Cut-off and toxicity levels for drugs-of-abuse testing - Clinical and Professional Reference Guides

Medical Laboratory Observer, August, 2003

This table summarizes information useful in the interpretation of
drugs-of-abuse assays. It was developed by Daniel M. Baer, MD,
professor emeritus of pathology, Oregon Health Sciences University,
Portland OR, and updated by Richard A. Paulson, MT(ASCP), supervisor
of chemistry and toxicology, VA Medical Center, Portland, OR. The
table was updated for CLR 2003-2004 by Robert H. Williams, PhD, DABCC,
FACB, MT (ASCP), Clinical Scientist/Consultant, Quest Diagnostics,
Inc. and Clinical Associate Professor of Pathology, University of
South Florida, both in Tampa, FL.

Drug (and              Some common        Detectable duration
trade name)            street names       in urine after
                                          last dose
OPIATES

Heroin                 Horse,             >24 hours
(Diacetylmorphine)     Stuff,             (total opiate)(S)(1)
                       Smack,             150 ng/mL (S)(2)
                       Junk,              (as 6-monacetyl morphine)
                                          18 ng/mL (C)(3)
                                          (as 6-monacetyl morphine)

Morphine               M,                 2 days
(Duramorph)            Junk,
                       Morpho,
                       White stuff

Methadone              Methadose          3 days
(Dolophine,
Amidone)

Meperidine             Fortis,            2-3 days
(Demerol, Pethidine)   Demies

Codeine                Rabo,              2 days
(Analgesics with       School boy
codeine)

Propoxyphene           Yellow,            6 hours to 2 days
(Darvon,               Footballs
Darvocet-N)

Oxycodone              Oxy,               1-3 days
(Oxycontin,            OC,

OxyIR, Percocet,       Oxycotton,
Percodan)              Killer

HALLUCINOGENS

Lysergic acid,         Acid,              1-5 days
diethylamide           Microdot,
(LSD)                  White lightning

Marijuana and          Marijuana,         Single use:
cannabinoids           Hashish,           2-7 days
                       Bhang,             (as [DELTA]9-THC-COOH)
                       Ganja,
                       Sensemilla         Prolonged use:
                                          1-2 months
                                          (as [DELTA]9-THC-COOH)

Phencyclidine          PCP,               Single use:
                       Angel dust,        1 week
                       Killer weed,
                       Hog                Prolonged use:

STIMULANTS

                                 2-4 weeks

Cocaine                Coke,              Single use:
                       Crack,             3 days
                       Flake,
                       Snow               Prolonged use:
                                          4 days

Amphetamine            Speed,             Single use:
(Benzedrine,           Bennies,           48 hours
Dexedrine)             Uppers,
                       Dexies             Prolonged use:
                                          7-10 days

Methylene-3,4 dioxy-   Ecstasy,           Single use:
Methamphetamine        Adam,              Urine: 24 hours
(MDMA)                 XTC,               Plasma: 5-6 hours
                       Love drug,
                       Hug drug

Methamphetamine        Speed,             Single use:
(Desoxyn,              Meth,              48 hours
Methedrine)            Crystal ice,
                       Crank              Prolonged use:
                                          7-10 days

BARBITURATES

Pentobarbital          Goof balls,        2 days
(Nembutal)             Downers,
                       Nembies,
                       Yellow jackets,
                       Yellow submarine

Secobarbital           Bullets,           2 days
(Seconal)              Pink ladies,
                       Reds

Butabarbital           Goof balls,        2 days
(Butisol)              Candy,
                       Peanuts,
                       Stoppers

Butalbital             Goof balls,        2 days
(Fiorinal)             Sleepers,
                       Stoppers,
                       Peanuts

Phenobarbital          Barbs,             1-3 weeks
                       Downers

ALCOHOLS, DIOLS, &
METABOLITES

Ethanol                Booze,             < 1 day
                       Hooch

Methanol               Wood               < 1 day
                       alcohol

Isopropanol            Rubbing            < 1 day
                       alcohol

Acetone                                   <1 day

Ethylene Glycol        Antifreeze         <1 day

SEDATIVES/HYPNOTICS/ANESTHETICS

Diazepam               Tranks,            Single use:
(Valium)               Downers,           Not detected
                       Blues,
                       Yellows,           Prolonged use:
                       Blue Magoo,        5-7 days
                       V                  (up to 30 days)

