Comprehensive Drug Screen Limits of Detection

Background

The comprehensive drug screen was designed to rapidly detect the presence of a broad array of compounds in patients presenting with a possible overdose. It consists of screening immunoassays for several drugs or drug classes, a quantitative enzymatic assay for ethanol and a gas chromatography-mass spectrometry (GC/MS) assay for a wide variety of therapeutic and abused drugs, as listed below. The assay can be run on miscellaneous pills, powders and liquids to identify a suspected ingested substance that a patient might arrive with at the hospital, and in this case, only the GC/MS assay is performed.

Because of the intended primary use of the comprehensive drug screen, the GC/MS assay was designed for rapid detection of a wide range of drugs when present at overdose concentrations, rather than for high sensitivity for any specific drug. As a result, drugs present at therapeutic concentrations may not always be detected. This limits the utility of the comprehensive drug screen for monitoring compliance or for confirming the results of screening immunoassays. Positive findings by GC/MS are highly reliable, due to the high specificity of mass spectrometry. However, negative results do not necessarily indicate the absence of the drug in question. When it is important to detect the presence of any amount of a drug, one should choose an assay designed specifically to measure the drug in question, and not a screening test.

The screening immunoassays cutoffs given are the concentrations above which the assay is reported as positive; note that a drug present below the cutoff will be reported as negative on an immunoassay screen even though it is present. The immunoassay sensitivities are listed for specific drugs, but each assay can detect related compounds with similar but variable sensitivities (i.e. the opiates assay detects morphine and codeine similarly, but oxycodone is detected poorly). Contact the laboratory with any questions about the cross-reactivity of any specific drug with this assay.

The GC/MS comprehensive screen drugs are listed with the minimum concentration of a spiked drug that was detected in a urine sample during the validation of the analytical method. Because of the complexity of this test, and because the test is not run in a quantitative mode, these sensitivities should only be used in concert with other clinical and historical data to guide clinical interpretation. In some cases, as with fentanyl, drugs are included on this list because the assay is also used to detect the drug in pharmaceutical preparations. In these cases, the claimed sensitivity is inadequate to detect the presence of the drug in urine even after an overdose.

Screening immunoassay panel (qualitative)

Drug Class Cutoff Concentration of Representative Drug
AMPHETAMINES 500 ng/mL d-methamphetamine
BARBITURATES 200 ng/mL secobarbital
BENZODIAZEPINES 200 ng/mL lormetazepam
CANNABINOIDS 50 ng/mL 11-nor-Δ9-THC-COOH
COCAINE METABOLITE 150 ng/mL benzoylecgonine
FENTANYL 1 ng/mL fentanyl
METHADONE 150 ng/mL methadone
OPIATES 300 ng/mL morphine
PHENCYCLIDINE 25 ng/mL PCP
SALICYLATE 10 mg/dL salicylic acid
TRICYCLIC ANTIDEPRESSANTS 1000 ng/mL nortriptyline
ACETAMINOPHEN 5 mcg/mL acetaminophen

Enzymatic assay (quantitative)

ETHANOL <10 mg/dL ethanol reported as negative

Comprehensive screen - GC/MS assay (qualitative)

Drug Detectable Urine Concentration
ACETAMINOPHEN (Tylenol) 1 mcg/mL
ACETYL-FENTANYL 100 ng/mL
ALFENTANIL 200 ng/mL
ALPRAZOLAM (Xanax) 500 ng/mL
AMANTADINE (Symmetrel) 100 ng/mL
7-AMINOCLONAZEPAM (Clonazepam metabolite) 500 ng/mL
AMITRIPTYLINE (Elavil) 100 ng/mL
AMOBARBITAL (Amytal) 100 ng/mL
AMOXAPINE (Ascendin) 1mcg/mL
AMPHETAMINE 100 ng/mL
AMPHETAMINE ARTIFACT 100 ng/mL
ANABASINE

100 ng/mL

4-ANPP 100 ng/mL
ATROPINE 100 ng/mL
BENZOYLECGONINE (Cocaine metabolite) 20 mcg/mL
BENZTROPINE (Cogentin) 100 ng/mL
1-BENZYLPIPERAZINE 1 mcg/mL
BROMPHENIRAMINE (Dimetapp) 100 ng/mL
BUPRENORPHINE 2 mcg/mL
BUPROPION (Wellbutrin) 100 ng/mL
BUPROPION METABOLITE 200 ng/mL
BUPIVACAINE 100 ng/mL
BUSPIRONE 100 ng/mL
BUTALBITAL 100 ng/mL
CAFFEINE 100 ng/mL
CARBAMAZEPINE (Tegretol) 100 ng/mL
10, 11-CARBAMAZEPINE EPOXIDE (Carbamazepine metabolite) 1 mcg/mL
CARFENTANIL

