Keywords
Cut-off values
GC-MS
Judicial implications
Urine drug testing
Opiates
Immunoassay
Abstract
Objective: Opiates are one of the most abused drugs with growing concern.In recent years, it is seen that changes have been made to the cut-off values for opiates.The cut-offs for opiates in screening tests increased from 300 to 2000ng/mL.The aim of this study was to present the opiate results of 8-year study and to evaluate the data according to cut-off values increased from 300 to 2000 ng/mL.
Methods: A total of 11,348 urine samples were analyzed between 2014–2021.Preliminary diagnoses, outpatient admissions, and toxicological test results were compared under two cut-offs. Screening tests were performed using immunoassay method (Randox Evidence and CEDIA), and confirmation analysis was conducted by Gas Chromatography-Mass Spectrometry (GC-MS).
Results: At the 300 ng/mL cut-off value, 3.45% of the cases were opiate-positive. 69.1% of the cases were from addiction clinics, demonstrating the clinical importance of sensitive cut-offs in detecting substance use among patients requiring treatment. In this study, it is shown that 39.8% of cases requiring judicial action were missed when the cut-off value was raised to 2000 ng/mL, highlighting the risk of false negatives in forensic settings.
Conclusion: The findings highlight that opiate cut-off values and analytical sensitivity may influence both medical evaluations and legal interpretations.
References
Li S, Wang X, Bi G, Xin G, Qin S, Xu P, et al. A retrospective analysis of data from illicit drug abuse cases in Beijing between 2018 and 2020. 2022 [cited 2023 Nov 28]; Available from: https://doi.org/10.1016/j.legalmed.2022.102086
United Nations Office on Drugs and Crime (UNODC). UNODC World Drug Report 2021: pandemic effects ramp up drug risks, as youth underestimate cannabis dangers [Internet]. 2021 [cited 2022 Apr 18]. Available from: https://www.unodc.org/unodc/press/releases/2021/June/unodc-world-drug-report-2021_-pandemic-effects-ramp-up-drug-risks--as-youth-underestimate-cannabis-dangers.html
Smith ML, Nichols DC, Underwood P, Fuller Z, Moser MA, Lodico C, et al. Morphine and Codeine Concentrations in Human Urine following Controlled Poppy Seeds Administration of Known Opiate Content. Forensic Sci Int. 2014;241:87–90.
Judd D, King CR, Galke C. The Opioid Epidemic: A Review of the Contributing Factors, Negative Consequences, and Best Practices. Cureus [Internet]. 2023 Jul 10 [cited 2024 Dec 30];15(7):e41621. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10410480/
Pichini S, Zaami S, Pacifici R, Tagliabracci A, Busardò FP. Editorial: The challenge posed by new synthetic opioids: Pharmacology and toxicology. Front Pharmacol [Internet]. 2019 May 21 [cited 2024 Mar 19];10(MAY):465005. Available from: www.frontiersin.org
Alexander GC, Stoller KB, Haffajee RL, Saloner B. An Epidemic in the Midst of a Pandemic: Opioid Use Disorder and COVID-19. https://doi.org/107326/M20-1141 [Internet]. 2020 Apr 2 [cited 2022 Jun 2];173(1):57–8. Available from: https://www.acpjournals.org/doi/full/10.7326/M20-1141
Becker WC, Fiellin DA. When Epidemics Collide: Coronavirus Disease 2019 (COVID-19) and the Opioid Crisis. https://doi.org/107326/M20-1210 [Internet]. 2020 Apr 2 [cited 2022 Jun 2];173(1):59–60. Available from: https://www.acpjournals.org/doi/full/10.7326/M20-1210
Feenstra ML, Jansen S, Eshuis WJ, van Berge Henegouwen MI, Hollmann MW, Hermanides J. Opioid-free anesthesia: A systematic review and meta-analysis. J Clin Anesth. 2023 Nov 1;90:111215.
Milone MC. Laboratory Testing for Prescription Opioids. J Med Toxicol. 2012;8(4):408–16.
Posey BL, Kimble SN. High-Performance Liquid Chromatographic Study of Codeine, Norcodeine, and Morphine as Indicators of Codeine Ingestion. J Anal Toxicol [Internet]. 1984 Mar 1 [cited 2023 Nov 24];8(2):68–74. Available from: https://dx.doi.org/10.1093/jat/8.2.68
Fraser AD, Worth D. Experience with a Urine Opiate Screening and Confirmation Cutoff of 2000 ng/mL. J Anal Toxicol [Internet]. 1999 [cited 2022 May 13];23. Available from: https://academic.oup.com/jat/article/23/6/549/863548
European Workplace Drug Testing Society. European Guidelines for Workplace Drug Testing in Urine. 2015.
EWDTS. European Workplace Drug Testing Society European Guidelines for Workplace Drug Testing in Urine. 2015 [cited 2022 Aug 24];Version2.0. Available from: www.ewdts.org.
Swiss Committee for Drugs of Abuse Testing. SCDAT [Internet]. 2021 [cited 2022 Aug 24]. Available from: https://www.scdat.ch/
Substance Abuse and Mental Health Services Administration (SAMHSA). Drug Testing Resources. 2021.
