Specific drug analysis. The following drugs are reported as positive when above the threshold level and negative when below:

Opiates: (Morphine, Codeine, 6-Mono-Acetyl Morphine (heroin metabolite), Dihydrocodeine, Oxycodone are reported when the group is positive)

Amphetamine

Cocaine metabolite (Benzoylecognine),

Methadone metabolite (EDDP),

Benozodiazepine group: Prescription drugs: Diazepam, Temazepam, Oxazepam, Nitrazepam, Nordiazepam - (diazepam/chlordiazepoxide metabolite) and 7amino-clonazepam (clonazepam metabolite)

Gabapentin.

Pregabalin.

Buprenorphine metabolite.

The following drugs are included in the specific drug analysis but will only be reported as positive when above the threshold level: MDMA (ecstacy), Metamphetamine,Tramadol, Oxycodone. Street benzodiazepines: Alprazolam and Etizolam will be reported when positive (separately from prescription benzodiazepines).

Diazepam, Nordiazepam, Temazepam, Oxazepam, Nitrazepam and Clonazepam are included in the benzodiaepine group

Heroin contains diacetyl morphine and acetyl codeine. Both of these are rapidly metabolised to 6-monoacetyl morphine and codeine respectively and the parent drugs are not detected in urine. Both 6-mono-acetyl morphine and codeine further metabolise to morphine. Finding 6-mono-acetyl morphine in urine is specific for heroin. Finding codeine without 6MAM is consistent with codeine administration. Finding morphine only is consistent with MST, heroin or codeine. Dihydrocodeine does not metabolise to either codeine or morphine. Oxycodone is compatible with Oxycodone, Oxynorm or Oxycontin.

Diazepam is metabolised to both Nordiazepam and Temazepam, both of which are further metabolised to Oxazepam. Finding Nordiazepam is consistent with either Diazepam or chlordiazepoxide.

Full history plus any prescribed drugs or administered in hospital required. Contact Duty Biochemist to discuss if other drugs suspected or required quickly.

Threshold levels:

Morphine, codeine, dihydrocodeine, oxycodone: 50µg/L

6MAM: 20µg/L

Amphetamine, metamphetamine, MDMA: 300µg/L

EDDP: 100µg/L

Cocaine metabolite: 100µg/L (Note: lower threshold implemented 11/03/24 in line with current guidance)

Benzodiazepine group: 5-20µg/L. Benzodiazepine group will be reported as positive when any of the prescription drugs listed are positive. This will not include street benzodiazepines, which will be reported separately.

Street benzodiazepines: Alprazolam and Etizolam: 5µg/L

Gabapentin, Tramadol, Pregabalin: 300µg/L

Norbuprenorphine: 10µg/L

Spiked sample:

Samples with high levels of EDDP, Buprenorphine or diazepam, with undetected methadone metabolite, norbuprenorphine or nordiazepam respectively are suggestive of spiked samples.