200 ng/mL

CARISOPRODOL (Soma) 100 ng/mL
CHLORDIAZEPOXIDE 100 ng/mL
CHLORPHENIRAMINE 100 ng/mL
CHLORPROMAZINE (Thorazine) 100 ng/mL
CITALOPRAM / ESCITALOPRAM 100 ng/mL
CLOMIPRAMINE (Anafranil) 100 ng/mL
CLONAZEPAM 400 ng/mL
CLONIDINE 100 ng/mL
CLOZAPINE (Clozaril, Leponex) 100 ng/mL
CLOZAPINE METABOLITE 1 mcg/mL
COCAETHYLENE 100 ng/mL
COCAINE 100 ng/mL
CODEINE 100 ng/mL
COTININE (Nicotine metabolite) 100 ng/mL
CYCLIZINE 100 ng/mL
CYCLOBENZAPRINE 100 ng/mL
DELTA-9 THC COOH 1 mcg/mL
DESIPRAMINE (Norpramin) 1 mcg/mL
DESMETHYLDOXEPIN (Nordoxepin) 1 mcg/mL
DEXTROMETHORPHAN 100 ng/mL
DEXTRORPHAN (Dextromethorphan metabolite; see LEVORPHANOL) 100 ng/mL
DIACETYLMORPHINE (Heroin) 100 ng/mL
DIAZEPAM (Valium) 20 ng/mL
DIHYDROCODEINE 100 ng/mL
DILTIAZEM (Cardizem) 100 ng/mL
DIPHENHYDRAMINE / DIMENHYDRINATE (Benadryl/Dramamine) 100 ng/mL
DISOPYRAMIDE (Norpace, Rythmodan) 100 ng/mL
DOXEPIN 100 ng/mL
DOXYLAMINE 100 ng/mL
DULOXETINE > 40 mcg/mL
ECGONINE METHYL ESTER (Cocaine metabolite) 100 ng/mL
EDDP (Methadone metabolite) 100 ng/mL
EPHEDRINE / PSEUDOEPHEDRINE 400 ng/mL
ETHOTOIN 100 ng/mL
ETOMIDATE 100 ng/mL
FENTANYL 1 mcg/mL
FLUCONAZOLE 100 ng/mL
FLUOXETINE (Prozac) 1 mcg/mL
FLUPHENAZINE 10 mcg/mL
FLURAZEPAM (Dalmane) 1 mcg/mL
FURANYL FENTANYL 100 ng/mL
GABAPENTIN (Neurontin) 30 mcg/mL
GEMFIBROZIL 1 mcg/mL
GLUTETHIMIDE (Doriden) 100 ng/mL
GUAIFENESIN/METHOCARBAMOL 1 mcg/mL
HALOPERIDOL (Haldol) 1 mcg/mL
HYDROCODONE 1 mcg/mL
HYDROMORPHONE (Dilaudid) 10 mcg/mL
HYDROXYZINE (Atarax, Vistaril) 5 mcg/mL
4-HYDROXYL XYLAZINE 1 mcg/mL
IBUPROFEN (Advil, Motrin) 1 mcg/mL
IMIPRAMINE (Tofranil) 20 ng/mL
JWH-018 [1-pentyl-3-(1-naphthoyl)indole] 2 mcg/mL
KETAMINE 100 ng/mL
LAMOTRIGINE 1 mcg/mL
LEVAMISOLE 100 ng/mL
LEVETIRACETAM (Keppra) 100 ng/mL
LEVORPHANOL/DEXTRORPHAN (optical isomers) 100 ng/mL
LIDOCAINE (Xylocaine) 100 ng/mL
LOXAPINE 100 ng/mL
MEDETOMIDINE 100 ng/mL
MEPERIDINE (Demerol) 100 ng/mL
MEPHOBARBITAL 100 ng/mL
MEPHEDRONE

