Ordering Recommendation

Useful for general testing in contexts of compliance and/or abuse, primarily in the pain management population. Testing is qualitative and uses a combination of mass spectrometry as well as immunoassays with documented low false positive rates.
Results indicate whether findings are consistent or inconsistent with supplied medication information. Refer to Medication Submission Guidelines for details.
Secondary testing is generally not indicated but is available if confirmation or quantitation is desired.
If medication information is not available or interpretation is not necessary, consider Pain Management Drug Panel by High-Resolution Time-of-Flight Mass or Tandem Spectrometry and Enzyme Immunoassay, Urine (2007479).

Mnemonic
PAIN HYB 2
Methodology

Qualitative Liquid Chromatography/Time of Flight Mass Spectrometry or Tandem Mass Spectrometry/Enzyme Immunoassay/Quantitative Spectrophotometry

Performed

Sun-Sat

Reported

1-4 days

New York DOH Approval Status
This test is New York DOH approved.
Specimen Required
Patient Preparation

Information on the patient's current medications must be submitted with the order. Include trade name, generic name, dosing frequency and date of last dose, if known. Alternatively, please indicate if no prescription medication or drugs are being taken.

Collect

Random urine.

Specimen Preparation

Transfer 4 mL each into two (2) ARUP Standard Transport Tubes urine with no additives or preservatives. (Min: 2 mL each)

Storage/Transport Temperature

Refrigerated

Unacceptable Conditions

Specimens exposed to repeated freeze/thaw cycles.

Remarks
Stability

Ambient: 1 week; Refrigerated: 1 month; Frozen: 3 years

Reference Interval

Effective November 17, 2014

Drugs covered and range of cutoff concentrations.
Note: Some drugs are identified based on the presence of unique drug metabolites not listed below.
Drugs/Drug Classes
Range of Cutoff Concentrations
Barbiturates 200 ng/mL
Benzodiazepine-like:
alprazolam, clonazepam, diazepam, lorazepam, midazolam, nordiazepam, oxazepam,  temazepam, zolpidem
20 - 60 ng/mL
Cannabinoids (11-nor-9-carboxy-THC) 20 ng/mL
Ethyl Glucuronide 500 ng/mL
Muscle Relaxant(s):
carisoprodol, meprobamate
100 ng/mL
Opiates/Opioids:
buprenorphine, codeine, fentanyl, heroin, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, propoxyphene, tapentadol, tramadol
2-300 ng/mL
Phencyclidine (PCP) 25 ng/mL
Stimulants:
amphetamine, cocaine, methamphetamine, methylphenidate, MDMA (Ecstasy), MDEA (Eve), MDA, phentermine
100-400  ng/mL

Interpretive Data

Methodology: Qualitative Enzyme Immunoassay and Qualitative Liquid Chromatography-Time-of-Flight-Mass Spectrometry or Tandem Mass Spectrometry, Quantitative Spectrophotometry

The absence of expected drug(s) and/or drug metabolite(s) may indicate non-compliance, inappropriate timing of specimen collection relative to drug administration, poor drug absorption, diluted/adulterated urine, or limitations of testing. The concentration must be greater than or equal to the cutoff concentration to be reported as present. If specific drug concentrations are required, contact the laboratory within two weeks of specimen collection to request confirmation and quantification by a second analytical technique. Interpretive questions should be directed to the laboratory.

Results based on immunoassay detection that do not match clinical expectations should be interpreted with caution. Confirmatory testing by mass spectrometry for immunoassay-based results is available if ordered within two weeks of specimen collection. Additional charges apply.

For medical purposes only; not valid for forensic use.

No compliance statements are in use for this test.

Note

Creatinine concentration is also provided. The carisoprodol immunoassay has cross-reactivity to carisoprodol and meprobamate.

