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HelpTest Code CSMEU Controlled Substance Monitoring Enhanced Profile with Reflex, 21 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, and alcohol
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 |
| PNRCH | Drug Immunoassay Panel, U | No | Yes |
| TOPSU | Targeted Opioid Screen, U | Yes, (Order TOSU) | Yes |
| TABSU | Targeted Benzodiazepine Screen, U | Yes, (Order TBSU) | Yes |
| TSTIM | Targeted Stimulant Screen, U | Yes, (Order TSPU) | Yes |
| ETGSR | Ethyl Glucuronide Scrn w/Reflex, U | No | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| COKEU | Cocaine and metabolite Conf, U | Yes | No |
| BARBU | Barbiturates Confirmation, U | Yes | No |
| THCU | Carboxy-THC Confirmation, U | Yes | No |
| 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.
If the immunoassay screen is positive, confirmation testing can be ordered separately. Confirmation with quantification of positive results for barbiturates, cocaine and metabolites, tetrahydrocannabinol metabolite, and ethyl glucuronide/ethyl sulfate will be performed at an additional charge.
Method Name
ADULT: Spectrophotometry
PNRCH: Immunoassay followed by Gas Chromatography Mass Spectrometry (GC-MS) or Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) as needed
TOPSU, TABSU, TSTIM: Liquid Chromatography Tandem Mass Spectrometry, High-Resolution Accurate Mass (LC-MS/MS HRAM)
ETGSR: Immunoassay followed by Liquid Chromatography Tandem Mass Spectrometry as needed
Reporting Name
CSM Enhanced Profile,21, HRMS/IA, USpecimen Type
UrineSpecimen Minimum Volume
20 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 14 days | |
| Frozen | 14 days |
Reference Values
ADULTERANT SURVEY:
Cutoff concentrations
Oxidants: 200 mg/L
Nitrites: 500 mg/L
DRUG IMMUNOASSAY PANEL:
Negative
Screening cutoff concentrations:
Barbiturates: 200 ng/mL
Cocaine (benzoylecgonine-cocaine metabolite): 150 ng/mL
Tetrahydrocannabinol carboxylic acid: 50 ng/mL
This report is intended for use in clinical monitoring or management of patients. It is not intended for use in employment-related testing.
TARGETED OPIOID SCREEN:
Not detected
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
Propoxyphene: 25 ng/mL
Norpropoxyphene: 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 SCREEN:
Not detected
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 STIMULANT SCREEN:
Not detected
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
ETHYL GLUCURONIDE SCREEN:
Negative
Screening cutoff concentrations:
Ethyl glucuronide: 500 ng/mL
Interpretation
A positive result derived by this testing indicates that the patient has used one of the drugs detected by these techniques in the recent past.
For information about drug testing, including estimated detection times and Result Interpretations, see Controlled Substance Monitoring on MayoClinicLabs.com.
Clinical Reference
1. Physicians' Desk Reference; 60th ed. Medical Economics Company; 2006
2. Bruntman LL, ed. Goodman and Gilman's: The Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill Book Company; 2006
3. Langman LJ, Bechtel LK, Holstege CP. Clinical toxicology. In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 43
4. Gutstein HB, Akil H. Opioid analgesics. In: Brunton LL, Lazo JS, Parker KL, eds. Goodman and Gilman's: The Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill Companies; 2006
5. Rovine T, Ferrero CL, American Pain Society: Chronic Pain in America: Roadblocks to Relief. Roper Starch Worldwide, Inc; 1999. Updated 2001. Accessed July 16, 2024. Available at http://accurateclinic.com/wp-content/uploads/2016/04/Chronic-Pain-In-America-Roadblocks-To-Relief-1999.pdf
6. Magnani B, Kwong T. Urine drug testing for pain management. Clin Lab Med. 2012;32(32):379-390
7. Jannetto PJ, Bratanow NC, Clark WA, et al. Executive summary: American Association of Clinical Chemistry Laboratory Medicine Practice Guideline-using clinical laboratory tests to monitor drug therapy in pain management patients. J Appl Lab Med. 2018;2(4):489-526
