Test Catalog

Test Id : CSMTU

Controlled Substance Monitoring Targeted Profile, 17 Drug Classes, Mass Spectrometry, Random, Urine

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

Detecting drug use involving stimulants, benzodiazepines, and opioids

 

This test is not intended for use in employment-related testing.

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
LPCM List Patient's Current Medications No Yes
ADULT Adulterants Survey, U Yes Yes
TOPSU Targeted Opioid Screen, U Yes, (order TOSU) Yes
TABSU Targeted Benzodiazepine Screen, U Yes, (order TBSU) Yes
TSTIM Targeted Stimulant Screen, U Yes, (order TSPU) Yes

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Testing begins with an adulterant survey. If the sample is found to be adulterated, testing will end, and the remaining tests will be canceled.

 

If the specimen is normal or only diluted, testing will proceed.

Method Name
A short description of the method used to perform the test

ADULT: Spectrophotometry (SP)

TOPSU, TABSU, TSTIM: 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.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

CSM Targeted Drug Profile,17,HRMS,U

Aliases
Lists additional common names for a test, as an aid in searching

6-monoacetylmorphine (heroin metabolite)

7-Amino Flunitrazepam (Metabolite of Flunitrazepam (Rohypnol)

7-Aminoclonazepam

Adderall (Amphetamine)

ADHD

Adipex-P (Phentermine)

Adzenys ER (Amphetamine)

Alprazolam (Xanax)

Amobarbital (Amytal)

Amphetamines

Amytal (Amobarbital)

Angel Dust (Phencyclidine)

Ativan (Lorazepam)

Benzodiazepines

Benzoylecgonine (Cocaine Metabolite)

Buprenorphine (Buprenex, Suboxone)

Chlordiazepoxide (Librium)

Clonazepam

Clorazepate (Tranxene)

Codeine

Codeine (Tylenol #3)

Codeine-6-beta-glucuronide (codeine metabolite)

Compliance monitoring

Concerta (Methylphenidate)

Dalmane (Flurazepam)

Date Rape Drug (Rohypnol [Flunitrazepam])

Desalkyl Flurazepam (Metabolite)

Desoxyn (Methamphetamine)

Dexedrine (Amphetamine)

Diazepam (Valium)

Dihydrocodeine(hydrocodone metabolite)

Drug Screen

Drugs of Abuse

Dyanavel XR (Amphetamine)

Ecstasy

EDDP (Methadone metabolite)

Fentanyl (Actiq, Duragesic, Fentora)

Flunitrazepam (Rohypnol)

Flurazepam (Dalmane)

Halcion (Triazolam)

Heroin

Hydrocodone (Lortab, Norco, Vicodin)

Hydromorphone (Dilaudid, Exalgo)

Hydromorphone-3-beta-glucuronide (hydromorphone metabolite)

Hydroxy-Ethyl Flurazepam (Metabolite of Flurazepam) (Dalmane)

Killer Weed (Phencyclidine)

Librium (Chlordiazepoxide)

Lomaira (Phentermine)

Lorazepam (Ativan)

MDA (Methylenedioxyamphetamine) Metabolite for Methylenedioxyethylamphetamine (MDEA) and Methylenedioxymethamphetamine (MDMA)

MDMA (Methylenedioxymethamphetamine)

Meperidine (Demerol)

Methadone (Dolophine)

Methadone metabolite (EDDP)

Methamphetamines (Desoxyn)

Methylenedioxyamphetamine (MDA) Metabolite for Methylenedioxyethylamphetamine (MDEA) and Methylenedioxymethamphetamine (MDMA)

Methylenedioxymethamphetamine (MDMA)

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)

Nordiazepam (Tranxene)

Norfentanyl (fentanyl metabolite)

Norhydrocodone (hydrocodone metabolite)

Normeperidine (Meperidine metabolite)

Noroxycodone (oxycodone metabolite)

Noroxymorphone (Oxymorphone metabolite)

Norpropoxyphene (propoxyphene metabolite)

O-desmethyltramadol (Tramadol metabolite)

Opiates

Opioid

Oxazepam (Serax)

Oxycodone (Endocet, Percocet, Oxycontin)

Oxymorphone (Numorphan, Opana)

Oxymorphone-3-beta-glucuronide (Oxymorphone metabolite)

Pain Management

PCP (Phencyclidine)

Phencyclidine (PCP)

Propoxyphene (Darvon, Darvocet)

Qsymia (Phentermine)

Restoril (Temazepam)

Ritalin (Methylphenidate)

Rocket Fuel (Phencyclidine)

Rohypnol (Flunitrazepam)

Serax (Oxazepam)

Speed (Amphetamines)

Sudafed (Pseudoephedrine)

Super Weed

Tapendtadol-beta-glucuronide (Tapentadol metabolite)

Tapentadol (Nucynta)

TCP (Phencyclidine)

Temazepam (Restoril)

Toxicology Screen, Drugs

Tramadol (Tradol, Ultram, Ultracet)

Tranxene (Clorazepate)

Triazolam (Halcion)

UDS

Valium (Diazepam)

Vicodin (Hydrocodone)

Vyvanse (Amphetamine)

Xanax (Alprazolam)

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Testing begins with an adulterant survey. If the sample is found to be adulterated, testing will end, and the remaining tests will be canceled.