Oxazepam               Tranks,            Single use:
(Serax)                Downers,           Not detected
                       Blues,
                       Yellows            Prolonged use:
                                          5-7 days

Alprazolam             Tranks,            Single use:
(Xanax)                Downers,           Not detected
                       Blues,
                       Yellows            Prolonged use:
                                          5-7 days

Clonazepam             Tranks,            Single use:
(Klonopin)             Downers,           Not detected
                       Blues,
                       Yellows            Prolonged use:
                                          5-14 days

Chlordiazepoxide       Tranks,            Single use:
(Librium)              Downers,           Not detected
                       Blues,
                       Yellows            Prolonged use:
                                          5-7 days
Lorazepam              Tranks,            Single use:
(Ativan,               Downers,           Not detected
Loraz)                 Blues,
                       Yellows            Prolonged use:
                                          5-7 days

Flunitrazepam          Roofies,           72 hours
(Rohypnol)             Rib,
                       Rope,
                       Roach-2,
                       R-2

Gamma-                 GHB,               12 hours
Hydroxybutyrate        G-Caps,
(Somatomax)            Geebers,
                       Fantasy,
                       Liquid Ecstasy

Ketamine               Special K,         < 72 hours
Hydrochloride          Lady Kay,
(Ketajet)              Vitamin K,
                       Jet,
                       Cat Valium

Drug (and              Some common        Urine cut-off points
trade name)            street names       for reporting positive
                                          or limit of quantitation *

OPIATES

Heroin                 Horse,             2000 ng/mL
(Diacetylmorphine)     Stuff,             (as morphine)
                       Smack,
                       Junk,

Morphine               M,                 2000 ng/mL (S)(1)
(Duramorph)            Junk,              300 ng/mL (C)(3)
                       Morpho,
                       White stuff

Methadone              Methadose          300 ng/mL
(Dolophine,                               200 ng/mL (C)(3)
Amidone)

Meperidine             Fortis,            200 ng/mL (S)(2)
(Demerol, Pethidine)   Demies             200 ng/mL (C)(3)

Codeine                Rabo,              2000 ng/mL (S)(1)
(Analgesics with       School boy         300 ng/mL (C)(3) lethal)
codeine)

Propoxyphene           Yellow,            300 ng/mL (S)(1)
(Darvon,               Footballs          200 ng/mL (C)(3)
Darvocet-N)

Oxycodone              Oxy,               100-500 ng/mL (S)(1)
(Oxycontin,            OC,                (highly variable)
OxyIR, Percocet,       Oxycotton,         100-300 ng/mL (C)(3)
Percodan)              Killer             (highly variable)

HALLUCINOGENS

Lysergic acid,         Acid,              0.5 ng/mL (S)(1)
diethylamide           Microdot,          100 pg/mL (C)(4)
(LSD)                  White lightning

Marijuana and          Marijuana,         100, 50, 25, or
cannabinoids           Hashish,           20 ng/mL (S)(1)
                       Bhang,             15 ng/mL (C)(3)
                       Ganja,
                       Sensemilla

Phencyclidine          PCP,               25 ng/mL(S)(1)
                       Angel dust,        25 ng/mL (C)(3)
                       Killer weed,
                       Hog

STIMULANTS

Cocaine                Coke,              300 ng/mL (S)(1)
                       Crack,             150 ng/mL (C)(3)
                       Flake,
                       Snow

Amphetamine            Speed,             100 ng/mL (S)(1)
(Benzedrine,           Bennies,           500 ng/mL (C)(3)
Dexedrine)             Uppers,
                       Dexies

Methylene-3,4 dioxy-   Ecstasy,           3000-5000 ng/mL (S)(1)
Methamphetamine        Adam,              5 ng/mL (C)(3)
(MDMA)                 XTC,
                       Love drug,
                       Hug drug

Methamphetamine        Speed,             100 ng/mL (S)(1)
(Desoxyn,              Meth,              500 ng/mL (C)(3)
Methedrine)            Crystal ice,
                       Crank

BARBITURATES

Pentobarbital          Goof balls,        425 ng/mL (S)(1)
(Nembutal)             Downers,           200 ng/mL (C)(3)
                       Nembies,
                       Yellow jackets,
                       Yellow submarine

