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HelpOrder Code PMHPU Pain Management Hybrid Profile, 22 Drug Classes, High-Resolution Mass Spectrometry and Immunoassay Screen, Random, Urine
Ordering Guidance
This test does not screen for drug classes other than those listed in Reference Values.
Specimen Required
Supplies: Urine Container, 60 mL (T313)
Collection Container/Tube: Plastic urine container
Submission Container/Tube: Plastic, 60-mL urine container
Specimen Volume: 30 mL
Collection Instructions:
1. Collect a random urine specimen.
2. Submit 30 mL in 1 plastic bottle.
3. No preservative.
Additional Information:
1. No specimen substitutions.
2. Submitting less than 30 mL may compromise the ability to perform all necessary testing.
3. STAT requests are not accepted for this test.
Useful For
Detecting drug use involving stimulants, barbiturate, benzodiazepines, cocaine, opioids, tetrahydrocannabinol, gabapentinoids, and alcohol.
Clinical monitoring or management of patients
This test is not intended for use in employment-related testing.
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| LPCM | List Patient's Current Medications | No | Yes |
| ADULT | Adulterants Survey, U | Yes | Yes |
| LDPU | Limited Drug Panel, 3, IA, U | No | Yes |
| TOPU | Targeted Opioid MS Screen, U | Yes, (Order TOSU) | Yes |
| TABSU | Targeted Benzodiazepine Screen, U | Yes, (Order TBSU) | Yes |
| TSIM | Gabapentinoid/Stim MS Screen, U | Yes, (Order TGSU) | Yes |
| ETGSR | Ethyl Glucuronide Scrn w/Reflex, U | No | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| ETGC | Ethyl Glucuronide Confirmation, U | Yes | No |
Testing Algorithm
Testing begins with an adulterant survey. If the sample is found to be adulterated, testing will end and the remaining tests will be canceled.
If the specimen is normal or only diluted, remaining testing will continue.
Positive results can be confirmed and quantitated by definitive methods: gas chromatography mass spectrometry for barbiturates, cocaine and metabolites and liquid chromatography tandem mass spectrometry for tetrahydrocannabinol metabolites. Ethyl glucuronide/ethyl sulfate confirmation will be performed at an additional charge.
Special Instructions
Method Name
ADULT: Spectrophotometry (SP)
ETGSR, LDPU: Immunoassay
TABSU, TOPU, TSIM: Liquid Chromatography Tandem Mass Spectrometry, High-Resolution Accurate Mass (LC-MS/MS HRAM)
Reporting Name
Pain Mgt Profile, 22, HRMS/IA, USpecimen Type
UrineSpecimen Minimum Volume
20 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Urine | Refrigerated (preferred) | 14 days |
| Frozen | 14 days |
Reject Due To
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.Reference Values
ADULTERANT SURVEY:
Cutoff concentrations
Oxidants: 200 mg/L
Nitrites: 500 mg/L
LIMITED DRUG PROFILE, 3 DRUG CLASSES, IMMUNOASSAY PANEL:
Negative
Screening cutoff concentrations:
Barbiturates: 200 ng/mL
Cocaine (benzoylecgonine-cocaine metabolite): 150 ng/mL
Tetrahydrocannabinol carboxylic acid: 50 ng/mL