 

If the specimen is normal or only diluted, testing will proceed.

Specimen Type
Describes the specimen type validated for testing

Urine

Ordering Guidance

This test does not screen for drug classes other than those listed above.

ORDER QUESTIONS AND ANSWERS

Question ID Description Answers
LPCM List patient's current medications

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Supplies: Urine Tubes, 10 mL (T068)

Collection Container/Tube: Plastic urine container

Submission Container/Tube: Plastic, 10 mL tube

Specimen Volume: 5 mL

Collection Instructions:

1. Collect a random urine specimen.

2. Submit 5 mL in 1 plastic bottle.

3. No preservative

Additional Information:

1. No specimen substitutions.

2. Submitting less than 5 mL may compromise the ability to perform all necessary testing.

3. STAT requests are not accepted for this procedure.

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

2 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

  All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

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
Frozen 14 days

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

Detecting drug use involving stimulants, benzodiazepines, and opioids

 

This test is not intended for use in employment-related testing.

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Testing begins with an adulterant survey. If the sample is found to be adulterated, testing will end, and the remaining tests will be canceled.

 

If the specimen is normal or only diluted, testing will proceed.

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

The targeted opioid, benzodiazepine, and stimulant screen portions are performed by liquid chromatography-tandem mass spectrometry, high-resolution accurate mass (LC-MS/MS HRAM) and are completed for all opioids, benzodiazepines, and stimulants. 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 (eg, methadone).

 

Benzodiazepines represent a large family of medications used to treat a wide range of disorders from anxiety to seizures and are also used in pain management. With a high risk for abuse and diversion, professional practice guidelines recommend compliance monitoring for these medications using urine drug tests. However, traditional benzodiazepine immunoassays suffer from a lack of cross-reactivity with all the benzodiazepines, so many compliant patients taking clonazepam (Klonopin) or lorazepam (Ativan) may screen negative by immunoassay but are positive when confirmatory testing is done. The new targeted benzodiazepine screening test provides a more sensitive and specific test to check for compliance to all the commonly prescribed benzodiazepines and looks for both parent and metabolites in the urine.

 

Stimulants are sympathomimetic amines that stimulate the central nervous system activity and, in part, suppress the appetite. Amphetamine and methamphetamine are also prescription drugs used in the treatment of narcolepsy and attention-deficit disorder/attention-deficit hyperactivity disorder (ADHD). Methylphenidate is another stimulant used to treat ADHD. Phentermine is indicated for the management of obesity. All of the other amphetamines (eg, methylenedioxymethamphetamine: MDMA) are Drug Enforcement Administration (DEA) scheduled Class I compounds. Due to 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.

 

This test is intended to be used in a setting where the test results can be used to make a definitive diagnosis.

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.

ADULTERANT SURVEY:

Cutoff concentrations

Oxidants: 200 mg/L

Nitrites: 500 mg/L

 

TARGETED OPIOID SCREEN:

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

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

 

TARGETED BENZODIAZEPINE SCREEN:

Not Detected

 

Cutoff concentrations:

Alprazolam: 10 ng/mL

Alpha-hydroxyalprazolam: 10 ng/mL

Alpha-hydroxyalprazolam glucuronide: 50 ng/mL

Chlordiazepoxide: 10 ng/mL

Clobazam: 10 ng/mL

N-desmethylclobazam: 200 ng/mL

Clonazepam: 10 ng/mL

7-Aminoclonazepam: 10 ng/mL

Diazepam: 10 ng/mL

Nordiazepam: 10 ng/mL

Flunitrazepam: 10 ng/mL

7-Aminoflunitrazepam: 10 ng/mL

Flurazepam: 10 ng/mL

2-Hydroxy ethyl flurazepam: 10 ng/mL

Lorazepam: 10 ng/mL

Lorazepam glucuronide: 50 ng/mL

Midazolam: 10 ng/mL

Alpha-hydroxy midazolam: 10 ng/mL

Oxazepam: 10 ng/mL

Oxazepam glucuronide: 50 ng/mL

Prazepam: 10 ng/mL

Temazepam: 10 ng/mL

Temazepam glucuronide: 50 ng/mL

Triazolam: 10 ng/mL

Alpha-hydroxy triazolam: 10 ng/mL

Zolpidem: 10 ng/mL

Zolpidem phenyl-4-carboxylic acid: 10 ng/mL

 

TARGETED STIMULANT SCREEN:

Not Detected

 

Cutoff concentrations:

Methamphetamine: 100 ng/mL

Amphetamine: 100 ng/mL

3,4-Methylenedioxymethamphetamine (MDMA): 100 ng/mL

3,4-Methylenedioxy-N-ethylamphetamine (MDEA): 100 ng/mL

3,4-Methylenedioxyamphetamine (MDA): 100 ng/mL

Ephedrine: 100 ng/mL

Pseudoephedrine: 100 ng/mL

Phentermine: 100 ng/mL

Phencyclidine (PCP): 20 ng/mL

Methylphenidate: 20 ng/mL

Ritalinic acid: 100 ng/mL

Interpretation
Provides information to assist in interpretation of the test results

For information about drug testing, including estimated detection times, see Specific Drug Groups.

