Cut-off and toxicity levels for drugs-of-abuse testing

Medical Laboratory Observer, August, 2006

Cut-off and toxicity levels for drugs-of-abuse testing

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 2006-2007 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 trade     Some common       Detectable duration in
name)               street names      urine after last dose

OPIATES

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

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

Methadone           Methadose         3 days
(Dolophine,
Amidone)

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

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

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

Oxycodone           Oxy, OC,          1-3 days
(Oxycontin, OxyIR,  Oxycotton,
Percocet,           Killer
Percodan)

HALLUCINOGENS

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

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

Phencyclidine       PCP, Angel dust,  Single use:
                    Killer weed, Hog  1 week
                                      Prolonged use:
                                      2-4 weeks

STIMULANTS

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

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

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

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

BARBITURATES

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

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

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

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

Phenobarbital       Barbs, Downers    1-3 weeks

ALCOHOLS, DIOLS, & METABOLITES

Ethanol             Booze, Hooch      <1 day

Methanol            Wood alcohol      <1 day

Isopropanol         Rubbing alcohol   <1 day

Acetone                               <1 day

Ethylene Glycol     Antifreeze        <1 day

SEDATIVES/HYPNOTICS/ANESTHETICS

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

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

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

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

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

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

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

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

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

Drug (and trade     Urine cut-off     Toxic blood level
name)               points for
                    reporting
                    positive or
                    limit of
                    quantitation *

OPIATES

Heroin              2000 ng/mL (as    >200 ng/mL
(Diacetylmorphine)  morphine)

Morphine            2000 ng/mL        >200 ng/mL
(Duramorph)         (S)(1)
                    300 ng/mL
                    (C)(3)

Methadone           300 ng/mL 200     1-2 [micro]g/mL
(Dolophine,         ng/mL (C)(3)
Amidone)

Meperidine          200 ng/mL (S)(2)  >1000 ng/mL
(Demerol,           200 ng/mL (C)(3)
Pethidine)

Codeine             2000 ng/mL        >1.1 [micro]g/mL
(Analgesics with    (S)(1)
codeine)            300 ng/mL
                    (C)(3) lethal)

Propoxyphene        300 ng/mL (S)(1)  >500 ng/mL
(Darvon,            200 ng/mL (C)(3)
Darvocet-N)

Oxycodone           100-500 ng/mL     >200 ng/mL
(Oxycontin, OxyIR,  (S)(1) (highly
Percocet,           variable)
Percodan)           100-300 ng/mL
                    (C)(3) (highly
                    variable)

HALLUCINOGENS

Lysergic acid,      0.5 ng/mL (S)(1)  >2 ng/mL
diethylamide (LSD)  100 pg/mL (C)(4)

Marijuana and       100, 50, 25, or   50-200 ng/mL
cannabinoids        20 ng/mL (S)(1)
                    15 ng/mL (C)(3)

Phencyclidine       25 ng/mL (S)(1)   1 mg/mL
                    25 ng/mL (C)(3)

STIMULANTS

Cocaine             300 ng/mL (S)(1)  >1 [micro]g/mL
                    150 ng/mL (C)(3)

Amphetamine         100 ng/mL (S)(1)  0.5-1.0 [micro]g/mL
(Benzedrine,        500 ng/mL (C)(3)
Dexedrine)

Methylene-3,4       3000-5000 ng/mL   0.1-1.0 [micro]g/mL
dioxy-              (S)(1)
Methamphetamine     5 ng/mL (C)(3)
(MDMA)

Methamphetamine     100 ng/mL (S)(1)  0.1-1.0 [micro]g/mL
(Desoxyn,           500 ng/mL (C)(3)
Methedrine)

BARBITURATES

Pentobarbital       425 ng/mL (S)(1)  >11 [micro]g/mL
(Nembutal)          200 ng/mL (C)(3)

Secobarbital        200 ng/mL (S)(1)  >10 [micro]g/mL
(Seconal)           200 ng/mL (C)(3)

Butabarbital        312 ng/mL (S)(1)  20 [micro]g/mL
(Butisol)           200 ng/mL (C)(3)

Butalbital          342 ng/mL (S)(1)  20 [micro]g/mL
(Fiorinal)          200 ng/mL (C)(3)

Phenobarbital       505 ng/mL (S)(1)  >40 [micro]g/mL
200 ng/mL (C)(3)

ALCOHOLS, DIOLS, & METABOLITES

Ethanol             10 mg/dL          80-400 mg/dL
Methanol            5 mg/dL (gas      >20 mg/dL
chromatography)

