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| A B C D E F G H I J K L M N O P Q R S T U V W X Y Z # |
1.4f- Toxicology Information Current
MessageUrine Toxicology screening is performed by the Chemistry Department.
BACL Chemistry Laboratory Supervisors
Laboratory Telephones
Confirmatory testing is handled by the Send Out Department.
BACL Send Out Supervisors
Laboratory Telephones
GENERAL INFORMATION AND REQUIREMENTS
Urine samples sent to the VISN-1 Chemistry Section for analysis for the presence of drugs of abuse (DAU) are screened for the presence of drugs using enzymatic immunoassay techniques. Screening assays available include amphetamines, barbiturates, benzodiazepines, buprenorphine, cannabinoids, cocaine, methadone, opiates and oxycodone. Effective 4/4/17 the urine screens will include testing for sample validity. Please see the validity testing information at the end of this document. Overdose drug screens are also available for serum and urine for emergency room samples and are respectively performed in the chemistry section of the laboratory at the West Roxbury and Boston divisions.
Tests which screen positive are reported as SCRN POS with a comment that if a confirmation is needed, a request should be placed using the DAU confirmation menu in CPRS. The process is like placing an order but it is actually a request that in BHS will send an alert to a lab group once you sign the order. In Bedford the alert prints in the lab. The sample will be held for 7 days. If no request is made for confirmation, the urine specimen will be discarded. Upon request of the provider, samples giving a positive screen will be sent to Quest Laboratories or VA Indianapolis for confirmation testing by LC/MS. VA Indianapolis offers two panels - an ETG confirmation panel and a comprehensive panel with 41 analytes. Quest Laboratories confirmation results are reported as Positive or Negative. In the instance of a Positive finding for amphetamines, barbiturates, benzodiazepines, buprenorphine, cannabinoids, cocaine, methadone, opiates and oxycodone, the specific drug(s) found to be present are reported (see below in table). VA Indianapolis confirmation results are reported numerically (see chart below for details).
For questions about the immunoassay screening procedures you can contact the Chemistry Supervisors at the West Roxbury, Boston, Brockton or Bedford divisions.
The labs used for confirmation testing are determined by contract so they periodically change. Here is some history:
From 10/1/10 to 10/19/15 confirmatory testing was performed by SECON Laboratories.
From 10/20/15 to 1/31/18 confirmatory testing was performed at Ameritox, LTD Laboratories, 486 Gallimore Dairy Rd, Greensboro, NC 27409.
From 2/1/18 to 2/1/19 confirmation testing was sent to Quest Diagnostics.
From 2/1/19 to 4/26/19 confirmation testing was sent to Hyperion Biotechnology in Texas. This contract did not work out and the labs resumed sending testing to Quest Diagnostics.
2/15/21 VA Indianapolis was added as a a testing lab.
The laboratory does not supervise the collection of urine specimens. Should a supervised specimen be desired, the collection is the responsibility of the practitioner or program submitting the specimen. Testing is for medical purposes only. The Toxicology Laboratory does not do legal or forensic testing, nor does it do employee testing.
All drug levels are given in ng/ml; the cutoff concentration of the analyte used as the cutoff calibrator is shown in parentheses.
* Only at very high concentrations (greater than 20 times the BACL cutoff concentration).
New FDA approved Fentanyl information effective 12/5/18:
Fentanyl screen information prior to 12/5/18:
VISN 1 Chemistry Functional Group; Drugs of Abuse Dilution, Substitution and Adulteration Screen Guidance - Final
Dilution, physiological or post-void, and substitution are known pre-analytical sources of error in drug of abuse testing. Some types of dilution and substitution can be detected by measurement of urine creatinine, specific gravity, and pH in the form of an ‘adulteration panel’. Creatinine and specific gravity (SG) primarily detect urine dilution, either physiological, pharmacological, or post-voiding; pH detects the presence of acidic and basic adulterants added to inhibit screening immunoassays. Other adulterants may not be detected by this limited panel of tests.
