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RTXMSJ06008UAH Toxicology Drug Testing Panels Document Number: RTXMSJ06008UAH Revision Number: 1.73 Document Type: Attachment Effective Date: 5/3/2021 3:08:59 PM Location: AHS Laboratory Services\Document Administration\Toxicology and Trace Elements\17. Drug Testing LCMSMS\1. Drug Testing LCMSMS Job Aids RTXMSJ06008UAH Toxicology Drug Testing Panels Urine Opioid Dependency Panel 1 (UODP) CUT-OFF DRUG CLASS COMMON TRADE NAMES INTERPRETIVE CONCENTRATION2 ANALYTE DETECTED (STREET NAME) NOTES (NG/ML) Amphetamines Adderall, Dexedrine, Vyvanse, A prescription drug; also a metabolite of Amphetamine 250 Lisdexamfetamine methamphetamine (Speed, Bennies, Crystal Meth, Metabolite of Selegiline; Metabolized to Methamphetamine 250 Uppers) amphetamine Metabolite of Methylenedioxyamphetamine (MDA) 250 methylenedioxymethamphetamine Methylenedioxymethamphetamine (Ecstasy, MDMA) Metabolized to methylenedioxyamphetamine 250 Page 1 of 15 RTXMSJ06008UAH Toxicology Drug Testing Panels Rev: 1.73 CUT-OFF DRUG CLASS COMMON TRADE NAMES INTERPRETIVE CONCENTRATION2 ANALYTE DETECTED (STREET NAME) NOTES (NG/ML) Benzodiazepines Flubromazepam prescription not available in Flubromazepam 50 Canada 7-Aminoclonazepam Metabolite of clonazepam (Rivotril) 50 7-Aminonitrazepam Metabolite of nitrazepam (Mogadon) 50 Alphahydroxyalprazolam Metabolite of alprazolam (Xanax) 50 Alphahydroxytriazolam Metabolite of triazolam (Halcion) 50 Bromazepam Lectopam 50 Clobazam Frisium Metabolized to norclobazam 50 o Norclobazam Metabolite of clobazam 50 Metabolite of chlordiazepoxide (Librium); Demoxepam 50 further metabolized to nordiazepam Page 2 of 15 RTXMSJ06008UAH Toxicology Drug Testing Panels Rev: 1.73 CUT-OFF DRUG CLASS COMMON TRADE NAMES INTERPRETIVE CONCENTRATION2 ANALYTE DETECTED (STREET NAME) NOTES (NG/ML) Benzodiazepines continued Metabolized to nordiazepam, temazepam, Diazepam Valium 50 oxazepam Metabolized to 3-hydroxyetizolam, Etizolam 50 prescription not available in Canada Metabolite of etizolam. Etizolam prescription o 3-Hydroxyetizolam 50 not available in Canada Flubromazolam Prescription not available in Canada 50 Lorazepam Ativan 50 Midazolam Versed Metabolized to 1-hydroxymidazolam 50 o 1-Hydroxymidazolam Metabolite of midazolam 50 Metabolite of diazepam (Valium) and Nordiazepam chlordiazepoxide (Librium); further 50 metabolized to oxazepam Metabolite of diazepam, temazepam, Oxazepam Serax 50 chlordiazepoxide Metabolite of diazepam; metabolized to Temazepam Restoril 50 oxazepam Cocaine Related Compounds Benzoylecgonine Metabolite of cocaine 150 Page 3 of 15 RTXMSJ06008UAH Toxicology Drug Testing Panels Rev: 1.73 CUT-OFF DRUG CLASS COMMON TRADE NAMES INTERPRETIVE CONCENTRATION2 ANALYTE DETECTED (STREET NAME) NOTES (NG/ML) Opioids 6-Acetylmorphine 6-monoacetylmorphine (6-MAM) Heroin metabolite 5 Tylenol with codeine, Tylenol No. 2, Codeine Tylenol No. 3, Tylenol No. 4, codeine Metabolized to morphine and hydrocodone 50 phosphate and others Metabolite of codeine; metabolized to MS Contin, M-Eslon, Kadian and Morphine hydromorphone; potentially detected after 150 others poppy seed consumption Metabolite of codeine; metabolized to Hydrocodone Vicodin 50 hydromorphone Hydromorphone Dilaudid, Hydromorph Contin, Jurnista Metabolite of hydrocodone 50 Oxycontin, OxyNeo, Percocet, Oxycodone Metabolized to oxymorphone 50 Percodan Metabolite of oxycodone, prescription not Oxymorphone Not Reported available in Canada Fentanyl Duragesic Metabolized to norfentanyl 5 o Norfentanyl Metabolite of fentanyl 5 Norcarfentanil Metabolite of carfentanil and remifentanil 0.5 Buprenorphine Butrans, Suboxone, Belbuca Metabolized to norbuprenorphine 10 o Norbuprenorphine Metabolite of buprenorphine 10 Methadone Methadose Metabolized to