Interpretation Guide: Broad Spectrum Urine Toxicology …

1 Interpretation guide : Broad Spectrum Urine Toxicology Screen January 2016 The Broad Spectrum Urine Toxicology Screen provided by Dynacare incorporates liquid chromatography and tandem mass spectrometry (LC-MS/MS) for the targeted identification of sixty three (63) different drugs, drug metabolites and preparation ingredients. All Urine specimens undergo enzymatic hydrolysis prior to testing, to yield additional free/unconjugated drug and thereby improve detection. We note that the ability to detect any drug or metabolite in Urine is dependent on many factors, including: the dose ingested the analytical method used the positive/negative cut off concentration selected the individual s metabolic variability - genetic factors, age, gender, etc. the individual s physical condition most notably kidney and liver disease the amount of fluid ingested the method and frequency of dosing the time the drug was ingested relative to the time the Urine sample was collected Dynacare Broad Spectrum Urine Toxicology screen is targeted for the specific drug, drug metabolite and preparation ingredients listed below.

2 It will not identify every licit and/or illicit drug that might be in a Urine sample. If the drug of interest is not listed in the table below it will not be detected by this screen, at this time. If a listed analyte was detected in the Urine and its concentration exceeded its defined positive/negative cut-off concentration, the specimen will be reported positive for that specific analyte. A positive result indicates that the analyte is present in the patient s Urine at a minimum concentration above its defined screening threshold. A positive result does not indicate the analytes route of administration, ingested dose, concentration in the Urine or the patient s level of intoxication. A negative result may not necessarily mean that the Urine is drug free. Negative results can obtained when the drug is present in the Urine , but at a concentration that is below the positive/negative cut-off threshold.

3 Negative results may also be obtained if the specific analyte of interest is not included in Dynacare Broad Spectrum Urine Toxicology screen. We suggest you review the Ontario Association of Medical Laboratories (OAML) guideline entitled Guidelines for Ordering Urine Testing for Drugs of Abuse: Targeted and Screening Tests (CLP013) , found at Contact Dynacare if additional information is required. Interpretation guide : Broad Spectrum Urine Toxicology Screen Drug, Drug Metabolite or Preparation Ingredient Common Trade Names Interpretive Notes Positive/ Negative Cut-off (ng/mL) Urine Detection Time Anesthetic Ketamine Ketalar Ketamine detected after use 100 ng/mL Anticonvulsant Gabapentin Neurontin Gabapentin detected after use 500 ng/mL Antidepressants Bupropion Wellbutrin, Zyban Bupropion detected after use 250 ng/mL mCPP Trazodone metabolite; designer drug 250 ng/mL Benzodiazepines Alprazolam Apo-Alpraz, Xanax Metabolized to alpha-hydroxyalprazolam; both may be detected after use 100 ng/mL 2-4 days -hydroxyalprazolam Alprazolam metabolite 100 ng/mL Clonazepam Clonapam Metabolized to 7-aminoclonazepam.

4 Metabolite primarily detected after use 100 ng/mL 2-4 days 7-Aminoclonazepam Clonazepam metabolite 100 ng/mL Diazepam Diastat, Diazemuls, Valium Metabolized to nordiazepam, temazepam and oxazepam; all may be detected after use 100 ng/mL 2-7 days Nordiazepam Diazepam metabolite 100 ng/mL Flunitrazepam Rohypnol Metabolized to 7-aminoflunitrazepam; metabolite primarily detected after use 100 ng/mL 1-4 days 7-Aminoflunitrazepam Flunitrazepam metabolite 100 ng/mL Flurazepam Dalmane, SOM-PAM Metabolized to desalkylflurazepam; metabolite primarily detected after use 100 ng/mL 1-2 days Desalkylflurazepam Flurazepam metabolite 100 ng/mL Lorazepam Ativan Lorazepam detected after use 100 ng/mL 5-7 days Nitrazepam Mogadon Metabolized to 7-aminonitrazepam; both may be detected after use 100 ng/mL 1-4 days 7-Aminonitrazepam Nitrazepam metabolite 100 ng/mL Oxazepam Novoxapam, Oxpam Oxazepam detected after use; nordiazepam and temazepam metabolite 100 ng/mL 2-7 days Phenazepam Phenazepam detected after use 100 ng/mL Interpretation guide : Broad Spectrum Urine Toxicology Screen Drug, Drug Metabolite or Preparation Ingredient Common Trade Names Interpretive Notes Positive/ Negative Cut-off Urine Detection Time Temazepam Restoril Metabolized to oxazepam; both may be detect after use.