Adulteration panels may be included as part of the DAU panel, or may be separately ordered depending on local procedures. I would recommend creating distinct tests for all of these as part of a routine DAU panel. Validity tests are to be arranged so they appear first on the DAU test report in CPRS.
The tables below describe the suggested reference ranges, interpretation of the tests and suggested comments to use and actions to take in response to adulteration test results.
References:
“Procedures for Transportation Workplace Drug and Alcohol Testing Programs.” Department of Transportation. Department of Transportation, 22 March 2016. Web. 28 March 2016. https://www.transportation.gov/odapc/part40
Fu, S. Adulterants in Urine Drug Testing. Advances in Clinical Chemistry, 2016, 76: 123–163
Prepared by Dr. Sheldon Campbell
1
Additional Toxicology testing performed by Quest:
VA Indianapolis Toxicology Information:
BACL Chemistry Laboratory Supervisors
| West Roxbury | Jonathan Dryjowicz-Burek | 857-203-5973 |
| Jamaica Plain | Joseph Manzone | 857-364-5092 |
| Brockton | Diane Robert | 774-826-2294 |
| Bedford | Bhumikaben Patel | 781-687-2976 |
Laboratory Telephones
| West Roxbury | 857-203-5973 |
| Jamaica Plain | 857-364-5115 |
| Brockton | 774-826-2297 |
| Bedford | 781-687-2603 |
Confirmatory testing is handled by the Send Out Department.
BACL Send Out Supervisors
| BHS | Mary Pitts | 857-203-5403 |
| Bedford | Bhumikaben Patel | 781-687-2976 |
Laboratory Telephones
| BHS Send Outs | 857-203-5975 |
| Bedford | 781-687-2605 |
GENERAL INFORMATION AND REQUIREMENTS
Urine samples sent to the VISN-1 Chemistry Section for analysis for the presence of drugs of abuse (DAU) are screened for the presence of drugs using enzymatic immunoassay techniques. Screening assays available include amphetamines, barbiturates, benzodiazepines, buprenorphine, cannabinoids, cocaine, methadone, opiates and oxycodone. Effective 4/4/17 the urine screens will include testing for sample validity. Please see the validity testing information at the end of this document. Overdose drug screens are also available for serum and urine for emergency room samples and are respectively performed in the chemistry section of the laboratory at the West Roxbury and Boston divisions.
Tests which screen positive are reported as SCRN POS with a comment that if a confirmation is needed, a request should be placed using the DAU confirmation menu in CPRS. The process is like placing an order but it is actually a request that in BHS will send an alert to a lab group once you sign the order. In Bedford the alert prints in the lab. The sample will be held for 7 days. If no request is made for confirmation, the urine specimen will be discarded. Upon request of the provider, samples giving a positive screen will be sent to Quest Laboratories or VA Indianapolis for confirmation testing by LC/MS. VA Indianapolis offers two panels - an ETG confirmation panel and a comprehensive panel with 41 analytes. Quest Laboratories confirmation results are reported as Positive or Negative. In the instance of a Positive finding for amphetamines, barbiturates, benzodiazepines, buprenorphine, cannabinoids, cocaine, methadone, opiates and oxycodone, the specific drug(s) found to be present are reported (see below in table). VA Indianapolis confirmation results are reported numerically (see chart below for details).
For questions about the immunoassay screening procedures you can contact the Chemistry Supervisors at the West Roxbury, Boston, Brockton or Bedford divisions.
The labs used for confirmation testing are determined by contract so they periodically change. Here is some history:
From 10/1/10 to 10/19/15 confirmatory testing was performed by SECON Laboratories.
From 10/20/15 to 1/31/18 confirmatory testing was performed at Ameritox, LTD Laboratories, 486 Gallimore Dairy Rd, Greensboro, NC 27409.
From 2/1/18 to 2/1/19 confirmation testing was sent to Quest Diagnostics.