EDDP 50 3 o EDDP Metabolite of methadone 50 Page 4 of 15 RTXMSJ06008UAH Toxicology Drug Testing Panels Rev: 1.73 1. Sample hydrolysis performed prior to analysis by liquid chromatography/mass spectrometry (LC-MS/MS) allowing detection of both free and conjugated drug. A positive result does not give any indication as to level of impairment/intoxication, route of administration or ingested dose. Determining concentration of drug (i.e. the drug level) in urine does not overcome these limitations. Concentrations are NOT reported. A negative result does not necessarily mean the urine is drug free. A negative result may mean: the sample is drug free or drugs are present but were not at or above the cut-off concentrations listed or the drug present in the sample is not detected by this method. 2. The cut-off concentration is the concentration that distinguishes whether a drug is reported as detected or not detected. 3. EDDP = 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine Page 5 of 15 RTXMSJ06008UAH Toxicology Drug Testing Panels Rev: 1.73 Urine General Toxicology Panel 1 (UGTP) CUT-OFF DRUG CLASS COMMON TRADE NAMES INTERPRETIVE CONCENTRATION2 ANALYTE DETECTED (STREET NAME) NOTES (NG/ML) Amphetamines Adderall, Dexedrine, Vyvanse, A prescription drug; also a metabolite of Amphetamine 250 Lisdexamfetamine methamphetamine (Speed, Bennies, Crystal Meth, Metabolite of Selegiline; Metabolized to Methamphetamine 250 Uppers) amphetamine Metabolite of Methylenedioxyamphetamine (MDA) 250 methylenedioxymethamphetamine Methylenedioxymethamphetamine (Ecstasy, MDMA) Metabolized to methylenedioxyamphetamine 250 Metabolite of Paramethoxyamphetamine (PMA) 50 paramethoxymethamphetamine Paramethoxymethamphetamine (PMMA) Metabolized to paramethoxyamphetamine 50 Analgesics Tapentadol Nucynta 50 Tramadol Tramacet Metabolized to O-desmethyltramadol 50 o O-desmethyltramadol Metabolite of tramadol 50 Anesthetics Ketamine Metabolized to norketamine 100 o Norketamine Metabolite of ketamine 100 Page 6 of 15 RTXMSJ06008UAH Toxicology Drug Testing Panels Rev: 1.73 CUT-OFF DRUG CLASS COMMON TRADE NAMES INTERPRETIVE CONCENTRATION2 ANALYTE DETECTED (STREET NAME) NOTES (NG/ML) Anticonvulsants Gabapentin Neurontin 10,000 Antihistamine Diphenhydramine\ Dimenhydrinate is the 8-chlorotheophylline 50 Dimenhydrinate salt of diphenhydramine Barbiturates Fiorinal (with codeine in some Butalbital 300 preparations) Phenobarbital Luminal, phenobarbitone 300 Benzodiazepines Flubromazepam prescription not available in Flubromazepam 50 Canada 7-Aminoclonazepam Metabolite of clonazepam (Rivotril) 50 7-Aminonitrazepam Metabolite of nitrazepam (Mogadon) 50 Alphahydroxyalprazolam Metabolite of alprazolam (Xanax) 50 Alphahydroxytriazolam Metabolite of triazolam (Halcion) 50 Page 7 of 15 RTXMSJ06008UAH Toxicology Drug Testing Panels Rev: 1.73 CUT-OFF DRUG CLASS COMMON TRADE NAMES INTERPRETIVE CONCENTRATION2 ANALYTE DETECTED (STREET NAME) NOTES (NG/ML) Benzodiazepines continued Bromazepam Lectopam 50 Clobazam Frisium Metabolized to norclobazam 50 o Norclobazam Metabolite of clobazam 50 Metabolite of chlordiazepoxide (Librium); Demoxepam 50 further metabolized to nordiazepam Metabolized to nordiazepam, temazepam, Diazepam Valium 50 oxazepam Metabolized to 3-hydroxyetizolam, Etizolam 50 prescription not available in Canada Metabolite of etizolam. Etizolam prescription o 3-Hydroxyetizolam 50 not available in Canada Flubromazolam Prescription not available in Canada 50 Lorazepam Ativan 50 Midazolam Versed Metabolized to 1-hydroxymidazolam 50 o 1-Hydroxymidazolam Metabolite of midazolam 50 Metabolite of diazepam (Valium) and Nordiazepam chlordiazepoxide (Librium); further 50 metabolized to oxazepam Metabolite of diazepam, temazepam, Oxazepam Serax 50 chlordiazepoxide Metabolite of