Isopropanol         5 mg/dL (gas      50 mg/dL
                    chromatography)

Acetone             5 mg/dL (gas      >33 mg/dL (gas
                    chromatography)     chromatography)

Ethylene Glycol     5 mg/dL (gas      >50 mg/dL (gas
                    chromatography)     chromatography)

SEDATIVES/HYPNOTICS/ANESTHETICS

Diazepam (Valium)   160 ng/mL (S)(1)  Drug plus
                    100 ng/mL (C)(3)  Metabolite: >3.0
                                      [micro]g/mL

Oxazepam (Serax)    240 ng/mL (S)(1)  >1.4 [micro]g/mL
                    100 ng/mL (C)(3)

Alprazolam (Xanax)  240 ng/mL (S)(1)  >350 ng/mL
                    100 ng/mL (C)(3)

Clonazepam          540 ng/mL (S)(1)  >80 ng/mL
(Klonopin)          100 ng/mL (C)(3)

Chlordiazepoxide    600 ng/mL (S)(2)  >23 [micro]g/mL
(Librium)           100 ng/mL (C)(3)

Lorazepam (Ativan,  675 ng/mL (S)(1)  0.3-0.6 [micro]g/mL
Loraz)              100 ng/mL (C)(3)  0.05-0.24 [micro]g/mL

Flunitrazepam       12-60 ng/mL       50 ng/mL (gas
(Rohypnol)          (S)(1)            chromatography mass
                    (Immunoassay)     spectrometry,
                    100 pg/mL (C)(4)  LC-MS/MS)
Gamma-              1-10 mg/L (gas    >250 mg/L (gas
Hydroxybutyrate     chromatography;   chromatography,
(Somatomax)         gas               mass spectrometry)
chromatography,
mass
spectrometry)

Ketamine            15 ng/mL (S)(5)   >7-27 [micro]g/mL
Hydrochloride       (Immunoassay)     (highly variable)
(Ketajet)           5-10 ng/mL (gas
chromatography,
mass
spectrometry)

Drug (and trade     Blood reference
name)               (therapeutic) range

OPIATES

Heroin              None detected
(Diacetylmorphine)

Morphine            65-80 ng/mL
(Duramorph)

Methadone           For narcotic
(Dolophine,         stabilization: 300-1000
Amidone)            ng/mL For pain: 50-100
ng/mL

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

Codeine             13-33 ng/mL
(Analgesics with
codeine)

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

Oxycodone           10-100 ng/mL
(Oxycontin, OxyIR,
Percocet,
Percodan)

HALLUCINOGENS

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

Marijuana and       None detected
cannabinoids

Phencyclidine       None detected

STIMULANTS

Cocaine             100-500 ng/mL

Amphetamine         30-50 ng/mL
(Benzedrine,
Dexedrine)

Methylene-3,4       20-30 ng/mL

dioxy-Methamphetamine (MDMA)
Methamphetamine     20-30 ng/mL
(Desoxyn,
Methedrine)

BARBITURATES

Pentobarbital       <10 [micro]g/mL

(Nembutal)
Secobarbital        1-5 [micro]g/mL

(Seconal)
Butabarbital        3-25 [micro]g/mL

(Butisol)
Butalbital          5-15 [micro]g/mL

(Fiorinal)
Phenobarbital       10-40 [micro]g/ml

ALCOHOLS, DIOLS, & METABOLITES

Ethanol             100-150 mg/dL (for
treatment of toxic
alcohols)

Methanol            <0.5 mg/dL

Isopropanol         None detected

Acetone             <1.0 mg/dL

Ethylene Glycol     None detected

SEDATIVES/HYPNOTICS/ANESTHETICS

Diazepam (Valium)   Drug plus Metabolite:
                    0.2-2.0 [micro]g/mL

Oxazepam (Serax)    0.2-1.4 [micro]g/mL

Alprazolam (Xanax)  20-30 ng/mL

Clonazepam          10-50 ng/mL
(Klonopin)

Chlordiazepoxide    0.1-3.0 [micro]g/mL
(Librium)

Lorazepam (Ativan,  50-240 ng/mL
Loraz)

Flunitrazepam       5-15 ng/mL
(Rohypnol)

Gamma-              48-125 mg/L (for
Hydroxybutyrate     narcolepsy)
(Somatomax)

Ketamine            0.5-6.3 [micro]g/mL
Hydrochloride
(Ketajet)

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