Urine toxicology screen
- Urine drug screen (UDS / UTOX) is typically ordered in trauma, psych, and altered mental status patients where there results can assist inpatient management.
- Cooperative psych patients do not require Utox as part of the ED screen (unless local policy dictates)
- Routine testing of activated traumas is reasonable, but discretionary testing of nonactivated traumas should be adopted
- Unlikely to have any significant impact on the management of ED patients
- Drug testing alone never significantly better than history
- Appropriate in pediatric altered mental status workup, determining brain death, management of psychiatric disease (dual diagnosis treatment), and in trauma victim patients (substance abuse counseling).
|Screen||Interval (Prolonged Use)|
|Amphetamines||1-2 d (2-4 d)|
|Cannabinoids||1-3 d (>1 mo)|
|Cocaine||2 d (1 wk)|
|Opiates||1-4 d (<1 wk)|
|Phencyclidine||4-7 d (>1 mo)|
|Amphetamines||Amantadine, bupropion, chlorpromazine, desipramine. fluoxetine, L-methamphetamine, labetalol, methylphenidate, phentermine, phenylephrine, phenylpropanolamine, promethazine, pseudoephedrine, ranitidine, thioridazine, trazodone|
|Cannabinoids||Dronabinol, nonsteroidal anti-inflammatory drugs, proton pump inhibitors|
|Cocaine||Topical anesthetics containing cocaine|
|Opiates||Dextromethorphan, diphenhydramine, fluoroquinolones, poppy seeds, quinine, rifampin, verapamil|
|Phencyclidine||Dextromethorphan, diphenhydramine, ibuprofen, imipramine, ketamine, meperidine, thioridazine, tramadol, venlafaxine|
True Positives and False Negatives
- Most benzodiazepine screens look for oxazepam which is a metabolite of diazepam and chlordiazepoxide. Therefore, lorazepam, alprazolam, and clonazepam are commonly missed.
|Amphetamines||MDA & MDMA|
|Benzodiazepines||Oxazepam, temazepam, diazepam, alprazolam, triazolam||Lorazepam, clonazepam, midazolam|
|Opiates||Morphine, Codeine, Heroin||Fentanyl, tramadol, meperidine, methadone, oxycodone, buprenorphine, hydrocodone, hydromorphone|
|Phencyclidine||New screens are very specific|
- Lukens, TW, et al. Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department. Annals of Emergency Medicine. 2006; 47(1):79-99.
- Dunham CM, Chirichella, TJ. Trauma Activation Patients: Evidence for Routine Alcohol and Illicit Drug Screening. PLoS ONE. 2012; 7(10): e47999.
- Tenenbein M. Do you really need that emergency drug screen? Clin Toxicol (Phila). 2009 Apr;47(4):286-91. PMID:19514875
- Perrone J, De Roos F, Jayaraman S, Hollander JE. Drug screening versus history in detection of substance use in ED psychiatric patients. Am J Emerg Med. 2001 Jan;19(1):49-51. PMID: 11146019.
- Courtesy Kishan Kapadia and UMEM derived from Goldfrank's Toxicologic Emergencies, 9th ed; Table 6-10
- Standridge, JB, et al. Urine Drug Screening: A Valuable Office Procedure. Am Fam Physician. 2010; 81(5):635-640.
- Brahm N. et al.Commonly prescribed medications and potential false-positive urine drug screens Am J Health Syst Pharm August 15, 2010 67:1344-1350;