diazepam; metabolized to Temazepam Restoril 50 oxazepam Page 8 of 15 RTXMSJ06008UAH Toxicology Drug Testing Panels Rev: 1.73 CUT-OFF DRUG CLASS COMMON TRADE NAMES INTERPRETIVE CONCENTRATION2 ANALYTE DETECTED (STREET NAME) NOTES (NG/ML) Cannabinoids Marijuana Metabolite (THC COOH) Sativex (Cannabis, Cannabinoids, Metabolite of tetrahydrocannabinol (THC) 15 (11-nor-9-tetrahydrocannabinol-9- Weed, Grass, THC) carboxylic acid) Cutting Agents Cutting agent – may cause profound Levamisole 50 neutropenia Phenacetin Cutting agent 25 Xylazine Cutting agent 50 Cocaine and Related Compounds Cocaine (crack, blow, snow) Metabolized to a variety of metabolites 50 Benzoylecgonine Metabolite of cocaine 150 Metabolite arising from simultaneous use of Cocaethylene 25 cocaine and ethanol Page 9 of 15 RTXMSJ06008UAH Toxicology Drug Testing Panels Rev: 1.73 CUT-OFF DRUG CLASS COMMON TRADE NAMES INTERPRETIVE CONCENTRATION2 ANALYTE DETECTED (STREET NAME) NOTES (NG/ML) Opioids 6-Acetylmorphine 6-monoacetylmorphine (6-MAM) Metabolite of heroin (diacetylmorphine) 5 Tylenol with codeine, Tylenol No. 2, Codeine Tylenol No. 3, Tylenol No. 4, codeine Metabolized to morphine and hydrocodone 50 phosphate and others Metabolite of codeine; metabolized to MS Contin, M-Eslon, Kadian and Morphine hydromorphone; potentially detected after 150 others poppy seed consumption Metabolite of codeine; metabolized to Hydrocodone Vicodin 50 hydromorphone o Norhydrocodone Metabolite of hydrocodone 50 Hydromorphone Dilaudid, Hydromorph Contin, Jurnista Metabolite of hydrocodone 50 Oxycontin, OxyNeo, Percocet, Metabolized to noroxycodone and Oxycodone 50 Percodan oxymorphone o Noroxycodone Metabolite of oxycodone 50 Oxymorphone Prescription not available in Canada Metabolite of oxycodone Not Reported Metabolite of oxymorphone and naloxone; o Noroxymorphone 50 naltrexone pharmaceutical impurity Page 10 of 15 RTXMSJ06008UAH Toxicology Drug Testing Panels Rev: 1.73 CUT-OFF DRUG CLASS COMMON TRADE NAMES
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  • Flualprazolam Sample Type: Biological Fluid

    Flualprazolam Sample Type: Biological Fluid

    Flualprazolam Sample Type: Biological Fluid Latest Revision: June 25, 2019 Date of Report: June 25, 2019 1. GENERAL INFORMATION IUPAC Name: 8-chloro-6-(2-fluorophenyl)-1-methyl-4H-[1,2,4]triazolo[4,3- a][1,4]benzodiazepine InChI String: InChI=1S/C17H12ClFN4/c1-10-21-22-16-9-20-17(12-4-2-3-5- 14(12)19)13-8-11(18)6-7-15(13)23(10)16/h2-8H,9H2,1H3 CFR: Not Scheduled (06/2019) CAS# 28910-91-0 Synonyms: 2’-Fluoro Alprazolam, ortho-Fluoro Alprazolam Source: NMS Labs – Toxicology Department 2. CHEMICAL DATA Chemical Molecular Molecular Exact Mass Analyte Formula Weight Ion (M) [M+H]+ Flualprazolam C17H12ClFN4 326.75 326 327.0807 Important Note: All identifications were made based on evaluation of analytical data (LC-QTOF) in comparison to analysis of acquired reference material. Report Prepared By: Alex J. Krotulski, MSFS, and Barry K. Logan, PhD, F-ABFT 3. SAMPLE HISTORY Flualprazolam has been identified in three cases since March 2018. The geographical and demographic breakdown is below: Geographical Location: Pennsylvania (n=2), Indiana (n=1) Biological Sample: Blood (n=3) Date of First: Collection: March 8, 2018 Receipt: March 10, 2018 Date of Most Recent: Collection: June 3, 2019 Receipt: June 7, 2019 Additional NPS: Etizolam (n=2), Clonazolam (n=1), Flubromazolam (n=1) 4. BRIEF DESCRIPTION Flualprazolam is classified as a novel benzodiazepine, although its synthesis and activity have been previously described in the literature.1 Benzodiazepines are central nervous system depressants. Novel benzodiazepines, often pirated from early drug discovery or pharmaceutical studies, have appeared on novel and illicit drug markets in recent years.