100 ng/mL

MEPIVACAINE 10 ng/mL
MEPROBAMATE (Equanil, Miltown) 100 ng/mL
METAXALONE 100 ng/mL
METHADONE (Dolophine) 100 ng/mL
METHADONE METABOLITE (EDDP) 100 ng/mL
METHAMPHETAMINE 200 ng/mL
METHAQUALONE (Quaalude) 50 ng/mL
METHCATHINONE 100 ng/mL
METHOCARBAMOL (Robaxin) 1 mcg/mL
METHOXYACETYL FENTANYL 100 ng/mL
METHSUXIMIDE 100 ng/mL
METHYL SALICYLATE 5 mcg/mL
METHYLENEDIOXYAMPHETAMINE (MDA) 1 mcg/mL
METHYLENEDIOXYMETHAMPHETAMINE (MDMA) 100 ng/mL
METHYLENEDIOXYPYROVALERONE 100 ng/mL
METHYLPHENIDATE (Ritalin, Concerta) 100 ng/mL
METHYPRYLON 50 ng/mL
METOCLOPRAMIDE (Reglan) 500 ng/mL
METOPROLOL (Lopressor) 10 mcg/mL
METRONIDAZOLE (Flagyl) 1 mcg/mL
MIDAZOLAM (Versed) 100 ng/mL
MIRTAZAPINE 100 ng/mL
6-MONOACETYLMORPHINE (Heroin metabolite) 100 ng/mL
MORPHINE 200 ng/mL
MITRAGYNINE 2.5 mcg/mL
N-ACETYL PROCAINAMIDE (NAPA) 2 mcg/mL
NALBUPHINE 1.25 mcg/mL
NAPROXEN (Aleve, Naprosyn) 10 mcg/mL
NICOTINE 100 ng/mL
NORBUPRENORPHINE 2 mcg/mL
NORDIAZEPAM 100 ng/mL
NORFENTANYL 100 ng/mL
NORFLUOXETINE 1 mcg/mL
NORKETAMINE 100 ng/mL
NORMEPERIDINE 100 ng/mL
NORTRIPTYLINE (Aventyl) 100 ng/mL
NORVERAPAMIL 2 mcg/mL
OLANZAPINE (Zyprexa) 100 ng/mL
OXAZEPAM (Serax) 30 mcg/mL
OXCARBAZEPINE (Trileptal, Trexapin) 1 mcg/mL
OXYCODONE (Oxycontin) 100 ng/mL
OXYMORPHONE (Numorphan) 5 mcg/mL
PAPAVERINE 1 mcg/mL
PARAXANTHINE (Caffeine metabolite) 2 mcg/mL
PAROXETINE (Paxil) 1 mcg/mL
PENTAZOCINE (Talwin) 100 ng/mL
PENTOBARBITAL 100 ng/mL
PENTOXIFYLLINE (Trental) 100 ng/mL
PHENACETIN 1 mcg/mL
PHENAZOPYRIDINE 10 mcg/mL
PHENCYCLIDINE (PCP) 100 ng/mL
PHENETHYLAMINE 10 ng/mL
PHENIRAMINE 100 ng/mL
PHENOBARBITAL 1 mcg/mL
PHENOTHIAZINE 100 ng/mL
PHENTERMINE 1 mcg/mL
PHENYLBUTAZONE 100 ng/mL
PHENYLPROPANOLAMINE 4 mcg/mL
PHENYTOIN (Dilantin) 100 ng/mL
PRIMIDONE (Mysoline) 200 ng/mL
PROCAINAMIDE 2 mcg/mL
PROCAINE 2 mcg/mL
PROCHLORPERAZINE (Compazine) 1 mcg/mL
PROMETHAZINE (Phenergan) 100 ng/mL
PROPRANOLOL (Inderal) 1 mcg/mL
PROPOFOL 1 mcg/mL
PROPOXYPHENE (Darvon) 100 ng/mL
PSILOCIN 2 mcg/mL
PSILOCYBIN >8 mcg/mL
PYRILAMINE 200 ng/mL
QUETIAPINE 5 mcg/mL
QUINIDINE / QUININE (Optical isomers) 1 mcg/mL
RANITIDINE (Zantac) 1 mcg/mL
REMIFENTANIL 100 ng/mL
ROPIVACAINE 100 ng/mL
SALICYLAMIDE 1 mcg/mL
SCOPOLAMINE 100 ng/mL
SECOBARBITAL 100 ng/mL
SERTRALINE (Zoloft) 100 ng/mL
STRYCHNINE 1 mc-g/mL
SUFENTANIL 200 ng/mL
TEMAZEPAM (Restoril) 400 ng/mL
TETRAHYDROCANNABINOL 1 mcg/mL
THEOPHYLLINE 2 mcg/mL
THIOPENTAL (Pentothal) 100 ng/mL
THIORIDAZINE (Mellaril) 100 ng/mL
TOPIRAMATE (Topamax) 100 ng/mL
TRAMADOL (Ultram) 20 ng/mL
TRAZODONE (Desyrel) 2 mcg/mL
TRIAZOLAM (Halcion) 200 ng/mL
TRIFLUPROMAZINE 100 ng/mL
3-TRIFLUOROMETHYLPHENYL-PIPERAZINE 100 ng/mL
TRIHEXYPHENIDYL (Artane) 200 ng/mL
TRIMETHOPRIM (Monotrim) 1 mcg/mL
TRIMIPRAMINE 100 ng/mL
TRIPELENNAMINE 100 ng/mL
VALERYL FENTANYL 100 ng/mL
VALPROIC ACID (Depakene, Depakote) 2 mcg/mL
VENLAFAXINE (Effexor) 100 ng/mL
VERAPAMIL 1 mcg/mL
XYLAZINE 100 ng/mL
ZALEPLON (Sonata) 1 mcg/mL
ZOLPIDEM (Ambien) 500 ng/mL
ZOPICLONE (Lunesta) 1 mcg/mL

Associated Tests

Code Name Specimen
UDRSCG Comprehensive Drug Screen, Urine Urine

Last updated 2025-09-16T20:03:33.980616+00:00