Drug Toxicology Benzodiazepines, with Confirmation, Oral Fluid

Included Tests

Alprazolam, Chlordiazepoxide, Clonazepam, Diazepam, Flunitrazepam, Flurazepam, Lorazepam, Midazolam, Nordiazepam, Oxazepam, Temazepam, Triazolam

Clinical Significance

Oral fluid is composed of saliva, mixed with buccal and mucosal transudates, cellular debris, bacteria, and residue of ingested products. Oral fluid as a test matrix shows promise for detection of recent drug use, and a significant body of scientific literature documents aspects such as drug disposition and detection times. Researchers comparing the effectiveness of oral fluid testing with urine drug testing found a similar pattern and frequency of positive drug test results in the general workforce over the same general period. Similarly in pain clinics, the pattern of licit and illicit drugs and metabolites observed in oral fluid paralleled results reported for urine, with some minor differences in detection rates for different drug classes. In some cases, oral fluid testing may be an acceptable alternative or the only available matrix. As an ultra-filtrate of blood, however, it shares the limitations of a decreased window of detection versus conventional urine drug testing.

Patient Preparation

Quantisal™: Avoid any food or drink consumption, or gum or tobacco use for 10 minutes prior to collecting. If donor's mouth is not empty immediately prior to collection, have subject rinse mouth with water (up to 4 oz) and wait a minimum of 10 minutes before collecting a specimen 

Specimen Requirements

1.0 mL oral fluid submitted in Quantisal™ collection device

Alternate Specimen

 

TransportAndStorage

72 hours Ambient
7 days Refrigerated
30 days Frozen

Store refrigerated 2-8°C if not delivered to the testing site (Quest) within 48 hours of collection

Collection Instructions

1 mL oral fluid inserted into 3 mL buffer tube collected in Quantisal™ device

If donor's mouth is not empty immediately prior to collection, have subject rinse his/her mouth with water (up to 4 oz) and wait a minimum of 10 minutes before collecting a specimen. Collect random oral fluid sample in a standard Oral-Eze® collection container.

Quantisal™: Using the standard Quantisal™ collection container - Follow collection instructions on package.

• Place the swab under the tongue.
• Donor should keep head down to allow gravity to help with saliva collection.
• Leave in place until blue dye indicates that the collection pad is saturated sufficiently.

Minimum Volume

2.0 mL Oral Fluid

Neonatal Volumne

Reference Range:

Refer to Interpretive Results

Test Comments:

If screening drug class result is equal to or greater than the cutoff, then confirmation testing will be performed at an additional charge (CPT code(s): 80346).

Methodology:

• Mass Spectrometry (MS)

Clinical Significance

Oral fluid is composed of saliva, mixed with buccal and mucosal transudates, cellular debris, bacteria, and residue of ingested products. Oral fluid as a test matrix shows promise for detection of recent drug use, and a significant body of scientific literature documents aspects such as drug disposition and detection times. Researchers comparing the effectiveness of oral fluid testing with urine drug testing found a similar pattern and frequency of positive drug test results in the general workforce over the same general period. Similarly in pain clinics, the pattern of licit and illicit drugs and metabolites observed in oral fluid paralleled results reported for urine, with some minor differences in detection rates for different drug classes. In some cases, oral fluid testing may be an acceptable alternative or the only available matrix. As an ultra-filtrate of blood, however, it shares the limitations of a decreased window of detection versus conventional urine drug testing.

CDM

0919303 (0918880)

CPT Coding

80307 (80346)