Secobarbital           Bullets,           200 ng/mL (S)(1)
(Seconal)              Pink ladies,       200 ng/mL (C)(3)
                       Reds

Butabarbital           Goof balls,        312 ng/mL (S)(1)
(Butisol)              Candy,             200 ng/mL (C)(3)
                       Peanuts,
                       Stoppers

Butalbital             Goof balls,        342 ng/mL (S)(1)
(Fiorinal)             Sleepers,          200 ng/mL (C)(3)
                       Stoppers,
                       Peanuts

Phenobarbital          Barbs,             505 ng/mL (S)(1)
                       Downers            200 ng/mL (C)(3)

ALCOHOLS, DIOLS, &
METABOLITES

Ethanol                Booze,             10 mg/dL
                       Hooch

Methanol               Wood               5 mg/dL (gas
                       alcohol            chromatography)

Isopropanol            Rubbing            5 mg/dL (gas
                       alcohol            chromatography)

Acetone                                   5 mg/dL (gas
                                          chromatography)

Ethylene Glycol        Antifreeze         5 mg/dL (gas
                                          chromatography)

SEDATIVES/HYPNOTICS/ANESTHETICS

Diazepam               Tranks,            160 ng/mL (S)(1)
(Valium)               Downers,           100 ng/mL (C)(3)
                       Blues,
                       Yellows,
                       Blue Magoo,
                       V

Oxazepam               Tranks,            240 ng/mL (S)(1)
(Serax)                Downers,           100 ng/mL (C)(3)
                       Blues,
                       Yellows

Alprazolam             Tranks,            240 ng/mL (S)(1)
(Xanax)                Downers,           100 ng/mL (C)(3)
                       Blues,
                       Yellows

Clonazepam             Tranks,            540 ng/mL (S)(1)
(Klonopin)             Downers,           100 ng/mL (C)(3)
                       Blues,
                       Yellows

Chlordiazepoxide       Tranks,            600 ng/mL (S)(2)
(Librium)              Downers,           100 ng/mL (C)(3)
                       Blues,
                       Yellows

Lorazepam              Tranks,            675 ng/mL (S)(1)
(Ativan,               Downers,           100 ng/mL (C)(3)
Loraz)                 Blues,
                       Yellows

Flunitrazepam          Roofies,           12-60 ng/mL (S)(1)
(Rohypnol)             Rib,               (Immunoassay)
                       Rope,              100 pg/mL (C)(4)
                       Roach-2,
                       R-2

Gamma-                 GHB,               1-10 mg/L (gas
Hydroxybutyrate        G-Caps,            chromatography;
(Somatomax)            Geebers,           gas chromatography,
                       Fantasy,           mass spectrometry)
                       Liquid Ecstasy

Ketamine               Special K,         15 ng/mL (S)(5)
Hydrochloride          Lady Kay,          (Immunoassay)
(Ketajet)              Vitamin K,         5-10 ng/mL (gas
                       Jet,               chromatography,
                       Cat Valium         mass spectrometry)

Drug (and              Some common        Toxic
trade name)            street names       blood level

OPIATES

Heroin                 Horse,             > 200 ng/mL
(Diacetylmorphine)     Stuff,
                       Smack,
                       Junk,

Morphine               M,                 > 200 ng/mL
(Duramorph)            Junk,
                       Morpho,
                       White stuff
Methadone              Methadose          1-2 [micro]g/mL
(Dolophine,
Amidone)

Meperidine             Fortis,            > 1000 ng/mL
(Demerol, Pethidine)   Demies

Codeine                Rabo,              > 1.1 [micro]g/mL
(Analgesics with       School boy
codeine)

Propoxyphene           Yellow,            > 500 ng/mL
(Darvon,               Footballs
Darvocet-N)

Oxycodone              Oxy,               > 200 ng/mL
(Oxycontin,            OC,
OxyIR, Percocet,       Oxycotton,
Percodan)              Killer

HALLUCINOGENS

Lysergic acid,         Acid,              > 2 ng/mL
diethylamide           Microdot,
(LSD)                  White lightning
Marijuana and          Marijuana,         50-200 ng/mL
cannabinoids           Hashish,
                       Bhang,
                       Ganja,
                       Sensemilla

Phencyclidine          PCP,               1 mg/mL
                       Angel dust,
                       Killer weed,
                       Hog

STIMULANTS

Cocaine                Coke,              > 1 [micro]g/mL
                       Crack,
                       Flake,
                       Snow