5 Diazepam metabolite 100 ng/mL 1-4 days Triazolam Triazolam detected after use 100 ng/mL Cannabinoids THCA Cannabinoid metabolite 40 ng/mL 1-45 days JWH-200 Synthetic Cannabinoid 40 ng/mL JWH-018 Synthetic Cannabinoid 20 ng/mL Opioids and Related Drug Preparation Ingredients Buprenorphine Buprenorphine/ Naloxone, Butrans, Suboxone Metabolized to norbuprenorphine; both may be detected after use; Suboxone and Buprenorphine/Naloxone preparations also include naloxone 15 ng/mL Norbuprenorphine Buprenorphine metabolite 15 ng/mL Codeine Tylenol with Codeine No. 2, No. 3 and No. 4; included in many other preparations Metabolized to norcodeine, morphine and hydrocodone; all may be detected after use 100 ng/mL 2-3 days Norcodeine Codeine metabolite 100 ng/mL Fentanyl Abstral, Duragesic Mat, Fentanyl Patch Metabolized to norfentanyl; both may be detected after use 25 ng/mL 1-3 days Norfentanyl Fentanyl metabolite 25 ng/mL Heroin Metabolized to 6-acetylmorphine, metabolite primarily detected after use 6-Acetylmorphine Heroin metabolite 10 ng/mL <1 day Hydrocodone Hydrocan, Novahistex DH, Novahistine DH, Tussionex Metabolized to norhydrocodone, dihydrocodeine and hydromorphone; all may be detected after use.

6 Codeine metabolite 100 ng/mL 2-3 days Norhydrocodone Hydrocodone metabolite 100 ng/mL Dihydrocodeine Hydrocodone metabolite 100 ng/mL Hydromorphone Dilaudid, Hydromorph Contin, Jurnista Hydromorphone detected after use; hydrocodone and morphine metabolite 100 ng/mL 2-3 days Interpretation guide : Broad Spectrum Urine Toxicology Screen Drug, Drug Metabolite or Preparation Ingredient Common Trade Names Interpretive Notes Positive/ Negative Cut-off Urine Detection Time Morphine Kadian Capsules, MS Contin, MS IR Tab, Statex; included in many other preparations Metabolized to hydromorphone; both may be detect after use; 6AM and codeine metabolite 100 ng/mL 2-3 days Naloxone Included in Targin preparations of oxycodone; Included in Suboxone preparations of buprenorphine Naloxone detected after use 15 ng/mL Naltrexone Relistor, Revia Naltrexone detected after use 100 ng/mL Meperidine Demerol Metabolized to normeperidine; both may be detected after use 200 ng/mL 1-2 days Normeperidine Meperidine metabolite 200 ng/mL Methadone Metadol, Methadose Metabolized to EDDP; both may be detected after use 100 ng/mL 1-14 days EDDP Methadone metabolite 100 ng/mL Oxycodone Endocet, , Oxyneo, Percocet, Rivacocet, Supeudol, Targin Metabolized to noroxycodone; both may be detected after use; Targin preparations also included naloxone 100 ng/mL 2-3 days Noroxycodone Oxycodone metabolite 100 ng/mL Stimulants and Related Drug Preparation Ingredients Amphetamine Adderall, Dexedrine Amphetamine detected after use.

7 Methamphetamine metabolite 250 ng/mL 3-5 days Methamphetamine Metabolized to amphetamine; both may be detected after use 250 ng/mL 3-5 days MDEA Metabolized to MDA; both may be detected after use 250 ng/mL MDMA Ecstasy; metabolized to MDA; both may be detected after use 250 ng/mL MDA MDEA and MDMA metabolite 250 ng/mL Interpretation guide : Broad Spectrum Urine Toxicology Screen Drug, Drug Metabolite or Preparation Ingredient Common Trade Names Interpretive Notes Positive/ Negative Cut-off Urine Detection Time Cocaine Metabolized to benzoylecgonine, norcocaine and cocaethylene; all may be detected after use; cocaine is often cut with levamisole which may also be detected after use 100 ng/mL < 1 day Benzoylecgonine Cocaine metabolite 100 ng/mL 1-2 days Norcocaine Cocaine metabolite 100 ng/mL Cocaethylene Cocaine metabolite; formed when cocaine is used with alcohol 100 ng/mL Levamisole Cutting agent mixed with cocaine; 10 ng/mL 1-2 days Benzylpiperazine Synthetic stimulant; designer drug 250 ng/mL MDPV Synthetic amphetamine; designer drug sometimes referred to as a bath salt 250 ng/mL Mephedrone Synthetic amphetamine; designer drug sometimes referred to as a bath salt 250 ng/mL Methylphenidate Biphentin, Concerta, Ritalin Metabolized to ritalinic acid.

8 Both may be detected after use 100 ng/mL <1 day Ritalinic Acid Methylphenidate metabolite 500 ng/mL Diphenhydramine Included in many cold, sinus and flu preparations and over-the-counter products Diphenhydramine detected after use 100 ng/mL Ephedrine/ Pseudoephedrine Included in many cold, sinus and flu preparations and over-the-counter products Ephedrine/Pseudoephedrine detected after use 500 ng/mL Cotinine Nicotine metabolite 300 ng/mL 1-7 days Acronyms: EDDP, 2 ethylidene 1,5 dimethyl 2,2 diphenylpyrrolidine; mCPP, 1 (3 chlorophenyl)piperazine; MDA, methylenedioxyamphetamine; MDEA, methylenedioxyethylamphetamine; MDMA, methylenedioxymethamphetamine; MDPV, 3,4 methylenedioxypyrovalerone; THCA, 11 nor 9 carboxy 9 tetrahydrocannabinol. The listed Urine detection times are approximations. The actual detection time depends upon the drug dose, its frequency of use and individual patient metabolism.

9 If cell is left blank, Urine detection times are unknown.