TARGETED OPIOID MASS SPECTROMETRY SCREEN:
Not detected (Positive results are reported with qualitative "Present" results)
Cutoff concentrations:
Codeine: 25 ng/mL
Codeine-6-beta-glucuronide: 100 ng/mL
Morphine: 25 ng/mL
Morphine-6-beta-glucuronide: 100 ng/mL
6-Monoacetylmorphine: 25 ng/mL
Hydrocodone: 25 ng/mL
Norhydrocodone: 25 ng/mL
Dihydrocodeine: 25 ng/mL
Hydromorphone: 25 ng/mL
Hydromorphone-3-beta-glucuronide: 100 ng/mL
Oxycodone: 25 ng/mL
Noroxycodone: 25 ng/mL
Oxymorphone: 25 ng/mL
Oxymorphone-3-beta-glucuronide: 100 ng/mL
Noroxymorphone: 25 ng/mL
Fentanyl: 2 ng/mL
Norfentanyl: 2 ng/mL
Meperidine: 25 ng/mL
Normeperidine: 25 ng/mL
Naloxone: 25 ng/mL
Naloxone-3-beta-glucuronide: 100 ng/mL
Methadone: 25 ng/mL
2-Ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP): 25 ng/mL
Tramadol: 25 ng/mL
O-desmethyltramadol: 25 ng/mL
Tapentadol: 25 ng/mL
N-desmethyltapentadol: 50 ng/mL
Tapentadol-beta-glucuronide: 100 ng/mL
Buprenorphine: 5 ng/mL
Norbuprenorphine: 5 ng/mL
Norbuprenorphine glucuronide: 20 ng/mL
TARGETED BENZODIAZEPINE MASS SPECTROMETRY SCREEN:
Not detected (Positive results are reported with qualitative "Present" results)
Cutoff concentrations:
Alprazolam: 10 ng/mL
Alpha-hydroxyalprazolam: 10 ng/mL
Alpha-hydroxyalprazolam glucuronide: 50 ng/mL
Chlordiazepoxide: 10 ng/mL
Clobazam: 10 ng/mL
N-desmethylclobazam: 200 ng/mL
Clonazepam: 10 ng/mL
7-Aminoclonazepam: 10 ng/mL
Diazepam: 10 ng/mL
Nordiazepam: 10 ng/mL
Flunitrazepam: 10 ng/mL
7-Aminoflunitrazepam: 10 ng/mL
Flurazepam: 10 ng/mL
2-Hydroxy ethyl flurazepam: 10 ng/mL
Lorazepam: 10 ng/mL
Lorazepam glucuronide: 50 ng/mL
Midazolam: 10 ng/mL
Alpha-hydroxymidazolam: 10 ng/mL
Oxazepam: 10 ng/mL
Oxazepam glucuronide: 50 ng/mL
Prazepam: 10 ng/mL
Temazepam: 10 ng/mL
Temazepam glucuronide: 50 ng/mL
Triazolam: 10 ng/mL
Alpha-hydroxytriazolam: 10 ng/mL
Zolpidem: 10 ng/mL
Zolpidem phenyl-4-carboxylic acid: 10 ng/mL
TARGETED GABAPENTINOID AND STIMULANT MASS SPECTROMETRY SCREEN:
Not detected (Positive results are reported with qualitative "Present" results)
Cutoff concentrations:
Methamphetamine: 100 ng/mL
Amphetamine: 100 ng/mL
3,4-Methylenedioxymethamphetamine (MDMA): 100 ng/mL
3,4-Methylenedioxy-N-ethylamphetamine (MDEA): 100 ng/mL
3,4-Methylenedioxyamphetamine (MDA): 100 ng/mL
Ephedrine: 100 ng/mL
Pseudoephedrine: 100 ng/mL
Phentermine: 100 ng/mL
Phencyclidine (PCP): 20 ng/mL
Methylphenidate: 20 ng/mL
Ritalinic acid: 100 ng/mL
Gabapentin: 500 ng/mL
Pregabalin: 500 ng/mL
ETHYL GLUCURONIDE SCREEN:
Negative
Screening cutoff concentrations:
Ethyl glucuronide: 500 ng/mL
Method Description
Adulterant:
All results are measured using spectrophotometry at wavelengths specified by the reagent manufacturer. The use of a refractometer may also be used in the specific gravity measurement.(Package inserts: Specimen Validity Test Creatinine. Roche Diagnostics; V3.0, 05/2023; Specimen Validity Test Nitrite. Roche Diagnostics; V2.0, 05/2022, Specimen Validity Test Oxidant. Roche Diagnostics; V2.0, 05/2022; Specimen Validity Test pH Roche Diagnostics; V2.0, 05/2022, Specimen Validity Test Specific Gravity. Roche Diagnostics; V3.0, 08/2022)