Amphetamine            Speed,             0.5-1.0 [micro]g/mL
(Benzedrine,           Bennies,
Dexedrine)             Uppers,
                       Dexies

Methylene-3,4 dioxy-   Ecstasy,           0.1-1.0 [micro]g/mL
Methamphetamine        Adam,
(MDMA)                 XTC,
                       Love drug,
                       Hug drug
Methamphetamine        Speed,             0.1-1.0 [micro]g/mL
(Desoxyn,              Meth,
Methedrine)            Crystal ice,
                       Crank

BARBITURATES

Pentobarbital          Goof balls,        > 11 [micro]g/mL
(Nembutal)             Downers,
                       Nembies,
                       Yellow jackets,
                       Yellow submarine

Secobarbital           Bullets,           > 10 [micro]g/mL
(Seconal)              Pink ladies,
                       Reds

Butabarbital           Goof balls,        20 [micro]g/mL
(Butisol)              Candy,
                       Peanuts,
                       Stoppers

Butalbital             Goof balls,        20 [micro]g/mL
(Fiorinal)             Sleepers,
                       Stoppers,
                       Peanuts
Phenobarbital          Barbs,             > 40 [micro]g/mL
                       Downers

ALCOHOLS, DIOLS, &
METABOLITES

Ethanol                Booze,             80-400 mg/dL
                       Hooch

Methanol               Wood               > 20 mg/dL
                       alcohol

Isopropanol            Rubbing            50 mg/dL
                       alcohol

Acetone                                   > 33 mg/dL (gas
                                          chromatography)

Ethylene Glycol        Antifreeze         > 50 mg/dL (gas
                                          chromatography)

SEDATIVES/HYPNOTICS/ANESTHETICS

Diazepam               Tranks,            Drug plus
(Valium)               Downers,           Metabolite:
                       Blues,             > 3.0 [micro]g/mL
                       Yellows,
                       Blue Magoo,
                       V

Oxazepam               Tranks,            > 1.4 [micro]g/mL
(Serax)                Downers,
                       Blues,
                       Yellows

Alprazolam             Tranks,            > 350 ng/mL
(Xanax)                Downers,
                       Blues,
                       Yellows

Clonazepam             Tranks,            > 80 ng/mL
(Klonopin)             Downers,
                       Blues,
                       Yellows

Chlordiazepoxide       Tranks,            > 23 [micro]g/mL
(Librium)              Downers,
                       Blues,
                       Yellows

Lorazepam              Tranks,            0.3-0.6 [micro]g/mL
(Ativan,               Downers,           0.05-0.24 [micro]g/mL
Loraz)                 Blues,
                       Yellows

Flunitrazepam          Roofies,           50 ng/mL (gas
(Rohypnol)             Rib,               chromatography
                       Rope,              mass spectrometry,
                       Roach-2,           LC-MS/MS)
                       R-2

Gamma-                 GHB,               > 250 mg/L (gas
Hydroxybutyrate        G-Caps,            chromatography,
(Somatomax)            Geebers,           mass spectrometry)
                       Fantasy,
                       Liquid Ecstasy

Ketamine               Special K,         > 7-27 [micro]g/mL
Hydrochloride          Lady Kay,          (highly variable)
(Ketajet)              Vitamin K,
                       Jet,
                       Cat Valium

Drug (and              Some common        Blood reference
trade name)            street names       (therapeutic) range

OPIATES

Heroin                 Horse,             None detected
(Diacetylmorphine)     Stuff,
                       Smack,
                       Junk,

Morphine               M,                 65-80 ng/mL
(Duramorph)            Junk,
                       Morpho,
                       White stuff
Methadone              Methadose          For narcotic stabilization:
(Dolophine,                               300-1000 ng/mL
Amidone)                                  For pain: 50-100 ng/mL

Meperidine             Fortis,            70-500 ng/mL
(Demerol, Pethidine)   Demies

Codeine                Rabo,              13-33 ng/mL
(Analgesics with       School boy
codeine)

Propoxyphene           Yellow,            100-400 ng/mL
(Darvon,               Footballs
Darvocet-N)

Oxycodone              Oxy,               10-100 ng/mL
(Oxycontin,            OC,

