VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN

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VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain Table B-2. Urine Toxicology Screening Federal Work Place Cut Off Values [189-195] Extended UTS Regular UTS Initial drug test level (immunoassay) (ng/mL) Confirmatory drug test level (GCMS) (ng/mL) Confirmatory test analyte Marijuana metabolites 50 15 THCA Detection Period after Last Dose (days) 1 2-8 single use 20-30 chronic use 2 Cocaine metabolites 300 150 Benzyolyecgonine 1-3 Opioid metabolites 2000 3 2000 3 Morphine Codeine 6-MAM 2-3 days opiates 3-5 minutes heroin 12-24 hr 6-MAM Oxycodone 2-4 Amphetamines 1000 500 Amphetamine Methamphetamine MDMA, MDA, MDEA Methamphetamine Incomplete data 500 3-4 Benzodiazepines 300 200 Barbiturates 300 200 1-3 3 short-acting 30 long-acting 1 short-acting 21 long-acting Methadone 300 200 EDDP 3-6 Alcohol EtG, EtS 12 hr 1 Detection time for most drugs in urine is 1-3 days 2 Long-term use of lipid-soluble drugs (THC, diazepam, ketamine) can be detected for a longer period of time 3 Testing levels for opiates were raised from 300 ng/mL to 2000 ng/mL to reduce detection from foods containing poppy seeds Abbreviations: 6-MAM: 6-monoacetylmorpine; EDDP: 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine; EtG: ethyl glucuronide; EtS: ethyl sulfate; GCMS: gas chromatography-mass spectrometry; hr: hour(s); MDA: 3,4- methylenedioxy-amphetamine; MDEA: 3,4-methylenedioxy-N-ethyl-amphetamine; MDMA: 3,4-methylenedioxymethamphetamine; mL: milliliter(s); ng: nanogram(s); THC: tetrahydrocannabinol; THCA: delta-9- tetrahydrocannabinol-9-carboxylic acid; UTS: urine toxicology screening February 2017 Page 76 of 192
VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain Table B-3. Summary of Agents Potentially Contributing to False Positives [189-194] Agent Marijuana metabolites • dronabinol • efavirenz Summary of Agents Potentially Contributing to False Positives • NSAIDs 1 • proton pump inhibitors Cocaine metabolites • coca leaf teas • topical anesthetics containing cocaine Opioid metabolites Amphetamines/ Methamphetamine (high rate of false positives) • dextromethorphan • flouroquinolones • levofloxacin • amantadine • benzphetamine • brompheniramine • bupropion • chlorpromazine • desipramine • dextroamphetamine • doxepin • ephedrine • fluoxetine • ofloxacin • poppy seeds • poppy oil Benzodiazepines • oxaprozin • sertraline Barbiturates • ibuprofen • naproxen Methadone • chlorpromazine • clomipramine • diphenhydramine • isometheptene • isoxsuprine • labetalol • l-methamphetamine (OTC nasal inhaler) • methylphenidate • MDMA • phentermine • phenylephrine • doxylamine • ibuprofen • quetiapine • hemp foods: tea, oil 2 • rifampin • quinine • propanolamine • promethazine • pseudoephedrine • ranitidine • selegiline • thioridazine • trazodone • trimethobenzamide • trimipramine • thioridazine • verapamil Alcohol • mouthwash • short-chain alcohols • OTC cough products (isopropyl alcohol) 1 Detection time for most drugs in urine is 1-3 days 2 Long-term use of lipid-soluble drugs (THC, diazepam, ketamine) can be detected for a longer period of time Abbreviations: NSAIDs: non-steroidal anti-inflammatory drugs; MDMA: 3,4-methylenedioxy-methamphetamine; OTC: over the counter; THC: tetrahydrocannabinol February 2017 Page 77 of 192
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VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN

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