8. McMillin GA, Marin SJ, Johnson-Davis KL, Lawlor BG, Strathmann FG. A hybrid approach to urine drug testing using high-resolution mass spectrometry and select immunoassays. Am J Clin Pathol. 2015;143(2):234-240
9. Cone EJ, Caplan YH, Black DL, Robert T, Moser F. Urine drug testing of chronic pain patients: licit and illicit drug patterns. J Anal Toxicol. 2008;32(8):530-543
Day(s) Performed
Monday through Saturday
Report Available
3 to 4 daysPerforming 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
80307
80347
80364
80326
G0482 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| CSMEU | CSM Enhanced Profile,21, HRMS/IA, U | 69739-1 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| LPCM | List Patient's Current Medications | 66423-5 |
| 610273 | Methamphetamine | 19554-5 |
| 20606 | Creatinine, U | 2161-8 |
| 2574 | Barbiturates | 70155-7 |
| 616033 | Ethyl Glucuronide Screen, U | 58375-7 |
| 604871 | Alprazolam | 94116-1 |
| 42323 | Codeine | 19411-8 |
| 42324 | Codeine-6-beta-glucuronide | 89310-7 |
| 604867 | Alpha-Hydroxyalprazolam | 19325-0 |
| 21652 | Cocaine | 19359-9 |
| 22312 | Specific Gravity | 5810-7 |
| 610274 | Amphetamine | 19343-3 |
| 610275 | 3,4-methylenedioxymethamphetamine (MDMA) | 19568-5 |
| 23509 | pH | 2756-5 |
| 2664 | Tetrahydrocannabinol | 19415-9 |
| 604891 | Alpha-Hydroxyalprazolam Glucuronide | 94115-3 |
| 42325 | Morphine | 19597-4 |
| 42326 | Morphine-6-beta-glucuronide | 89308-1 |
| 604872 | Chlordiazepoxide | 19385-4 |
| 23511 | Oxidants | 58714-7 |
| 610276 | 3,4-methylenedioxy-N-ethylamphetamine (MDEA) | 59844-1 |
| 610277 | 3,4-methylenedioxyamphetamine (MDA) | 19565-1 |
| 23510 | Nitrites | 32710-6 |
| 604889 | Clobazam | 94114-6 |
| 42327 | 6-monoacetylmorphine | 19321-9 |
| 42328 | Hydrocodone | 19482-9 |
| 604890 | N-Desmethylclobazam | 94113-8 |
| 30914 | Comment | 48767-8 |
| 610278 | Ephedrine | 99108-3 |
| 610279 | Pseudoephedrine | 99109-1 |
| 604873 | Clonazepam | 19399-5 |
| 42329 | Norhydrocodone | 89304-0 |
| 42330 | Dihydrocodeine | 19446-4 |
| 604267 | 7-aminoclonazepam | 94112-0 |
| 610280 | Phentermine | 19674-1 |
| 610281 | Phencyclidine (PCP) | 19659-2 |
| 604874 | Diazepam | 19443-1 |
| 42331 | Hydromorphone | 19486-0 |
| 42332 | Hydromorphone-3-beta-glucuronide | 89309-9 |
| 604880 | Nordiazepam | 19624-6 |
| 610282 | Methylphenidate | 19577-6 |
| 610283 | Ritalinic acid | 99110-9 |
| 604875 | Flunitrazepam | 19466-2 |
| 42333 | Oxycodone | 19642-8 |
| 42334 | Noroxycodone | 89303-2 |
| 604866 | 7-aminoflunitrazepam | 94111-2 |
| 610284 | Stimulant Interpretation | 54247-2 |
| 604876 | Flurazepam | 19474-6 |
| 42335 | Oxymorphone | 19646-9 |
| 42336 | Oxymorphone-3-beta-glucuronide | 89301-6 |
| 604868 | 2-Hydroxy Ethyl Flurazepam | 94110-4 |
| 604877 | Lorazepam | 19520-6 |
| 42337 | Noroxymorphone | 89302-4 |
| 42338 | Fentanyl | 59673-4 |
| 604878 | Lorazepam Glucuronide | 94109-6 |
| 604879 | Midazolam | 19585-9 |
| 42339 | Norfentanyl | 43199-9 |
| 42340 | Meperidine | 19532-1 |
| 604869 | Alpha-Hydroxy Midazolam | 94108-8 |
| 604881 | Oxazepam | 19638-6 |
| 42341 | Normeperidine | 27920-8 |
| 42342 | Naloxone | 42618-9 |
| 604882 | Oxazepam Glucuronide | 94107-0 |
| 604883 | Prazepam | 19678-2 |
| 42343 | Naloxone-3-beta-glucuronide | 89307-3 |
| 42344 | Methadone | 19550-3 |
| 604884 | Temazepam | 19698-0 |
| 604885 | Temazepam Glucuronide | 94106-2 |
| 42345 | EDDP | 93495-0 |
| 42346 | Propoxyphene | 19429-0 |
| 604886 | Triazolam | 19714-5 |
| 604870 | Alpha-Hydroxy Triazolam | 94105-4 |
| 42347 | Norpropoxyphene | 19632-9 |
| 42348 | Tramadol | 19710-3 |
| 604887 | Zolpidem | 94104-7 |
| 604888 | Zolpidem Phenyl-4-Carboxylic acid | 94103-9 |
| 42349 | O-desmethyltramadol | 86453-8 |
| 42350 | Tapentadol | 72485-6 |
| 604949 | Benzodiazepine Interpretation | 69050-3 |
| 42351 | N-desmethyltapentadol | 89306-5 |
| 42352 | Tapentadol-beta-glucuronide | 89300-8 |
| 42353 | Buprenorphine | 93494-3 |
| 42354 | Norbuprenorphine | 82371-6 |
| 42355 | Norbuprenorphine glucuronide | 89305-7 |
| 65059 | Opioid Interpretation | 69050-3 |
Forms
If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
-Renal Diagnostics Test Request (T830)
-Therapeutics Test Request (T831)