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Drug Monitoring, Methamphetamine D/L Isomers, Urine
Test Code39413
CPT Codes
80374 (HCPCS: G0480) <br><br data-cke-filler="true">
Includes
If you require medMATCH for this order code, you must also order code 39158 - Prescribed Drugs, medMATCH®. If 39158 is ordered, all Drug Monitoring order codes will be treated as medMATCH.
If this test code is not ordered with 39158, all medMATCH result codes will be DNR’d.
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d-Methamphetamine and l-Methamphetamine
If this test code is not ordered with 39158, all medMATCH result codes will be DNR’d.
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d-Methamphetamine and l-Methamphetamine
Preferred Specimen
9 mL urine collected in a clinical drug test transport vial
Minimum Volume
5 mL
Other Acceptable Specimens
Urine collected in urine collection container
Transport Temperature
Room temperature
Specimen Stability
Room temperature: 5 days
Refrigerated: 14 days
Frozen: 30 days
Refrigerated: 14 days
Frozen: 30 days
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Preserved samples
Methodology
Chromatography/Mass Spectrometry
FDA Status
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.
Setup Schedule
Set up: Daily; Report available: 3 days
Reference Range
See Laboratory Report
Clinical Significance
This test measures the ratio of the D and L isomers of methamphetamine in urine. Methamphetamine isomers are biomarkers to identify which forms of methamphetamine are present. The test is a definitive drug assay using the liquid chromatography/mass spectrometry (LC/MS-MS) method of analysis.
Methamphetamine is a stimulant drug of abuse as well as a prescription drug used to treat attention deficit hyperactivity disorders (ADHD) and obesity. Methamphetamine has two isomer forms (D and L). The L isomer is used in over-the-counter nasal decongestant products and is also a metabolite of the drug selegiline. The D isomer is used for prescription methamphetamine and is also a metabolite of the drug benzphetamine. Illicit methamphetamine formulations are primarily the D form. Approximately 62% of an oral dose is excreted with ~33% as unchanged drug and ~66% metabolites (including amphetamine) [1].
According to the American Association for Clinical Chemistry (AACC), testing drugs/drug metabolites is recommended and effective for detecting the use of relevant over-the-counter, prescribed, and nonprescribed drugs, and illicit substances in pain-management patients [2]. Laboratory testing is more effective than other physician tools for the detection of these substances in pain-management patients and is useful for routine monitoring of adherence. Instances where unchanged drug is detected, but metabolite(s) is not, may be indicative of drug added to the specimen after collection (eg, pill shaving, drug spiking) [2].
Note: No single monitoring approach provides adequate information about the pattern or dose of patient drug use. Safest prescribing habits should include a combination of tools and laboratory test results to correctly detect drug use patterns.
Urine drug test results equal to or greater than cutoff are reported as quantitative values and results less than cutoff are reported as negative. Quantitative values cannot be used to assess the drug dose because the drug is extensively metabolized and excreted in the urine.
References
1. Desoxyn® [package insert]. Deerfield, IL: Ovation Pharmaceuticals, Inc; 2007.
2. AACC. Using clinical laboratory tests to monitor drug therapy in pain management patients. November 2017. https://www.aacc.org/-/media/Files/Science-and-Practice/Practice-Guidelines/Pain-Management/LMPGPain-Management20171220.pdf. Accessed November 21, 2019.
Methamphetamine is a stimulant drug of abuse as well as a prescription drug used to treat attention deficit hyperactivity disorders (ADHD) and obesity. Methamphetamine has two isomer forms (D and L). The L isomer is used in over-the-counter nasal decongestant products and is also a metabolite of the drug selegiline. The D isomer is used for prescription methamphetamine and is also a metabolite of the drug benzphetamine. Illicit methamphetamine formulations are primarily the D form. Approximately 62% of an oral dose is excreted with ~33% as unchanged drug and ~66% metabolites (including amphetamine) [1].
According to the American Association for Clinical Chemistry (AACC), testing drugs/drug metabolites is recommended and effective for detecting the use of relevant over-the-counter, prescribed, and nonprescribed drugs, and illicit substances in pain-management patients [2]. Laboratory testing is more effective than other physician tools for the detection of these substances in pain-management patients and is useful for routine monitoring of adherence. Instances where unchanged drug is detected, but metabolite(s) is not, may be indicative of drug added to the specimen after collection (eg, pill shaving, drug spiking) [2].
Note: No single monitoring approach provides adequate information about the pattern or dose of patient drug use. Safest prescribing habits should include a combination of tools and laboratory test results to correctly detect drug use patterns.
Urine drug test results equal to or greater than cutoff are reported as quantitative values and results less than cutoff are reported as negative. Quantitative values cannot be used to assess the drug dose because the drug is extensively metabolized and excreted in the urine.
References
1. Desoxyn® [package insert]. Deerfield, IL: Ovation Pharmaceuticals, Inc; 2007.
2. AACC. Using clinical laboratory tests to monitor drug therapy in pain management patients. November 2017. https://www.aacc.org/-/media/Files/Science-and-Practice/Practice-Guidelines/Pain-Management/LMPGPain-Management20171220.pdf. Accessed November 21, 2019.
