Interpretation Guide: Broad Spectrum Urine Toxicology Screen January 2016

The Broad Spectrum Urine Toxicology Screen provided by Dynacare incorporates liquid chromatography and tandem mass spectrometry (LC-MS/MS) for the targeted identification of sixty‐three (63) different drugs, drug metabolites and preparation ingredients. All urine specimens undergo enzymatic hydrolysis prior to testing, to yield additional free/unconjugated drug and thereby improve detection.

We note that the ability to detect any drug or metabolite in urine is dependent on many factors, including:  the dose ingested  the analytical method used  the positive/negative cut‐off concentration selected  the individual’s metabolic variability - genetic factors, age, gender, etc.  the individual’s physical condition – most notably kidney and liver disease  the amount of fluid ingested  the method and frequency of dosing  the time the drug was ingested relative to the time the urine sample was collected

Dynacare Broad Spectrum Urine Toxicology screen is targeted for the specific drug, drug metabolite and preparation ingredients listed below. It will not identify every licit and/or illicit drug that might be in a urine sample. If the drug of interest is not listed in the table below it will not be detected by this screen, at this time.

If a listed analyte was detected in the urine and its concentration exceeded its defined positive/negative cut-off concentration, the specimen will be reported positive for that specific analyte.

A positive result indicates that the analyte is present in the patient’s urine at a minimum concentration above its defined screening threshold. A positive result does not indicate the analytes route of administration, ingested dose, concentration in the urine or the patient’s level of intoxication.

A negative result may not necessarily mean that the urine is drug free. Negative results can obtained when the drug is present in the urine, but at a concentration that is below the positive/negative cut-off threshold. Negative results may also be obtained if the specific analyte of interest is not included in Dynacare Broad Spectrum Urine Toxicology screen.

We suggest you review the Ontario Association of Medical Laboratories (OAML) guideline entitled “Guidelines for Ordering Urine Testing for Drugs‐of‐Abuse: Targeted and Screening Tests (CLP013)”, found at www.OAML.com. Contact Dynacare if additional information is required.

Interpretation Guide: Broad Spectrum Urine Toxicology Screen Drug, Common Interpretive Positive/ Urine Drug Metabolite or Trade Names Notes Negative Detection Preparation Ingredient Cut-off Time‡ (ng/mL) Anesthetic Ketamine Ketalar Ketamine detected after use 100 ng/mL Anticonvulsant Gabapentin Neurontin Gabapentin detected after use 500 ng/mL Antidepressants Bupropion Wellbutrin, Zyban Bupropion detected after use 250 ng/mL mCPP Trazodone metabolite; designer drug 250 ng/mL Benzodiazepines Metabolized to alpha-hydroxyalprazolam; both may be Alprazolam Apo-Alpraz, Xanax 100 ng/mL detected after use 2-4 days α-hydroxyalprazolam Alprazolam metabolite 100 ng/mL Metabolized to 7-aminoclonazepam; metabolite Clonazepam Clonapam 100 ng/mL primarily detected after use 2-4 days 7-Aminoclonazepam Clonazepam metabolite 100 ng/mL Diastat, Diazemuls, Metabolized to nordiazepam, temazepam and Diazepam 100 ng/mL Valium oxazepam; all may be detected after use 2-7 days Nordiazepam Diazepam metabolite 100 ng/mL Metabolized to 7-aminoflunitrazepam; metabolite Flunitrazepam Rohypnol 100 ng/mL primarily detected after use 1-4 days 7-Aminoflunitrazepam Flunitrazepam metabolite 100 ng/mL Metabolized to desalkylflurazepam; metabolite Flurazepam Dalmane, SOM-PAM 100 ng/mL primarily detected after use 1-2 days Desalkylflurazepam Flurazepam metabolite 100 ng/mL Lorazepam Ativan Lorazepam detected after use 100 ng/mL 5-7 days Metabolized to 7-aminonitrazepam; both may be Nitrazepam Mogadon 100 ng/mL detected after use 1-4 days 7-Aminonitrazepam Nitrazepam metabolite 100 ng/mL Oxazepam detected after use; nordiazepam and Oxazepam Novoxapam, Oxpam 100 ng/mL 2-7 days temazepam metabolite Phenazepam Phenazepam detected after use 100 ng/mL

