In-office Urine Drug Testing (UDT)
In-office (Point-of-Care) testing can be conducted with CLIA-waived instant-read devices, as well as instrumented devices (e.g. analyzers). These devices perform qualitative immunoassay tests only.
In-office urine drug test devices are used to provide healthcare professionals with immediate preliminary information, particularly on initial patient intake. While providing certain clinical value to the treating healthcare professional, these qualitative immunoassay tests are generally by drug class and do not detect specific medications and drugs. Additional considerations such as their high cutoff levels and potential cross-reactivity are why confirmation of preliminary results and quantitative testing from a lab is desirable, at the discretion of the treating medical professional.
Drug tests included on Point-of-Care deviceA typical CLIA-waived instant read device can detect up to 12 drugs or drug classes, such as barbiturates, benzodiazepines, opiates, oxycodone, propoxyphene, methadone, tricyclic antidepressants and the illicit drugs methamphetamine, marijuana, cocaine, methylenedioxymethamphetamine (MDMA), and phencyclidine (PCP). These devices do not measure many drug metabolites.
Laboratory Testing with LC-MS/MS Technology
Laboratory testing, such as Liquid Chromatography Tandem Mass-Spectrometry (LC-MS/MS), is a more specific method, and returns a quantitative analytical result. These results provide precise information including the presence and amount of specific drugs and metabolites. When used in combination with in-office testing, laboratory quantitative testing can provide a validation of the immunoassay tests conducted in the office and offer additional tests when medically necessary.
LC-MS/MS technology uses significantly lower cutoff levels than in-office drug tests and, is therefore, more accurate in determining whether a patient is taking prescribed medications, other legal substances and/or illicit drugs.
Additional features of LC-MS/MS testingLC-MS/MS testing will identify drug classes, as well as specific drugs within that class and their metabolites. For instance, the test for the drug class opiates can also provide valuable information on the following drugs/metabolites within the opiate drug class: codeine, morphine, hydrocodone, hydromorphone, norhydrocodone, and norhydromorphone. Additionally, LC-MS/MS can test for fentanyl, tramadol, carisoprodol, meperidine, ethylglucuronide (alcohol metabolite), and many other medications and drugs of interest to healthcare professionals that are not included on the in-office drug test devices.
LC-MS/MS and In-office Drug Test Cutoff Level* Comparison
Drug (Analyte) |
In-office UDT cutoff |
LC-MS/MS cutoff** |
| Amphetamine | 1000 | 50 |
| Barbiturates | 300 | 200 |
| Benzodiazepines | 300 | 20 |
| Cocaine | 300 | 20 |
| MDMA | 500 | 10 |
| Methadone | 300 | 10 |
| Methamphetamine | 1000 | 50 |
| Opiates 300 | 300 | 40 |
| Oxycodone | 100 | 40 |
| PCP | 25 | 10 |
| THC (Marijuana) | 50 | 5 |
| Tricyclic Antidepressants | 1000 | 50 |
* cutoff levels measured in ng/mL
** LC-MS/MS cutoff level is listed as lowest possible level for urine or oral fluid testing