From 2/1/19 to 4/26/19 confirmation testing was sent to Hyperion Biotechnology in Texas. This contract did not work out and the labs resumed sending testing to Quest Diagnostics.
2/15/21 VA Indianapolis was added as a a testing lab.
The laboratory does not supervise the collection of urine specimens. Should a supervised specimen be desired, the collection is the responsibility of the practitioner or program submitting the specimen. Testing is for medical purposes only. The Toxicology Laboratory does not do legal or forensic testing, nor does it do employee testing.
| ABBOTT IMMUNOASSAY |
ANALYTES ROUTINELY EXPECTED TO GIVE A POSITIVE RESULT FOR THE ABBOTT IMMUNOASSAY |
| AMPHETAMINES (monoclonal) |
d-Methamphetamine (1000) d-Amphetamine l-Amphetamine( >12,500) l-Methamphetamine ( >10,000) Methylenedioxyamphetamine (MDA) Methylenedioxymethphetamine (MDMA) |
| BARBITURATES | Secobarbital (200) Amobarbital Aprobarbital Barbital Butabarbital Butalbital Diallybarbital Pentobarbital Phenobarbital Talbutal Thiopental |
| BENZODIAZEPINES | Lormetazepam (200) a-OH-Alprazolam Alprazolam 7-aminoclonazepam Bromazepam Chlordiazepoxide Clobazam Clonazepam Clotiazepam Demoxepam N-Desmethyldiazepam Diazepam Estazolam Flunitrazepam N-Desalkylflurazepam 1-N-OH-Ethylflurazepam Flurazepam Halazepam Ketazolam Lorazepam Medazepam Midazolam Nitrazepam Norchlordiazepoxide Oxazepam Prazepam Temazepam Tetrazepam a-OH-Triazolam Triazolam |
| CANNABINOIDS | 11-nor-Δ9-THC-9-carboxylic acid (50) L-11-Nor-Δ8-THC-COOH L-11-Nor-Δ9-THC-COOH 8-β-Hydroxy-Δ9-THC 8-β-11-hydroxy-Δ9-THC Δ9-THC (Dronabinol) Cannabinol |
| COCAINE | Benzoylecgonine (300) Cocaine* Ecgonine* |
| METHADONE | Methadone (300) Methadol |
| OPIATES | Morphine (300) Codeine Dihydrocodeine Heroin Hydrocodone Hydromorphone Levorphanol* 6-Monoacetyl Morphine Morphine-3-glucuronide Morphine-6-glucuronide Oxycodone* Oxymorphone* |
| OXYCODONE | Oxycodone (100) Oxymorphone |
* Only at very high concentrations (greater than 20 times the BACL cutoff concentration).
New FDA approved Fentanyl information effective 12/5/18:
Fentanyl screen information prior to 12/5/18:
| CONFIRMATION ASSAY | REPORTABLE ANALYTES (Quest) | Cutoff(ng/mL) |
| AMPHETAMINES | Amphetamine Methamphetamine Methylenedioxyamphetamine (MDA) Methylenedioxymethamphetamine (MDMA, ecstasy) |
250 |
| BARBITURATES | Amobarbital Butalbital Pentobarbital Phenobarbital Secobarbital |
100 |
| BENZODIAZEPINES | Alphahydroxyalprazolam Alphahydroxymidazolam Alphahydroxytriazolam Aminoclonazepam Hydroxyethylflurazepam Lorazepam Nordiazepam Oxazepam Temazepam |
Xanax & Klonopin 25, Rest 50 |
| BUPRENORPHINE | Buprenorphine Norbuprenorphine |
5 |
| CANNABINOIDS | Delta-9-COOH-THC | 5 |
| COCAINE | Benzoylecgonine | 100 |
| ETG | ETG | 500 |
| ETS | 100 | |
| FENTANYL | 0.5 | |
| MDMA | Methylenedioxyamphetamine (MDA) Methylenedioxymethamphetamine (MDMA, ecstasy) |
200 |
| METHADONE | Methadone EDDP |
100 |
| OPIATES | 6-acetylmorphine (Heroin) Codeine Hydrocodone Hydromorphone Meperidine Morphine Norhydrocodone Normeperidine Noroxycodone Oxycodone Oxymorphone |
50 |
| OXYCODONE | Oxycodone Oxymorphone Noroxycodone |
50 |
VISN 1 Chemistry Functional Group; Drugs of Abuse Dilution, Substitution and Adulteration Screen Guidance - Final
Dilution, physiological or post-void, and substitution are known pre-analytical sources of error in drug of abuse testing. Some types of dilution and substitution can be detected by measurement of urine creatinine, specific gravity, and pH in the form of an ‘adulteration panel’. Creatinine and specific gravity (SG) primarily detect urine dilution, either physiological, pharmacological, or post-voiding; pH detects the presence of acidic and basic adulterants added to inhibit screening immunoassays. Other adulterants may not be detected by this limited panel of tests.
