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HelpEpic Test Code LAB1297 Drug Toxicology Monitoring 1, with Confirmation, Oral Fluid
Performing Laboratory
Quest Diagnostics Nichols Chantilly
14225 Newbrook Drive
Chantilly, VA 20151
Includes
- Amphetamines, Barbiturates, Benzodiazepines, Buprenorphine, Cocaine, Fentanyl, Heroin Metabolite, Marijuana, MDMA, Meprobamate, Methadone, Nicotine Metabolite, Opiates, Phencyclidine, Tapentadol, Tramadol, Zolpidem
Specimen Type
1 mL oral fluid inserted into 3 mL buffer tube collected in Quantisal™ device,
Preferred Container
1 mL oral fluid inserted into 3 mL buffer tube collected in Quantisal™ device.
Patient Preparation
Quantisal™ : Avoid any food or drink consumption, or gum or tobacco use for 10 minutes prior to collecting. If donor's mouth is not empty immediately prior to collection, have subject rinse mouth with water (up to 4 oz) and wait a minimum of 10 minutes before collecting a specimen.
Collection Instructions
- If donor's mouth is not empty immediately prior to collection, have subject rinse his/her mouth with water (up to 4 oz) and wait a minimum of 10 minutes before collecting a specimen.
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Quantisal™: Using the standard Quantisal™ collection container, place the swab under the tongue. Donor should keep head down to allow gravity to help with saliva collection. Leave in place until blue dye indicates that the collection pad is saturated sufficiently. Follow collection instructions on package.
Minimum Volume
See specimen collection guidance for minimum
Specimen Stability
Quantisal™ specimen
Room temperature: 10 days
Refrigerated: 30 days
Frozen: 30 days
Transportation Needs
Refrigerated
Reject Criteria
Mislabeled or unlabeled specimen
Specimens submitted in a non-Quantisal™ collection device •
Specimens received with any food debris or foreign objects present in the sample
Multiple swabs present in a single device
No swab present with the device
Quantisal™ Collection wand inverted inside the collection tube
Clinical Significance
Drug Toxicology Monitoring 1, with Confirmation, Oral Fluid - Oral fluid is composed of saliva, mixed with buccal and mucosal transudates, cellular debris, bacteria, and residue of ingested products. Oral fluid as a test matrix shows promise for detection of recent drug use, and a significant body of scientific literature documents drug disposition and detection times. Researchers comparing effectiveness of oral fluid and urine drug testing found a similar pattern and frequency of positive drug test results in the general workforce over the same general period. Similarly in pain clinics, the pattern of licit and illicit drugs and metabolites observed in oral fluid paralleled results reported for urine, with some minor differences in detection rates for different drug classes. In some cases, oral fluid testing may be an acceptable alternative or the only available matrix. As an ultra-filtrate of blood, however, it shares the limitations of a decreased window of detection versus conventional urine drug testing.
Additional Information
Oral Fluid Abuse Testing Technical Bulletin
Because salivary glands are highly perfused, drugs are rapidly transferred into the bloodstream. Thus, drugs tend to become detectable in oral fluid sooner than in urine, and become undetectable more rapidly as well. The parent drug can be determined in most cases. Some drugs, i.e. cocaine and heroin, have a very narrow detection window in oral fluid, but most remain for 24-50 hours after ingestion. Limited specimen volumes (<3mL) may preclude testing. The use of salivary stimulants should be avoided as these may change the pH of the fluid and the drug concentration.
Drug concentrations in oral fluid tend to be substantially lower than in urine, necessitating lower cut-off limits for defining positive results. Weakly basic drugs, i.e. benzodiazepines, tend to have especially low concentrations in oral fluid.
Drugs detected by this test are shown below.
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Alcohol metabolite (ethyl sulfate) |
Meprobamate, carisoprodol |
Opioids: buprenorphine, codeine, dihydrocodeine, fentanyl, heroin, hydrocodone, hydromorphone, morphine, naloxone, norbuprenorphine, noroxycodone, norhydrocodone, oxycodone, oxymorphone, tapentadol, tramadol |
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Amphetamine/Methamphetamine |
Methadone, EDDP |
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|
Barbituates: amobarbital, butalbital, pentobarbital, Phenobarbital, secobarbital |
Methylphenidate |
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Benzodiazepines: alprazolam, chlordiazeperoxide, clonazepam, diazepam, flunitrazepam, flurazepam, lorazepam, midazolam, nordiazepam, oxazepam, temazepam, triazolam |
Naltrexone, betahydroxynaltrexone |
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Cocaine, benzoylecgonine |
Nicotine, cotinine |
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Marijuana (THC) |
Phencyclidine |
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MDMA |
Zoplidam |
Maximum Laboratory Time
3-5 days
Methodology
All tests excluding THC: Mass Spectrometry (MS)
THC: Screen: Immunoassay (IA) • Confirmation: Mass Spectrometry (MS)
CPT Code
- If screening drug class result is equal to or greater than the cutoff, then confirmation testing will be performed at an additional charge (CPT code(s): dependent on the drug class being confirmed - Amphetamines - 80324, Barbiturates - 80345, Benzodiazepines - 80346, Buprenorphine - 80348, Cocaine - 80353, Fentanyl - 80354, Heroin Metabolite - 80356, Marijuana - 80349, MDMA - 80359, Meprobamate - 80369, Methadone - 80358, Nicotine Metabolite - 80323, Opiates - 80361, Phencyclidine - 83992, Tapentadol - 80372, Tramadol - 80373, Zolpidem - 80368). HCPCS: G0480 or G0481
Last Updated
18-April-23 BHD