Testing for Drugs of Abuse in Children and Adolescents

Sharon Levy; Lorena M. Siqueira; COMMITTEE ON SUBSTANCE ABUSE

doi:10.1542/peds.2014-0865

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TABLE 1

Approximate Duration of Detectability and Common Cutoffs for Selected Drugs

Drug	Metabolite	Window of Detection	Comments
Alcohol	Alcohol	7–12 h	Ethyl 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 glucuronide	Up to 5 d
Amphetamines
Amphetamine (AMP)	MAMP	1–3 d	Note 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+MAMP	1–2 d
3,4-MethylenediozyAMP	MDA	1–2 d
3,4-MethylenediozyMAMP	MDMA	1–2 d
Barbiturates
Pento/secobarbital	Secobarbital	Short-acting, 4–6 d
Butalbital	Secobarbital	Intermediate, 3–8 d
Phenobarbital	Secobarbital	Long-acting, 10–30 d
Benzodiazepines
Triazolam	Hydroxyethyl flurazepam	Short-acting, 1 d	Most 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.
Clonazepam	7-amino Clonazepam	Intermediate, 1–12.5 d
Diazepam	Oxazepam	Long-acting, 5–8 d
Chronic use		Can last 30 d after last use
Cocaine	Benzoylecgonine	1–3 d
Cannabinoids	Carboxy-THC	Single use, 1–3 d	Note 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-LSD	4 h
Methadone	Methadone and metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine	1 d–1 wk
Opiates
Morphine (M)	Morphine	1–2 d
Codeine (C)	Morphine and codeine	1–2 d
Semisynthetic opiates	Hydrocodone	1–2 d
	Hydromorphone	1–2 d
	Oxycodone	1–3 d
	Oxymorphone	1.5–2.5 d
Heroin	6-acetyl-morphine +morphine	<24 h up to 1–2 d	6-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)	Phencyclidine	Casual use, 2–10 d
		Chronic use, several weeks