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. Physicians' Desk Reference: 60th ed. Medical Economics Company; 2006

2. Bruntman LL Lazo JS, Parker KL, eds: Goodman and Gilman's: The Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill Book Company; 2006

3. Langman LJ, Bechtel L, Meier BM, Holstege CP: Clinical toxicology In: Rifai N, Horwath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:832-887

4. 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 Companies; 2006:chap 21

5. Chronic Pain in America: Roadblocks to Relief, survey conducted for the American Pain Society, The American Academy of the Pain Medicine and Janssen Pharmaceutical; 1999

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

7. 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 Jan 1;2(4):489-526

8. McMillin GA, Marin SJ, Johnson-Davis KL, Lawlor BG, Strathmann FG: A hybrid approach to urine drug testing using high-resolution mass spectrometry and select immunoassays. Am J Clin Pathol. 2015 Feb;143(2):234-240

9. Cone EJ, Caplan YH, Black DL, Robert T, Moser F: Urine drug testing of chronic pain patients: licit and illicit drug patterns. J Anal Toxicol. 2008 Oct;32(8):530-543

Method Description
Describes how the test is performed and provides a method-specific reference

Adulterant:

All results are measured using spectrophotometry at wavelengths specified by the reagent manufacturer. The use of a refractometer may also be used in the specific gravity measurement.(Package insert: Creatinine plus ver 2, Specimen Validity Test Nitrite, Specimen Validity Test Oxidant, Specimen Validity Test pH, Specimen Validity Test Specific Gravity. Roche Diagnostics; 12/2016)

 

Targeted Screening Panels for opioids, benzodiazepines, and stimulants:

The urine sample is diluted with internal standard and clinical laboratory reagent water 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

No

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.

3 to 4 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

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 Regional Manager. 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. This test 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.

80347

80364

80326

G0482 (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
CSMTU CSM Targeted Drug Profile,17,HRMS,U In Process
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.
20606 Creatinine, U 2161-8
22312 Specific Gravity 5810-7
23509 pH 2756-5
23511 Oxidants 58714-7
23510 Nitrites 32710-6
30914 Comment 48767-8
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
604871 Alprazolam 94116-1
604867 Alpha-Hydroxyalprazolam 19325-0
604891 Alpha-Hydroxyalprazolam Glucuronide 94115-3
604872 Chlordiazepoxide 19385-4
604889 Clobazam 94114-6
604890 N-Desmethylclobazam 94113-8
604873 Clonazepam 19399-5
604267 7-aminoclonazepam 94112-0
604874 Diazepam 19443-1
604880 Nordiazepam 19624-6
604875 Flunitrazepam 19466-2
604866 7-aminoflunitrazepam 94111-2
604876 Flurazepam 19474-6
604868 2-Hydroxy Ethyl Flurazepam 94110-4
604877 Lorazepam 19520-6
604878 Lorazepam Glucuronide 94109-6
604879 Midazolam 19585-9
604869 Alpha-Hydroxy Midazolam 94108-8
604881 Oxazepam 19638-6
604882 Oxazepam Glucuronide 94107-0
604883 Prazepam 19678-2
604884 Temazepam 19698-0
604885 Temazepam Glucuronide 94106-2
604886 Triazolam 19714-5
604870 Alpha-Hydroxy Triazolam 94105-4
604887 Zolpidem 94104-7
604888 Zolpidem Phenyl-4-Carboxylic acid 94103-9
604949 Benzodiazepine Interpretation 69050-3
LPCM List Patient's Current Medications 66423-5
610273 Methamphetamine 19554-5
610274 Amphetamine 19343-3
610275 3,4-methylenedioxymethamphetamine (MDMA) 19568-5
610276 3,4-methylenedioxy-N-ethylamphetamine (MDEA) 59844-1
610277 3,4-methylenedioxyamphetamine (MDA) 19565-1
610278 Ephedrine 99108-3
610279 Pseudoephedrine 99109-1
610280 Phentermine 19674-1
610281 Phencyclidine (PCP) 19659-2
610282 Methylphenidate 19577-6
610283 Ritalinic acid 99110-9
610284 Stimulant Interpretation 54247-2

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports