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CUTOFF AND TOXICITY LEVELS FOR DRUGS-OF-ABUSE AND TOXICOLOGY TESTING


Tis table summarizes information for the interpretation of drugs-of-abuse toxicology assays; originally developed by the late Daniel M. Baer, MD, and updated by Richard A. Paulson, MT(ASCP), supervisor of Chemistry and Toxicology, VA Medical Center, Portland, OR. Te table was updated and reviewed this year by Allison B. Chambliss, PhD, DABCC, FAACC, Director of Clinical Chemistry and Point of Care Testing, LAC and USC Medical Center, Assistant Professor of Clinical Pathology, Keck School of Medicine of USC (University of Southern California).


Drug (and example trade names)


Heroin (Diacetylmorphine)


Morphine (Duramorph)


Methadone (Dolophine)


Meperidine (Demerol, Pethidine)


Codeine (Analgesics with codeine)


Tramadol1 (Ultram, Tramal Ultracet)


Oxycodone (Oxycontin, OxyIR, Percocet, Percodan)


Hydrocodone (Lorcet, Vicodin, Lortab, Hycodan)


Hydromorphone (Dilaudid)


Fentanyl2 (Sublimaze,


Duragesic, Actiq, Fentora)


Lysergic acid diethylamide (LSD)


Marijuana and cannabinoids


Common street names


Horse, Smack, Junk, Brown Sugar, China White, H, Skag, White Horse, Skunk


M, White stuff, Miss Emma, Monkey


Fizzies with MDMA Chocolate Chip Cookies, Amidone


Demmies, Pain Killer


School boy, Captain Cody, Cody, Lean, Sizzurp,


Ultra T


Oxy, Oxycotton, O.C., Oxycet, Hillbilly Heroin, Percs


Vikes, Watson-387


Juice, Smack, D, Footballs, Dillies


Apache, China girl, China white, Dance fever, Friend, Goodfella, Jackpot,Murder 8, TNT, Tango and Cash


Acid, Blotter, Boomers, Cid, Golden Dragon, Looney Tunes, Lucy Mae, Microdots, Tabs, Yellow Sunshine


Weed, Mary Jane, Ganja, Sensemilla, Blunt, Bud, Doobie, Dope, Grass, Pot, Green, Herb, Joint, Smoke, Stinkweed, Trees


Phencyclidine Cocaine


PCP, Angel dust, Hog, Embalming Fluid, Rocket Fuel, Sherms


Coke, Crack, Flake, Snow


Amphetamine (Benzedrine, Dexedrine)


Methylene-3,4 dioxy- Methamphetamine (MDMA)


Methamphetamine (Desoxyn, Methedrine)


Speed, Bennies, Uppers, Dexies


Ecstasy, Adam, XTC, Love drug, Hug drug


Speed, Meth, Crystal ice, Crank


Typical duration in urine aſter last dose


1-2 days


Common positive cutoff concentrations for urine screening assay*


2000 ng/mL (as morphine) 150 ng/mL (for 6-monoacetylmorphine)


2 days 3 days 2-3 days 2 days 6 hours to 2 days 1-3 days 1-2 days 1-2 days 1-2 days


2000 ng/mL 300 ng/mL


300 ng/mL 200 ng/mL 150 ng/mL


200 ng/mL


2000 ng/mL 300 ng/mL


200 ng/mL


100 ng/mL 300 ng/mL


300 ng/mL 100 ng/mL 50 ng/mL


2000 ng/mL 300 ng/mL


1 ng/mL 2 ng/mL


Toxic blood level Blood reference/ therapeutic range


>200 ng/mL None detected


>200 ng/mL >2000 ng/mL >1000 ng/mL >1000 ng/mL >1000 ng/mL >200 ng/mL >100 ng/mL >100 ng/mL


>3 ng/mL (naïve patients)


10-80 ng/mL


For narcotic stabilization: 300-1000 ng/mL For pain: 100-400 ng mL


70-500 ng/mL 10-100 ng/mL


100-800 ng/mL, variable by patient and dosing regimen


10-100 ng/mL 10-40 ng/mL 10-30 ng/mL


0.6-3.0 ng/mL (highly variable; depends on dose and route of administration)


1-5 days


0.5 ng/mL 100 pg/mL


>2 ng/mL None detected


Single use: 2-7 days (as ∆9-THC-COOH) Prolonged use: 1-2 months (as ∆9-THC-COOH)


15-100 ng/mL


50-200 ng/mL


None detected


Single use: 1 week Prolonged use: 2-4 weeks


Single use: 1-3 days Prolonged use: 4 days


Single use: 48 hours Prolonged use: 7-10 days


Single use: 24 hours


Single use: 48 hours Prolonged use: 7-10 days


25 ng/mL


300 ng/mL 150 ng/mL (as metabolite benzoylecgonine)


500 ng/mL 1000 ng/mL


300 ng/mL 500 ng/mL 1000 ng/mL


500 ng/mL 1000 ng/mL


>100 ng/mL >1000 ng/mL


None detected None detected


>200 ng/mL 100-1000 ng/mL >500 ng/mL


20-30 ng/mL 20-30 ng/mL 10-50 ng/mL


*Based on common screening assays currently in use and CAP Proficiency Testing reporting (2020) unless otherwise indicated. Confirmation results by Gas Chromatography-Mass Spectrometry (GC-MS) or Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS) vary by laboratory.


10 CLR 2021-2022 • MLO • www.clr-online.com


Stimulants


Hallucinogens


OPIATES


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