Limited drug profile immunoassay panel:
The barbiturate, cocaine metabolite, and tetrahydrocannabinol metabolite assays are based on the kinetic interaction of microparticles in a solution as measured by changes in light transmission. In the absence of sample drug, soluble drug conjugates bind to antibody-bound microparticles, causing the formation of particle aggregates. As the aggregation reaction proceeds in the absence of sample drug, the absorbance increases. When a urine sample contains the drug in question, this drug competes with the drug derivative conjugate for microparticle-bound antibody. Antibody bound to sample drug is no longer available to promote particle aggregation, and subsequent particle lattice formation is inhibited. The presence of sample drug diminishes the increasing absorbance in proportion to the concentration of drug in the sample. Sample drug content is determined relative to the value obtained for a known cutoff concentration of drug.(Package inserts: BARB. Roche Diagnostics; V3.0, 04/2024; THC2. Roche Diagnostics; V4.0, 06/2024; COC2. Roche Diagnostics; V4.0, 04/2024)
Opioid, benzodiazepine, and gabapentinoid/stimulant targeted screening panels:
The urine sample is diluted with internal standard and clinical laboratory reagent water and then analyzed by liquid chromatography tandem mass spectrometry using a high-resolution accurate mass orbitrap detector.(Unpublished Mayo method)
Ethyl glucuronide screen:
This assay is a homogeneous enzyme-linked immunosorbent assay technique. The assay will be performed semiquantitatively. The assay is based on competition between free drug in the urine sample and a drug labeled with the enzyme glucose-6-phosphate dehydrogenase for a fixed amount of specific antibody binding sites. Active enzyme converts nicotinamide adenine dinucleotide (NAD[+]) to NADH, which results in an absorbance change that can be measured spectrophotometrically at 340 nm.(Package insert: ETG. Immunalysis; 03/2019)
Day(s) Performed
Monday through Saturday
Performing Laboratory
Mayo Clinic Laboratories in Rochester
CPT Code Information
G0482
80307
80364 (if appropriate for select payers)
80347 (if appropriate for select payers)
80326 (if appropriate for select payers)
80321 (if appropriate for select payers)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| PMHPU | Pain Mgt Profile, 22, HRMS/IA, U | 69739-1 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| LPCM | List Patient's Current Medications | 66423-5 |
| 615289 | Barbiturates | 19270-8 |
| 20606 | Creatinine, U | 2161-8 |
| 616033 | Ethyl Glucuronide Screen, U | 58375-7 |
| 624198 | Methamphetamine | 19554-5 |
| 604871 | Alprazolam | 94116-1 |
| 624213 | Codeine | 19411-8 |
| 624214 | Codeine-6-beta-glucuronide | 89310-7 |
| 604867 | Alpha-Hydroxyalprazolam | 19325-0 |