Interpretation Guide: Broad Spectrum Urine Toxicology Screen Drug, Common Interpretive Positive/ Urine Drug Metabolite or Trade Names Notes Negative Detection Preparation Ingredient Cut-off Time‡ Metabolized to oxazepam; both may be detect after Temazepam Restoril 100 ng/mL 1-4 days use; diazepam metabolite Triazolam Triazolam detected after use 100 ng/mL Cannabinoids THCA Cannabinoid metabolite 40 ng/mL 1-45 days JWH-200 Synthetic Cannabinoid 40 ng/mL JWH-018 Synthetic Cannabinoid 20 ng/mL Opioids and Related Drug Preparation Ingredients Metabolized to norbuprenorphine; both may be Buprenorphine/ detected after use; Suboxone and Buprenorphine Naloxone, Butrans, 15 ng/mL Buprenorphine/Naloxone preparations also include Suboxone naloxone Norbuprenorphine Buprenorphine metabolite 15 ng/mL Tylenol with Codeine No. 2, No. 3 and No. 4; Metabolized to norcodeine, morphine and Codeine 100 ng/mL included in many other hydrocodone; all may be detected after use 2-3 days preparations Norcodeine Codeine metabolite 100 ng/mL Abstral, Duragesic Mat, Metabolized to norfentanyl; both may be detected Fentanyl 25 ng/mL Fentanyl Patch after use 1-3 days Norfentanyl Fentanyl metabolite 25 ng/mL Metabolized to 6-acetylmorphine, metabolite primarily Heroin detected after use 6-Acetylmorphine Heroin metabolite 10 ng/mL <1 day Hydrocan, Novahistex Metabolized to norhydrocodone, dihydrocodeine and Hydrocodone DH, Novahistine DH, hydromorphone; all may be detected after use; 100 ng/mL Tussionex codeine metabolite 2-3 days Norhydrocodone Hydrocodone metabolite 100 ng/mL Dihydrocodeine Hydrocodone metabolite 100 ng/mL Dilaudid, Hydromorph Hydromorphone detected after use; hydrocodone and Hydromorphone 100 ng/mL 2-3 days Contin, Jurnista morphine metabolite

Interpretation Guide: Broad Spectrum Urine Toxicology Screen Drug, Common Interpretive Positive/ Urine Drug Metabolite or Trade Names Notes Negative Detection Preparation Ingredient Cut-off Time‡ Kadian Capsules, MS Contin, MS IR Tab, Metabolized to hydromorphone; both may be detect Morphine Statex; included in 100 ng/mL 2-3 days after use; 6AM and codeine metabolite many other preparations Included in Targin preparations of Naloxone oxycodone; Included in Naloxone detected after use 15 ng/mL Suboxone preparations of buprenorphine Naltrexone Relistor, Revia Naltrexone detected after use 100 ng/mL Metabolized to normeperidine; both may be detected Meperidine Demerol 200 ng/mL after use 1-2 days Normeperidine Meperidine metabolite 200 ng/mL Methadone Metadol, Methadose Metabolized to EDDP; both may be detected after use 100 ng/mL 1-14 days EDDP Methadone metabolite 100 ng/mL Endocet, Oxy.IR, Oxyneo, Percocet, Metabolized to noroxycodone; both may be detected Oxycodone 100 ng/mL 2-3 days Rivacocet, Supeudol, after use; Targin preparations also included naloxone Targin Noroxycodone Oxycodone metabolite 100 ng/mL Stimulants and Related Drug Preparation Ingredients Amphetamine detected after use; methamphetamine Amphetamine Adderall, Dexedrine 250 ng/mL 3-5 days metabolite Metabolized to amphetamine; both may be detected Methamphetamine 250 ng/mL 3-5 days after use MDEA Metabolized to MDA; both may be detected after use 250 ng/mL Ecstasy; metabolized to MDA; both may be detected MDMA 250 ng/mL after use MDA MDEA and MDMA metabolite 250 ng/mL

Interpretation Guide: Broad Spectrum Urine Toxicology Screen Drug, Common Interpretive Positive/ Urine Drug Metabolite or Trade Names Notes Negative Detection Preparation Ingredient Cut-off Time‡ Metabolized to benzoylecgonine, norcocaine and cocaethylene; all may be detected after use; cocaine Cocaine 100 ng/mL < 1 day is often cut with levamisole which may also be detected after use Benzoylecgonine Cocaine metabolite 100 ng/mL 1-2 days Norcocaine Cocaine metabolite 100 ng/mL Cocaine metabolite; formed when cocaine is used Cocaethylene 100 ng/mL with alcohol Levamisole Cutting agent mixed with cocaine; 10 ng/mL 1-2 days Benzylpiperazine Synthetic stimulant; designer drug 250 ng/mL Synthetic amphetamine; designer drug sometimes MDPV 250 ng/mL referred to as a “bath salt” Synthetic amphetamine; designer drug sometimes Mephedrone 250 ng/mL referred to as a “bath salt” Biphentin, Concerta, Metabolized to ritalinic acid; both may be detected Methylphenidate 100 ng/mL Ritalin after use <1 day Ritalinic Acid Methylphenidate metabolite 500 ng/mL Included in many cold, sinus and flu Diphenhydramine Diphenhydramine detected after use 100 ng/mL preparations and over- the-counter products Included in many cold, Ephedrine/ sinus and flu Ephedrine/Pseudoephedrine detected after use 500 ng/mL Pseudoephedrine preparations and over- the-counter products Cotinine Nicotine metabolite 300 ng/mL 1-7 days Acronyms: EDDP, 2‐ethylidene‐1,5‐dimethyl‐2,2‐diphenylpyrrolidine; mCPP, 1‐(3‐chlorophenyl)piperazine; MDA, methylenedioxyamphetamine; MDEA, methylenedioxyethylamphetamine; MDMA, methylenedioxymethamphetamine; MDPV, 3,4‐methylenedioxypyrovalerone; THCA, 11‐nor‐9‐carboxy‐Δ9‐tetrahydrocannabinol. ‡ The listed urine detection times are approximations. The actual detection time depends upon the drug dose, its frequency of use and individual patient metabolism. If cell is left blank, urine detection times are unknown.