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Test ID PNCSU Pain Clinic Survey, Urine

Secondary ID

65062

Useful For

Detecting drug use involving amphetamines, barbiturates, benzodiazepines, cocaine, opioids, phencyclidine, and tetrahydrocannabinol

 

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

Profile Information

Test ID Reporting Name Available Separately Always Performed
ADULT Adulterants Survey, U Yes Yes
TOPSU Targeted Opioid Screen, U Yes Yes
PNRCH Pain Clinic Immunoassay Panel, U No Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
AMPHU Amphetamines Confirmation, U Yes No
COKEU Cocaine and metabolite Conf, U Yes No
BENZU Benzodiazepines Confirmation, U Yes No
BARBU Barbiturates Confirmation, U Yes No
PCPU Phencyclidine Confirmation, U Yes No
THCU Carboxy-THC Confirmation, U Yes No

Testing Algorithm

Testing will begin with ADULT / Adulterants Survey, Urine (ADULT). If sample is found to be adulterated, testing will end, and the remaining tests will be canceled.  If sample is normal or only diluted, remaining testing will continue.  If immunoassay screen is positive, confirmation is performed. Confirmation with quantification of positives for amphetamines, barbiturates, benzodiazepines, cocaine and metabolites, phencyclidine, and tetrahydrocannabinol metabolite will be performed at an additional charge. 

Method Name

ADULT, PNRCH: Screened by Immunoassay

TOPSU: Liquid Chromatography-Tandem Mass Spectrometry, High Resolution Accurate Mass (LC-MS/MS HRAM)

Reporting Name

Pain Clinic Survey, U

Specimen Type

Urine

Collection Container/Tube: Plastic urine container

Submission Container/Tube: Plastic, 60-mL urine container (T-313)

Specimen Volume: 30 mL

Collection Instructions:

1. Collect a random urine specimen.

2. Submit 30 mL in 1 plastic bottle.

3. No preservative.

Additional Information:

1. No specimen substitutions.

2. Submitting less than 30 mL will compromise our ability to perform all necessary testing.

3. No STATS are accepted for this procedure.

4. For situations where chain of custody is required, a Chain-of-Custody Kit (T282) is available. For chain-of-custody testing, order PANOX / Pain Clinic Survey 10, Chain of Custody, Urine.

5. Additional drug panels and specific requests are available. Call Mayo Medical Laboratories at 800-533-1710 or 507-266-5700.

Forms: Chain-of-Custody Request Form is included in the Chain-of-Custody Kit (T282). A copy of this form is also available at http://www.mayomedicallaboratories.com/it-mmfiles/chain-of-custody-request-form.pdf.

Specimen Minimum Volume

20 mL

Specimen Stability Information

Specimen Type Temperature Time
Urine Refrigerated (preferred) 14 days
  Frozen  14 days
  Ambient  72 hours

Clinical Information

This test uses the simple screening technique that involves immunologic testing for drugs by class. All positive immunoassay screening results are confirmed by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-tandem mass spectrometry (LC-MS/MS), and quantitated, before a positive result is reported.

 

This assay was designed to test for and confirm by the following:

-Barbiturates

-Benzodiazepines

-Cocaine

-Phencyclidine

-Tetrahydrocannabinol

 

Confirmation by LC-MS/MS is completed for all amphetamines.

 

The targeted opioid screen portion is performed by liquid chromatography-tandem mass spectrometry, high-resolution accurate mass (LC-MS/MS HRAM) and is completed for all opioids. 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 (ie, methadone).

Reference Values

ADULT:

Normal

Cutoff concentrations

Oxidants: 200 mg/L

Nitrites: 500 mg/L

 

PNRCH:

Negative

Screening cutoff concentrations:

Amphetamines: 500 ng/mL

Barbiturates: 200 ng/mL

Benzodiazepines: 100 ng/mL

Cocaine (benzoylecgonine-cocaine metabolite): 150 ng/mL

Phencyclidine: 25 ng/mL

Tetrahydrocannabinol carboxylic acid: 50 ng/mL

This report is intended for use in clinical monitoring or management of patients. It is not intended for use in employment-related testing.

 

TOPSU:

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

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

Cautions

Not intended for use in employment-related testing

 

For situations where chain of custody is required, a Chain-of-Custody Kit (T282) is available. See PANOX / Pain Clinic Survey 10, Chain of Custody, Urine.

 

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

Day(s) Performed

Monday through Friday; Varies

Report Available

2 days

Performing Laboratory

Mayo Medical Laboratories in Rochester

CPT Code Information

PNRCH - 80301, G0479 (if appropriate)

TOPSU - 80364, G0480 (if appropriate)

NY State Approved

Yes