
Testing begins with immunoassay screen. Positives are confirmed and quantified by liquid chromatography tandem mass spectrometry at an additional charge.
Enzyme-Linked Immunosorbent Assay (ELISA)
"J" (Jane) (Tetrahydrocannabinol)
Amphetamines
Benzoylecgonine (Cocaine Metabolite)
Cannabinoids (Tetrahydrocannabinol)
Cocaine
Coke (Cocaine)
Crack (Cocaine)
Desoxyn (Methamphetamines)
Drugs of Abuse
Heroin (as Morphine)
Jane (Tetrahydrocannabinol)
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
Speed (Amphetamines)
Tetrahydrocannabinol (THC)
THC (Tetrahydrocannabinol)
Testing begins with immunoassay screen. Positives are confirmed and quantified by liquid chromatography tandem mass spectrometry at an additional charge.
Meconium
For chain-of-custody testing, order DSM4X / Drugs of Abuse Screen 4, Chain of Custody, Meconium.
Supplies: Stool container, Small (Random), 4 oz (T288)
Container/Tube: Stool container
Specimen Volume: 1 g (approximately 1 teaspoon)
Collection Instructions: Collect entire random meconium specimen.
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.
0.45 g (approximately 0.5 teaspoon)
Grossly bloody | Reject, Pink OK |
Stool Diapers | Reject |
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Meconium | Frozen (preferred) | 14 days | |
Refrigerated | 24 hours |
Identifying amphetamines (and methamphetamines), opiates, as well as metabolites of cocaine and marijuana in meconium specimens
Testing begins with immunoassay screen. Positives are confirmed and quantified by liquid chromatography tandem mass spectrometry at an additional charge.
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 tenth to twelfth week of gestation and slowly moves into the colon by the sixteenth week of gestation.(3) Therefore, the presence of drugs in meconium has been proposed to be indicative of in utero drug exposure during the final 4 to 5 months of pregnancy, a longer historical measure than is possible by urinalysis.(2)
Negative
Positives are reported with a quantitative liquid chromatography tandem mass spectrometry result.
Cutoff concentrations by enzyme-linked immunosorbent assay:
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
A positive result indicates that the baby was exposed to the drugs indicated.
No significant cautionary statements
1. Ostrea EM Jr: Understanding drug testing in the neonate and the role of meconium analysis. J Perinat Neonatal Nurs 2001 Mar;14(4):61-82; quiz 105-106
2. Ostrea EM Jr, Brady MJ, Parks PM, et al: Drug screening of meconium in infants of drug-dependent mothers: an alternative to urine testing. J Pediatr 1989 Sep;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 Jan;60(1):45-56; quiz 73-74
4. Langman LJ Bechtel LK, Meier BM, Holstege C: Clinical toxicology. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:832-887
Meconium specimen is homogenized in a buffer. The homogenate is analyzed by enzyme-linked immunosorbent assay (ELISA) to detect the presence of drug. If drug presence is indicated by a positive result of ELISA, liquid chromatography tandem mass spectrometry analysis is performed to verify the presence of the drug.(Unpublished Mayo method)
Monday through Saturday
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
80307
See individual reflex tests for appropriate CPT codes
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
DASM4 | Drugs of Abuse Screen, Meconium 4 | 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.
|
---|---|---|
32078 | Amphetamine | 26895-3 |
32080 | Methamphetamine | 27289-8 |
32082 | Cocaine | 26956-3 |
32084 | Opiate | 29158-3 |
32086 | Tetrahydrocannabinol | 26893-8 |
32087 | Chain of Custody | 77202-0 |