• modify their urine sample with chemicals
• drink large amounts of water prior to testing to dilute their sample

Historically, “instant” urine drug testing has been used for pre-employment, workplace monitoring, and law enforcement applications. In these instances, results were used to verify that individuals are not under the influence or abusing drugs. Standard cut-off levels (normally as high as 300 or 2,000ng/mL for opiates) are adequate for detecting drug concentrations in their most basic form. However, standard cut-off levels are not effective in providing accurate assessments of patient compliance, or to monitor detox. Medication monitoring and the most accurate drug testing requires much lower cut-off levels that can only be achieved at a lab. DRUGSCAN cut-off levels are designed to achieve 100% accuracy.

POCT devices and analyzers are based on immunoassay technologies, which not only have elevated cut-offs but also are unable to identify specific drugs within a class. DRUGSCAN uses the most advanced technology that provides a unique “chemical fingerprint” for the drug in question, enabling positive identification and quantitation at very low levels.

Manufacturers’ instructions regarding POCT devices suggest subsequent quantification by a more specific method, such as LC/MS/MS. LC-MS/MS should be used when deemed medically necessary for the following reasons:

• A more sensitive method is required allowing for better detection of individual drugs and metabolites
• A more specific result is required that identifies both drug classes and specific drugs and metabolites within that class

This can happen when you rely solely on a POCT device or in office analyzer to determine results. Such devices recognize drug classes based on their “chemical shape” and most commonly change color when that shape is recognized. If other drugs with similar chemical shapes are present in the sample, this can result in a "false positive."

Sustiva, Protonix, and other proton pump inhibitors can cause individuals to test positive for THC, while common antibiotics such as amoxicillin can cause a person to test positive for cocaine on certain POCT devices. DRUGSCAN uses advanced technology to confirm specific drugs and metabolites with 100% accuracy.

Morphine is not known to metabolize to codeine. Trace urinary codeine concentrations may be present in individuals on high doses of morphine due to codeine impurities in the morphine tablet. The presence of this codeine impurity is well documented and can account for low concentrations of codeine detected in the urine from patients who have been prescribed relatively high doses of morphine for extended periods of time.

When the morphine concentration is low, this trace codeine impurity is undetectable; however, at high morphine concentrations, codeine may increase slightly above the minimum detection limit. That is why detection levels must not be too high or too low and set at just the right level to make a good decision.

There are many variables associated with urine drug levels. Caution should be used when interpreting quantitative levels. A few common reasons for the differences in urine levels for two patients on the same dose of drug include urine pH, co-administration of other drugs, hydration level, cardiac output, timing between dose and specimen collection, and possibly patient non-compliance.

While DRUGSCAN confirmation testing can accurately detect specific medications, drugs, and metabolites and demonstrate recent use; it is very difficult to correlate urine drug concentration with a patient’s dose because of the criteria listed above.