Adulteration panels may be included as part of the DAU panel, or may be separately ordered depending on local procedures. I would recommend creating distinct tests for all of these as part of a routine DAU panel. Validity tests are to be arranged so they appear first on the DAU test report in CPRS.
The tables below describe the suggested reference ranges, interpretation of the tests and suggested comments to use and actions to take in response to adulteration test results.
| Analyte | Reference low | Reference high | Comment |
| Creatinine DAU | 20 | (none) | Urine with Cr <5 is diluted or substituted. Cr between 5 and 20 is very dilute. |
| Specific gravity DAU | 1.003 | 1.020 | Urine with SG of 1.001 or less is diluted or substituted. SG of 1.003 or less is very dilute. |
| pH DAU | 4 | 10 | Urine with pH <3 or >11 has been adulterated. Urine with pH between 3 and 4 or 10 and 11 may have been adulterated. |
| If pH <3 or >11, do not enter DAU results | ACTION: DAU test(s) will be “commented out” with the following comment entered: “Urine with pH <3 or >11 has been adulterated; cannot perform DAU testing on this sample.” |
“Procedures for Transportation Workplace Drug and Alcohol Testing Programs.” Department of Transportation. Department of Transportation, 22 March 2016. Web. 28 March 2016. https://www.transportation.gov/odapc/part40
Fu, S. Adulterants in Urine Drug Testing. Advances in Clinical Chemistry, 2016, 76: 123–163
Prepared by Dr. Sheldon Campbell
1
Additional Toxicology testing performed by Quest:
| Test | Screen | Analyte(Confirmation) | Cut-off |
| Synthetic Cannabinoid(Spice) | Yes | AB-FUBINACA M2 AB-PINACA AKB48 pentanoicacid* BB-22 3-caboxyindole 5-Fluoro PB22 PB-22 3carboxyindole UR-144 Pentanoic Acid* AB-CHMINACA M2 ADB-PINACA ADBICA JWH 073 Butanoic Acid* JWH 018 Pentanoic Acid* |
2ng/mL for each analyte with the exception of * items Which have a cutoff of 0.2 ng/mL |
| Bath Salts | Yes | Butylone MDPV Methylone Mephedrone |
50 ng/mL |
| Dextromethorphan | Dextromethorphan | 5 ng/mL | |
| Gabapentin | Gabapentin | 1000 ng/mL | |
| Phencyclidine | Yes | Phencyclidine | 25 ng/mL |
| Propoxyphene | Yes | Propoxyphene Norpropoxyphene |
200 ng/mL |
| Ritalinic acid | Ritalinic acid | 100 ng/mL | |
| Tramadol | Yes | Tramadol O-desmethyltramadol |
100 ng/mL |
VA Indianapolis Toxicology Information:
Test Code
Toxicology (current)
Last Updated: May 17, 2022
