Drugs of Abuse Urine (DAU)

Lab menu: DAU and oxycodone screen

+Opiates:Indicates any combination of codeine, MSo4, hydrocodone, hydromorphone, oxycodone.

• When ordering DAU, add screen for oxycodone, buprenorphine, and fentanyl.
• Tramadol will not be detected by DAU opiate screen; confirmation required.

DAU tests specifically for cocaine and methadone metabolites benzoylecgonine and EDDP, respectively.

• Nucynta may produce false positive for methadone.

Detection Period

• Opiates: 1-2 days for most, 2-3 days for fentanyl
• Methadone: 3-11 days
• THC: 3 days single use, 4 days moderate use, 10 days heavy use, 30-36 days for chronic, heavy use
• Alcohol: 7-12 hours

• Collection: 50 ml, ward collect.
• Temperature: 90-100 degrees within four minutes of voiding.
• Tampering/Dilution: Order creatinine and specific gravity.
• Urine Creatinine: < 20mg/dl considered dilute.
• Urine specific gravity (SG): 1.002-1.020, SG H20 = 1.0.
• Substitution: pH extremely low < 3 or high > 11.
• Confirmation: GC/MS-confirms DAU result and identifies the drug.
• To order: Consult, lab consult, DAU confirmation outpt.
• False positives: To rule out (or in) especially amphetamine, BZD, other unexpected results.

Miscellaneous

Heroin: 6-MAM in ~6-8hr, then morphine

• Only the presence of 6-MAM confirms heroin:
  • + THC with passive exposure highly ulikely;
  • Poppyseed-+morphine, patient counseled to abstain; or next positive will be assumed to be illicit.
  • Low dose or PRN use-may not be + on DAU or confirmation
• Consider pill counts mid-prescription for actual use:
  • High dose oxycodone expect parent drug and metabolite i.e., oxycodone AND oxymorphone.
  • Absence of oxycodone implies not taken recently, oxymorphone can last 1-2 days after oxycodone.
  • Morphine can also confirm for hydromorphone.
  • Vicodin-hydrocodone or hydrocodone and hydromorphone or hydromorphone alone.

Approach to Opioid Tapering in the Patient without Addiction: BETTa

• Identify all Biopsychosocial treatment targets.
• Educate patient about pain contributors and benefits of opioid tapering.
• Treat all targets using an evidence-based, collaborative approach.
• Taper opioids very slowly – <10% of total daily dose every 1-2 months for those on chronic treatment.