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HelpTest Code BNZX Benzodiazepines Confirmation, Chain of Custody, Random, Urine
Specimen Required
Supplies: Chain of Custody Kit (T282)
Container/Tube: Chain of custody kit containing the specimen containers, seals, and documentation required
Specimen Volume: 5 mL
Collection Instructions: Collect specimen in the container provided, seal, and submit with the associated documentation to satisfy the legal requirements for chain-of-custody testing.
Additional Information: Submitting less than 5 mL will compromise the ability to perform all necessary testing.
Forms
1. Chain of Custody Request is included in the Chain of Custody Kit (T282).
2. If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.
Useful For
Detecting drug use involving benzodiazepines such as alprazolam, chlordiazepoxide, clonazepam, diazepam, midazolam, oxazepam, temazepam, clobazam, flunitrazepam, flurazepam, lorazepam, prazepam, triazolam, and zolpidem, in urine specimens handled through the chain-of-custody process
Providing chain of custody for when the results of testing could be used in a court of law. Its purpose is to protect the rights of the individual contributing the specimen by demonstrating that it was always under the control of personnel involved with testing the specimen; this control implies that the opportunity for specimen tampering would be limited.
Additional Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| COCH | Chain of Custody Processing | No | Yes |
| ADLTX | Adulterants Survey, CoC, U | Yes | Yes |
Testing Algorithm
Testing for adulterants will be performed on all chain-of-custody urine samples per regulatory requirements.
Method Name
Immunoassay/Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Benzodiazepines Conf, CoC, USpecimen Type
UrineSpecimen Minimum Volume
1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 7 days | |
| Frozen | 14 days |
Reference Values
Negative
Immunoassay Screen: <100 ng/mL
Cutoff concentrations by liquid chromatography tandem mass spectroscopy:
Alprazolam: 10 ng/mL
Alpha-hydroxyalprazolam: 10 ng/mL
Chlordiazepoxide: 10 ng/mL
Clonazepam: 10 ng/mL
7-Aminoclonazepam: 10 ng/mL
Diazepam: 10 ng/mL
Nordiazepam: 10 ng/mL
Midazolam: 10 ng/mL
Alpha-hydroxy midazolam: 10 ng/mL
Oxazepam: 10 ng/mL
Temazepam: 10 ng/mL
Clobazam: 10 ng/mL
N-Desmethylclobazam by LC-MS/MS: 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
Prazepam: 10 ng/mL
Triazolam: 10 ng/mL
Alpha-hydroxy triazolam: 10 ng/mL
Zolpidem: 10 ng/mL
Zolpidem phenyl-4-carboxylic acid: 10 ng/mL
Interpretation
Benzodiazepines are extensively metabolized, and the parent compounds are not detected in urine. This test screens for (and confirms) the presence of:
-Alprazolam
-Alpha-hydroxyalprazolam (metabolite of alprazolam)
-Chlordiazepoxide
-Clonazepam
-7-Aminoclonazepam (metabolite of clonazepam)
-Diazepam (separate prescribable drug and metabolite of medzazepam)
-Nordiazepam (metabolite of clorazepate, halazepam, prazepam, diazepam and medazepam)
-Midazolam
-Alpha-hydroxy midazolam (metabolite of midazolam)
-Oxazepam (separate prescribable drug and metabolite of clorazepate, halazepam, prazepam, medazepam, temazepam, and diazepam)
-Temazepam (separate prescribable drug and metabolite of medazepam and diazepam)
-Clobazam
-N-Desmethylclobazam (metabolite of clobazam)
-Flunitrazepam
-7-Aminoflunitrazepam (metabolite of flunitrazepam)
-Flurazepam
-2-Hydroxy ethyl flurazepam (metabolite of flurazepam)
-Lorazepam
-Prazepam
-Triazolam
-Alpha-hydroxy triazolam (metabolite of triazolam)
-Zolpidem
-Zolpidem phenyl-4-carboxylic acid (metabolite of zolpidem)
The clearance half-life of long-acting benzodiazepines is more than 24 hours. It takes 5 to 7 half-lives to clear 98% of a drug dose. Therefore, the presence of a long-acting benzodiazepine greater than the limit of quantification indicates exposure within a 5 to 20-day interval preceding specimen collection. Following a dose of diazepam, the drug and its metabolites appear in the urine within 30 minutes. Peak urine output is reached between 1 and 8 hours. For additional information including metabolism, clearance (half-life), and approximate detection times, see Optimize Urine Drug Monitoring for CNS Depressants.
Clinical Reference
1. Gudin JA, Mogali S, Jones JD, Comer SD. Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. Postgrad Med. 2013;125(4):115-130. doi:10.3810/pgm.2013.07.2684
2. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. 2022;71(3):1-95
3. Baselt RC. Disposition of Toxic Drugs and Chemical in Man. 12th ed. Biomedical Publications; 2020
4. Langman LJ, Bechtel LK, Holstege C. Clinical toxicology. In: Rifai N, Chiu RWK, Burnham CD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 43
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
80347
G0480 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| BNZX | Benzodiazepines Conf, CoC, U | 90890-5 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 608452 | Benzodiazepines Immunoassay Screen | 14316-4 |
| 608280 | Alprazolam by LC-MS/MS | 59615-5 |
| 608281 | Alpha-Hydroxyalprazolam by LC-MS/MS | 16348-5 |
| 608282 | Chlordiazepoxide by LC-MS/MS | 20522-9 |
| 608283 | Clonazepam by LC-MS/MS | 16229-7 |
| 608284 | 7-aminoclonazepam by LC-MS/MS | 51776-3 |
| 608285 | Diazepam by LC-MS/MS | 16227-1 |
| 608286 | Nordiazepam by LC-MS/MS | 16228-9 |
| 608287 | Midazolam by LC-MS/MS | 16233-9 |
| 608288 | Alpha-Hydroxy Midazolam by LC-MS/MS | 59590-0 |
| 608289 | Oxazepam by LC-MS/MS | 16201-6 |
| 608290 | Temazepam by LC-MS/MS | 20559-1 |
| 608291 | Clobazam by LC-MS/MS | 59635-3 |
| 608292 | N-Desmethylclobazam by LC-MS/MS | 97160-6 |
| 608293 | Flunitrazepam by LC-MS/MS | 20528-6 |
| 608294 | 7-aminoflunitrazepam by LC-MS/MS | 51777-1 |
| 608295 | Flurazepam by LC-MS/MS | 16231-3 |
| 608296 | 2-Hydroxy Ethyl Flurazepam by LC-MS/MS | 97159-8 |
| 608297 | Lorazepam by LC-MS/MS | 17088-6 |
| 608298 | Prazepam by LC-MS/MS | 17479-7 |
| 608299 | Triazolam by LC-MS/MS | 16232-1 |
| 608300 | Alpha-Hydroxy Triazolam by LC-MS/MS | 49876-6 |
| 608301 | Zolpidem by LC-MS/MS | 72770-1 |
| 608302 | Zolpidem Phenyl-4-Carboxylic acid by LC-MS/MS | 72768-5 |
| 608449 | Benzodiazepines Interpretation | 69050-3 |
| 608450 | Chain of Custody | 77202-0 |
Day(s) Performed
Monday through Friday