T.C. Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü Başkanlığı Tıbbi Laboratuvar Hizmetleri Dairesi. İdrar Numunelerinde Yasadışı ve Kötüye Kullanılan İlaç ve Madde Analizi Yapan Tıbbi Laboratuvarlar ile Madde Bağımlılığı Teşhis ve Tedavi Merkezlerindeki Tıbbi Laboratuvarların İşleyiş Esasları. 2016;1–38. Available from: https://dosyamerkez.saglik.gov.tr/Eklenti/5907,idrar-numunelerinde-yasadisi-vek22255513pdf.pdf?0
Lebeau MA. ANSI/ASB Standard 036 for Method Validation in Forensic Toxicology Has Replaced SWGTOX’s Version. J Anal Toxicol. 2020;44(4):414.
Scientific working group for forensic toxicology (SWGTOX) standard practices for method validation in forensic toxicology. J Anal Toxicol [Internet]. 2013 [cited 2019 Jan 18];37(7):452–74. Available from: https://academic.oup.com/jat/article-abstract/37/7/452/765476
Laing MK, Ti L, Marmel A, Tobias S, Shapiro AM, Laing R, et al. An outbreak of novel psychoactive substance benzodiazepines in the unregulated drug supply: Preliminary results from a community drug checking program using point-of-care and confirmatory methods. Int J Drug Policy. 2021 Jul 1;93:103169.
Liu S, O’Donnell J, Gladden RM, McGlone L, Chowdhury F. Trends in Nonfatal and Fatal Overdoses Involving Benzodiazepines — 38 States and the District of Columbia, 2019–2020. MMWR Morb Mortal Wkly Rep [Internet]. 2021 Aug 27 [cited 2024 Dec 29];70(34):1136–41. Available from: https://www.cdc.gov/mmwr/volumes/70/wr/mm7034a2.htm
Benzodiazepines and Opioids | National Institute on Drug Abuse (NIDA) [Internet]. [cited 2024 Dec 29]. Available from: https://nida.nih.gov/research-topics/opioids/benzodiazepines-opioids#Reference
Verstraete AG, Pierce A. Workplace drug testing in Europe. Forensic Sci Int [Internet]. 2001;121(1–2):2–6. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0379073801004455?via%3Dihub
French MT, Roebuck C, Alexandre PK. To test or not to test: do workplace drug testing programs discourage employee drug use? Soc Sci Res. 2004 Mar 1;33(1):45–63.
Chaudhari PP, Monuteaux MC, Shah P, Bachur RG. The Importance of Urine Concentration on the Diagnostic Performance of the Urinalysis for Pediatric Urinary Tract Infection. Ann Emerg Med. 2017 Jul 1;70(1):63-71.e8.
Chaudhari PP, Monuteaux MC, Shah P, Bachur RG. The Importance of Urine Concentration on the Diagnostic Performance of the Urinalysis for Pediatric Urinary Tract Infection. Ann Emerg Med [Internet]. 2017;70(1):63-71.e8. Available from: http://dx.doi.org/10.1016/j.annemergmed.2016.11.042
Chu CM, Lowder JL. Diagnosis and treatment of urinary tract infections across age groups. Am J Obstet Gynecol. 2018 Jul 1;219(1):40–51.
Lum G, Mushlin B. Urine Drug Testing: Approaches to Screening and Confirmation Testing. Lab Med. 2004 Jun;35(6):368–73.
Penders J, Verstraete A. Laboratory guidelines and standards in clinical and forensic toxicology. Accredit Qual Assur [Internet]. 2006 Jun 3 [cited 2022 May 29];11(6):284–90. Available from: https://link.springer.com/article/10.1007/s00769-006-0131-y
SOFT / AAFS. Forensic Toxicology Laboratory Guidelines. 2006.
Institutes EN of FS. Best Practice Manuals and Forensic Guidelines | ENFSI [Internet]. [cited 2025 Feb 26]. Available from: https://enfsi.eu/about-enfsi/structure/working-groups/documents-page/documents/best-practice-manuals/
Santoro PE, Nardis I De, Fronterrè P, Felli M, Martello S, Bergamaschi A, et al. A snapshot of workplace drug testing in Italy. Drug Test Anal [Internet]. 2012 Feb [cited 2023 Mar 2];4(2):66–70. Available from: https://pubmed.ncbi.nlm.nih.gov/22362571/
IOGP. Oil and gas contractor drug and alcohol testing guidelines. 2016;56.
Belgian National Institute of Criminalistics and Criminology; web site: https://enfsi.eu/member/member-national-institute-criminalistics-and-criminology-incc-brussels-belgium/
SAMHSA. 2023 / Rules and Regulations [Internet]. 2023 [cited 2024 Dec 20]. Available from: https://www.regulations.gov/.
Krug SA, Scott KS. A toxicological exploration of the opioid crisis. WIREs Forensic Sci. 2020 Nov;2(6).
Wu AHB, McKay C, Broussard LA, Hoffman RS, Kwong TC, Moyer TP, et al. National Academy of Clinical Biochemistry Laboratory Medicine practice guidelines: Recommendations for the use of laboratory tests to support poisoned patients who present to the emergency department. Clin Chem. 2003 Mar 1;49(3):357–79.
Luzzi VI, Saunders AN, Koenig JW, Turk J, Lo SF, Garg UC, et al. Analytic performance of immunoassays for drugs of abuse below established cutoff values. Clin Chem. 2004 Apr;50(4):717–22.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Duygu Yeşim OVAT- Rukiye ASLAN- Jose RESTOLHO- Serap Annette AKGÜR