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Urine toxicology screen
From WikEM
Contents
Background
- Urine drug screen (UDS / UTOX) is typically ordered in trauma, psych, and altered mental status patients where there results can assist inpatient management.
- Cooperative psych patients do not require Utox as part of the ED screen[1] (unless local policy dictates)
- Routine testing of activated traumas is reasonable, but discretionary testing of nonactivated traumas should be adopted[2]
- Unlikely to have any significant impact on the management of ED patients[3]
- Drug testing alone never significantly better than history[4]
Detection Interval[5]
| Screen | Interval (Prolonged Use) |
|---|---|
| Amphetamines | 1-2 d (2-4 d) |
| Barbiturates | 2-4 d |
| Benzodiazepines | 1-30 d |
| Cannabinoids | 1-3 d (>1 mo) |
| Cocaine | 2 d (1 wk) |
| Opiates | 1-4 d (<1 wk) |
| Phencyclidine | 4-7 d (>1 mo) |
Cross Reactivity
Many non-illicit drugs cross react with common drugs screened on the traditional urine drug screen [6][7]
| Screen | Drugs |
|---|---|
| Amphetamines | Amantadine, bupropion, chlorpromazine, desipramine. fluoxetine, L-methamphetamine, labetalol, methylphenidate, phentermine, phenylephrine, phenylpropanolamine, promethazine, pseudoephedrine, ranitidine, thioridazine, trazodone |
| Benzodiazepines | Oxaprozin, sertraline |
| Cannabinoids | Dronabinol, nonsteroidal anti-inflammatory drugs, proton pump inhibitors |
| Cocaine | Topical anesthetics containing cocaine |
| Opiates | Dextromethorphan, diphenhydramine, fluoroquinolones, poppy seeds, quinine, rifampin, verapamil |
| Phencyclidine | Dextromethorphan, diphenhydramine, ibuprofen, imipramine, ketamine, meperidine, thioridazine, tramadol, venlafaxine |
True Positives and False Negatives
- Most benzodiazepine screens look for oxazepam which is a metabolite of diazepam and chlordiazepoxide. Therefore, lorazepam, alprazolam, and clonazepam are commonly missed.
| Screen | TP | FN |
|---|---|---|
| Amphetamines | MDA & MDMA | |
| Benzodiazepines | Oxazepam, temazepam, diazepam, alprazolam, triazolam | Lorazepam, clonazepam, midazolam |
| Cannabinoids | Synthetics | |
| Cocaine | Unlikely | |
| Opiates | Morphine, Codeine, Heroin | Fentanyl, tramadol, meperidine, methadone, oxycodone, buprenorphine, hydrocodone, hydromorphone |
| Phencyclidine | New screens are very specific |
See Also
External Links
References
- ↑ Lukens, TW, et al. Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department. Annals of Emergency Medicine. 2006; 47(1):79-99.
- ↑ Dunham CM, Chirichella, TJ. Trauma Activation Patients: Evidence for Routine Alcohol and Illicit Drug Screening. PLoS ONE. 2012; 7(10): e47999.
- ↑ Tenenbein M. Do you really need that emergency drug screen? Clin Toxicol (Phila). 2009 Apr;47(4):286-91. PMID:19514875
- ↑ Perrone J, De Roos F, Jayaraman S, Hollander JE. Drug screening versus history in detection of substance use in ED psychiatric patients. Am J Emerg Med. 2001 Jan;19(1):49-51. PMID: 11146019.
- ↑ Courtesy Kishan Kapadia and UMEM derived from Goldfrank's Toxicologic Emergencies, 9th ed; Table 6-10
- ↑ Standridge, JB, et al. Urine Drug Screening: A Valuable Office Procedure. Am Fam Physician. 2010; 81(5):635-640.
- ↑ Brahm N. et al.Commonly prescribed medications and potential false-positive urine drug screens Am J Health Syst Pharm August 15, 2010 67:1344-1350;
Authors
Neil Young, Amr Badawy, Greg Armani, Ross Donaldson, Neil Manus, Daniel Ostermayer