Hotline History
N/A
CPT Codes

80307

Components
Component Test Code* Component Chart Name LOINC
0090386 Creatinine, Urine 2161-8
2007636 Codeine (cutoff 40 ng/mL) 3507-1
2007637 Morphine (cutoff 20 ng/mL) 3830-7
2007638 6-acetylmorphine (cutoff 20 ng/mL) 10976-9
2007640 Oxycodone (cutoff 40 ng/mL) 10998-3
2007641 Noroxycodone (cutoff 100 ng/mL) 61424-8
2007642 Oxymorphone (cutoff 40 ng/mL) 11247-4
2007643 Noroxymorphone (cutoff 100 ng/mL)
2007644 Hydrocodone (cutoff 40 ng/mL) 12308-3
2007646 Norhydrocodone (cutoff 100 ng/mL) 61421-4
2007647 Hydromorphone (cutoff 40 ng/mL) 9834-3
2007649 Buprenorphine (cutoff 5 ng/mL) 3414-0
2007651 Norbuprenorphine (cutoff 20 ng/mL) 58362-5
2007652 Fentanyl (cutoff 2 ng/mL) 11235-9
2007653 Norfentanyl (cutoff 2 ng/mL) 43199-9
2007654 Meperidine metabolite (cutoff 50 ng/mL) 3746-5
2007655 Tapentadol (cutoff 100 ng/mL) 72485-6
2007656 Tapentadol-o-Sulf (cutoff 200 ng/mL)
2007658 Methadone (cutoff 150 ng/mL) 3773-9
2007659 Propoxyphene (cutoff 300 ng/mL) 19141-1
2007660 Tramadol (cutoff 200 ng/mL) 43219-5
2007662 Amphetamine (cutoff 100 ng/mL) 19343-3
2007663 Methamphetamine (cutoff 400 ng/mL) 3779-6
2007664 MDMA- Ecstasy (cutoff 200 ng/mL) 14267-9
2007665 MDA (cutoff 200 ng/mL) 42253-5
2007666 MDEA- Eve (cutoff 200 ng/mL) 61048-5
2007668 Phentermine (cutoff 100 ng/mL) 3957-8
2007670 Benzoylecgonine (cutoff 150 ng/mL) 3393-6
2007672 Alprazolam (cutoff 40 ng/mL) 9351-8
2007673 Alpha-OH-Alprazolam (cutoff 20 ng/mL) 61036-0
2007674 Clonazepam (cutoff 20 ng/mL) 19245-0
2007675 7-Aminoclonazepam (cutoff 40 ng/mL) 61030-3
2007676 Diazepam (cutoff 50 ng/mL) 3550-1
2007677 Nordiazepam (cutoff 50 ng/mL) 3861-2
2007678 Oxazepam (cutoff 50 ng/mL) 12361-2
2007679 Temazepam (cutoff 50 ng/mL) 61060-0
2007680 Lorazepam (cutoff 60 ng/mL) 18187-5
2007681 Midazolam (cutoff 20 ng/mL) 19585-9
2007682 Zolpidem (cutoff 20 ng/mL) 33338-5
2007684 Barbiturates (cutoff 200 ng/mL) 3377-9
2007687 Ethyl Glucuronide (cutoff 500 ng/mL) 55349-5
2007688 Marijuana Metabolite (cutoff 20 ng/mL) 3435-5
2007689 PCP (cutoff 25 ng/mL) 3936-2
2007690 Carisoprodol (cut-off 100 ng/mL) 21142-5
2007691 Pain Management Drug Panel 8251-1
2009289 EER Pain Mgt Pan, Mass Spec/EMIT Interp 11526-1
2009290 DRUGS EXPECTED 48767-8
2009291 Pain Management Drug Panel Interp 48767-8
2013281 Methylphenidate (cutoff 100 ng/mL) 3808-3
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.
Aliases
  • Comprehensive hybrid
  • high res
  • high-res
  • Pain management, (drug screen, targeted, urine)
  • TOF
Pain Management Drug Screen with Interpretation by High-Resolution Time-of-Flight or Tandem Mass Spectrometry and Enzyme Immunoassay, Urine