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American Academy of Pediatrics
From the American Academy of PediatricsClinical Report

Testing for Drugs of Abuse in Children and Adolescents

Sharon Levy, Lorena M. Siqueira and COMMITTEE ON SUBSTANCE ABUSE
Pediatrics June 2014, 133 (6) e1798-e1807; DOI: https://doi.org/10.1542/peds.2014-0865
Sharon Levy
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Lorena M. Siqueira
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    TABLE 1

    Approximate Duration of Detectability and Common Cutoffs for Selected Drugs

    DrugMetaboliteWindow of DetectionComments
    AlcoholAlcohol7–12 hEthyl succinate and ethyl glucuronide can persist in the urine up to 5 d after heavy alcohol use. However, use of hand sanitizer, mouthwash, cough syrup, etc, can result in low levels without “alcohol use.”
    Ethyl succinate, ethyl glucuronideUp to 5 d
    Amphetamines
     Amphetamine (AMP)MAMP1–3 dNote that methylphenidate is not detected on a routine amphetamine panel; therefore, a positive amphetamine test result cannot be explained by use of a methylphenidate preparation.
     Methamphetamine (MAMP)>100 ng/mL of AMP+MAMP1–2 d
     3,4-MethylenediozyAMPMDA1–2 d
     3,4-MethylenediozyMAMPMDMA1–2 d
    Barbiturates
     Pento/secobarbitalSecobarbitalShort-acting, 4–6 d
     ButalbitalSecobarbitalIntermediate, 3–8 d
     PhenobarbitalSecobarbitalLong-acting, 10–30 d
    Benzodiazepines
     TriazolamHydroxyethyl flurazepamShort-acting, 1 dMost benzodiazepine screens identify oxazepam and will not pick up all benzodiazepines. If evaluating a patient for benzodiazepine use, it is important to find the specific drug on the test panel or speak with the laboratory personnel.
     Clonazepam7-amino ClonazepamIntermediate, 1–12.5 d
     DiazepamOxazepamLong-acting, 5–8 d
     Chronic useCan last 30 d after last use
    CocaineBenzoylecgonine1–3 d
    CannabinoidsCarboxy-THCSingle use, 1–3 dNote that synthetic cannabinoids will not be picked up on a cannabinoid screen. If use of synthetic cannabinoids is suspected, speak to the laboratory regarding availability of tests for these substances.
    Moderate use, 4 d; heavy use, 10 d
    Chronic, 3–5 wk after last use
    Lysergic acid diethylamide (LSD)Nor-LSD4 h
    MethadoneMethadone and metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine1 d–1 wk
    Opiates
     Morphine (M)Morphine1–2 d
     Codeine (C)Morphine and codeine1–2 d
    Semisynthetic opiatesHydrocodone1–2 d
    Hydromorphone1–2 d
    Oxycodone1–3 d
    Oxymorphone1.5–2.5 d
    Heroin6-acetyl-morphine +morphine<24 h up to 1–2 d6-acetyl-morphine is pathognomonic for heroin use but has a narrow time window and is most often not detected on a drug test. A test that is positive for morphine outside of the use of prescribed morphine is suggestive of heroin use.
    Phencyclidine (PCP)PhencyclidineCasual use, 2–10 d
    Chronic use, several weeks
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Pediatrics
Vol. 133, Issue 6
1 Jun 2014
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Testing for Drugs of Abuse in Children and Adolescents
Sharon Levy, Lorena M. Siqueira, COMMITTEE ON SUBSTANCE ABUSE
Pediatrics Jun 2014, 133 (6) e1798-e1807; DOI: 10.1542/peds.2014-0865

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Testing for Drugs of Abuse in Children and Adolescents
Sharon Levy, Lorena M. Siqueira, COMMITTEE ON SUBSTANCE ABUSE
Pediatrics Jun 2014, 133 (6) e1798-e1807; DOI: 10.1542/peds.2014-0865
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  • Article
    • Abstract
    • Introduction
    • Specimen Types
    • Urine Drug Tests
    • Indications for Drug Testing
    • Therapy and Monitoring
    • Screening
    • Home Drug Testing
    • School Clearance
    • Sources of Error in Interpreting Urine Drug Tests
    • Urine Specimen Collection
    • Confidentiality
    • Management
    • Summary
    • Lead Authors
    • Committee on Substance Abuse, 2013–2014
    • Liaisons
    • Staff
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • Comments

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