OxyIR, Percocet,       Oxycotton,
Percodan)              Killer

HALLUCINOGENS

Lysergic acid,         Acid,              None detected
diethylamide           Microdot,          5-20 ng/mL
(LSD)                  White lightning    (clinical studies)

Marijuana and          Marijuana,         None detected
cannabinoids           Hashish,
                       Bhang,
                       Ganja,
                       Sensemilla

Phencyclidine          PCP,               None detected
                       Angel dust,
                       Killer weed,
                       Hog

STIMULANTS

Cocaine                Coke,              100-500 ng/mL
                       Crack,
                       Flake,
                       Snow

Amphetamine            Speed,             30-50 ng/mL
(Benzedrine,           Bennies,
Dexedrine)             Uppers,
                       Dexies

Methylene-3,4 dioxy-   Ecstasy,           20-30 ng/mL
Methamphetamine        Adam,
(MDMA)                 XTC,
                       Love drug,
                       Hug drug

Methamphetamine        Speed,             20-30 ng/mL
(Desoxyn,              Meth,
Methedrine)            Crystal ice,
                       Crank

BARBITURATES

Pentobarbital          Goof balls,        < 10 [micro]g/mL
(Nembutal)             Downers,
                       Nembies,
                       Yellow jackets,
                       Yellow submarine

Secobarbital           Bullets,           1-5 [micro]g/mL
(Seconal)              Pink ladies,
                       Reds

Butabarbital           Goof balls,        3-25 [micro]g/mL
(Butisol)              Candy,
                       Peanuts,
                       Stoppers

Butalbital             Goof balls,        5-15 [mcro]g/mL
(Fiorinal)             Sleepers,
                       Stoppers,
                       Peanuts

Phenobarbital          Barbs,             10-40 [micro]g/ml
                       Downers

ALCOHOLS, DIOLS, &
METABOLITES

Ethanol                Booze,             100-150 mg/dL
                       Hooch              (for treatment of toxic
                                          alcohols)
Methanol               Wood               < 0.5 mg/dL
                       alcohol

Isopropanol            Rubbing            None detected
                       alcohol
Acetone                                   < 1.0 mg/dL

Ethylene Glycol        Antifreeze         None detected

SEDATIVES/HYPNOTICS/ANESTHETICS

Diazepam               Tranks,            Drug plus
(Valium)               Downers,           Metabolite:
                       Blues,             0.2-2.0 [micro]g/mL
                       Yellows,
                       Blue Magoo,
                       V

Oxazepam               Tranks,            0.2-1.4 [micro]g/mL
(Serax)                Downers,
                       Blues,
                       Yellows

Alprazolam             Tranks,            20-30 ng/mL
(Xanax)                Downers,
                       Blues,
                       Yellows

Clonazepam             Tranks,            10-50 ng/mL
(Klonopin)             Downers,
                       Blues,
                       Yellows

Chlordiazepoxide       Tranks,            0.1-3.0 [micro]g/mL
(Librium)              Downers,
                       Blues,
                       Yellows

Lorazepam              Tranks,            50-240 ng/mL
(Ativan,               Downers,
Loraz)                 Blues,
                       Yellows

Flunitrazepam          Roofies,           5-15 ng/mL
(Rohypnol)             Rib,
                       Rope,
                       Roach-2,
                       R-2

Gamma-                 GHB,               48-125 mg/L
Hydroxybutyrate        G-Caps,            (for narcolepsy)
(Somatomax)            Geebers,
                       Fantasy,
                       Liquid Ecstasy

Ketamine               Special K,         0.5-6.3 [micro]g/mL
Hydrochloride          Lady Kay,
(Ketajet)              Vitamin K,
                       Jet,
                       Cat Valium

NOTE: Refer to manufacturer's insert for information on other
Benzodiazepines and metabolites.

* Commonly accepted cut-off values; may be different for specific
jurisdictions and methods. Sensitivities to various drugs are
method-specific. Sensitivity/cut-off data are from method
literature and package inserts.

(S)= Screening cut-off (C)= Confirmation cut-off or Limit of
Quantitation (LOQ)

(1) Screening single-use immunoassay device (consult package insert
for specific method)

(2) High-performance liquid chromatography (HPLC)

(3) Gas Chromatography-Mass spectrometry (GC-MS)

(4) Liquid Chromatography--mass spectrometry/mass spectrometry
(LC-MS/MS)

(5) Screening single-use ELISA device--Forensic toxicology use only