| 624199 | Amphetamine | 19343-3 |
| 22312 | Specific Gravity | 5810-7 |
| 615290 | Cocaine | 19359-9 |
| 615291 | Tetrahydrocannabinol | 19415-9 |
| 23509 | pH | 2756-5 |
| 624200 | 3,4-methylenedioxymethamphetamine (MDMA) | 19568-5 |
| 604891 | Alpha-Hydroxyalprazolam Glucuronide | 94115-3 |
| 624215 | Morphine | 19597-4 |
| 624216 | Morphine-6-beta-glucuronide | 89308-1 |
| 604872 | Chlordiazepoxide | 19385-4 |
| 624201 | 3,4-methylenedioxy-N-ethylamphetamine (MDEA) | 59844-1 |
| 23511 | Oxidants | 58714-7 |
| 23510 | Nitrites | 32710-6 |
| 624202 | 3,4-methylenedioxyamphetamine (MDA) | 19565-1 |
| 604889 | Clobazam | 94114-6 |
| 624217 | 6-monoacetylmorphine | 19321-9 |
| 624218 | Hydrocodone | 19482-9 |
| 604890 | N-Desmethylclobazam | 94113-8 |
| 624203 | Ephedrine | 99108-3 |
| 30914 | Comment | 48767-8 |
| 624204 | Pseudoephedrine | 99109-1 |
| 604873 | Clonazepam | 19399-5 |
| 624219 | Norhydrocodone | 89304-0 |
| 624220 | Dihydrocodeine | 19446-4 |
| 604267 | 7-aminoclonazepam | 94112-0 |
| 624205 | Phentermine | 19674-1 |
| 624206 | Phencyclidine (PCP) | 19659-2 |
| 604874 | Diazepam | 19443-1 |
| 624221 | Hydromorphone | 19486-0 |
| 624222 | Hydromorphone-3-beta-glucuronide | 89309-9 |
| 604880 | Nordiazepam | 19624-6 |
| 624207 | Methylphenidate | 19577-6 |
| 624208 | Ritalinic acid | 99110-9 |
| 604875 | Flunitrazepam | 19466-2 |
| 624223 | Oxycodone | 19642-8 |
| 624224 | Noroxycodone | 89303-2 |
| 604866 | 7-aminoflunitrazepam | 94111-2 |
| 624209 | Gabapentin | 68439-9 |
| 624210 | Pregabalin | 105953-4 |
| 604876 | Flurazepam | 19474-6 |
| 624225 | Oxymorphone | 19646-9 |
| 624226 | Oxymorphone-3-beta-glucuronide | 89301-6 |
| 604868 | 2-Hydroxy Ethyl Flurazepam | 94110-4 |
| 624211 | Stimulant Interpretation | 54247-2 |
| 604877 | Lorazepam | 19520-6 |
| 624227 | Noroxymorphone | 89302-4 |
| 624228 | Fentanyl | 59673-4 |
| 604878 | Lorazepam Glucuronide | 94109-6 |
| 604879 | Midazolam | 19585-9 |
| 624229 | Norfentanyl | 43199-9 |
| 624230 | Meperidine | 19532-1 |
| 604869 | Alpha-Hydroxy Midazolam | 94108-8 |
| 604881 | Oxazepam | 19638-6 |
| 624231 | Normeperidine | 27920-8 |
| 624232 | Naloxone | 42618-9 |
| 604882 | Oxazepam Glucuronide | 94107-0 |
| 604883 | Prazepam | 19678-2 |
| 624233 | Naloxone-3-beta-glucuronide | 89307-3 |
| 624234 | Methadone | 19550-3 |
| 604884 | Temazepam | 19698-0 |
| 604885 | Temazepam Glucuronide | 94106-2 |
| 624235 | EDDP | 93495-0 |
| 624236 | Tramadol | 19710-3 |
| 604886 | Triazolam | 19714-5 |
| 604870 | Alpha-Hydroxy Triazolam | 94105-4 |
| 624237 | O-desmethyltramadol | 86453-8 |
| 624238 | Tapentadol | 72485-6 |
| 604887 | Zolpidem | 94104-7 |
| 604888 | Zolpidem Phenyl-4-Carboxylic acid | 94103-9 |
| 624239 | N-desmethyltapentadol | 89306-5 |
| 624240 | Tapentadol-beta-glucuronide | 89300-8 |
| 604949 | Benzodiazepine Interpretation | 69050-3 |
| 624241 | Buprenorphine | 93494-3 |
| 624242 | Norbuprenorphine | 82371-6 |
| 624243 | Norbuprenorphine glucuronide | 89305-7 |
| 624244 | 69050-3 |