FREQUENTLY ASKED QUESTIONS

Toxicology

 
What can a drug test tell me?
Drug testing can help providers confirm medication adherence by detecting the prescribed compound and/or expected metabolites of that drug.  It may also help identify prescription diversion or abuse of drugs that are not prescribed. Through careful interpretation of test results, clinicians are able to monitor compliance to treatment plans to ensure patient safety and improved outcomes
What can a drug test NOT tell me?

While providing the clinician with vital information, like concurrent medication use, possible diversion or misuse of prescribed drugs, or even chronic use of medications, a drug test cannot specifically indicate:

  • Dosage of a drug in question
  • Frequency or exact time frame of drug ingestion
  • Impairment or pharmacological implications from the drug

Thus, drug testing is just one of many valuable tools to help ensure patient compliance with medication and treatment algorithms.

What is the difference between a preliminary immunoassay screen and a quantitative confirmation test?

Each drug has a unique chemical makeup, which lends to its classification and identification through analytical method.  Drugs or compounds of similar structure and/or effect on the body are grouped into classes and can be identified through several unique means of testing.

Presumptive immunoassay screens are rapid, low-complexity tests that use antibodies to detect the presence of drugs and many other substances in urine. These tests return an answer of only “Positive” or “Negative” for a drug or compound in the specimen.  This positive or negative answer is typically drug class-specific only, and dependent upon the level of the compound above a predetermined cut-off level.

Because drugs are chemicals with unique structures, it is possible to identify an individual drug through highly specific laboratory analysis.  LabSolutions employs state of the art UPLC/MS/MS technology and highly sensitive and specific methodology to determine not just the presence, or absence, of a particular drug but also quantify the amount of drug present.

What is UPLC/MS/MS?

UPLC/MS/MS is the abbreviation for Ultra-Performance Liquid Chromatography/mass spectrometry/mass spectrometry, the testing methodology LabSolutions uses to confirm/quantify drug levels in a specimen.

UPLC/MS/MS provides identification of the target molecule(s) based on known characteristics and patterns at specific retention times.

Why are screening and confirmation cut-off levels different?

Screen and confirmation testing are performed using different instruments, which employ different types of testing methodologies. The immunoassay tests used to perform initial drug screening are designed to quickly react to detect a wide range of chemically similar compounds to provide a rapid qualitative result. In contrast, the UPLC/MS/MS testing LabSolutions performs, is an intensive process that identifies specific drugs and metabolites and quantifies their level in the specimen.

What does ng/mL mean?

LabSolutions employs highly sensitive testing methodology that can detect drugs down to billionths of a gram in one milliliter of solution, expressed as ng/mL (nanograms per milliliter).

What is specimen validity testing?

LabSolutions performs specimen validity testing at the provider’s request to detect substitution, adulteration, or dilution of urine specimens:

  • Substitution– Providing a specimen that is not characteristic of human urine. Typically, this may be water or water with substances added to mimic urine.
  • Adulteration– Providing a specimen with added substance(s) to a specimen to mask the presence of, or chemically destroy, the drug or drug metabolite that the specimen may contain.
  • Dilution– Result of either ingesting large amounts of water typically just before urine donation, adding water to the specimen after collection, or as a result of physiological conditions.
How long are drugs stable in a urine sample?

This length of time a drug is stable in a specimen is dependent upon the drug. Typically drugs are stable in urine for a week at room temperature and for at least a month at refrigerated temperatures. If frozen the sample remains stable for longer periods

Why were other drugs or compounds detected in the drug test, which were not prescribed to the patient?

There are possibly several potential reasons for this occurrence:

  • Metabolism – essentially all drugs are consumed or transformed in the body by multiple pathways to enhance their utilization and/or elimination. Slight structural modifications to a drug by enzymes can lead to the production of one or more compounds. Some of these are actively therapeutic and some are not. Some drugs, like some benzodiazepines can be metabolized to another therapeutic compound, which may cause confusion in the interpretation of results.
  • Abuse/diversion –the patient may be taking drugs they were not prescribed. If unexpected results do arise from a drug test it is important to carefully discuss them with your patient before taking next steps. A possible retest may be necessary to confirm.
Why were prescribed drugs not detected in the drug test?

There could be several reasons that a urine drug screen provided an unexpected negative result for a drug prescribed to a patient:

  • Patient non-compliance with medication therapy
  • Drug ingestion not taking place within detection timeframe. Drugs remain in the body for a limited amount of time based on their chemical properties.
  • Metabolism may also affect drug test results. Medications are often metabolized into other compounds and the actual prescription drug, or “parent drug” may no longer be present in the body.
  • The level of drug or compound in the urine specimen may have been below the cutoff levels of the device or instrument analysis.

If unexpected results do arise from a drug test it is important to carefully discuss them with your patient before taking next steps. A possible retest may be necessary to confirm.

How can the screen be negative and the confirmation test result be positive?

Immunoassay screen tests are by design, a low sensitivity, low specificity test and may not be able to detect drugs below a cutoff level that’s much higher than confirmation testing.  In addition, the preliminary screens may not be able to detect all drugs within the drug class, as not all members of that class will react equally to the methodology.  For example, many synthetic opioids like Tramadol, may not be detected by a standard Opioid screen.

LabSolutions offers confirmation testing with UPLC/MS/MS to uniquely identify individual drugs and metabolites through precise measurement of both mass and chemical structure of molecules in a specimen.  Quantitative methodology has a much higher level of both specificity and sensitivity to a targeted set of drugs or compounds and may detect analytes at a much lower concentration than the screen.

How can the POC screen I performed in my office be positive, but the confirmation test result be negative?

: The in-office preliminary screening devices are often subject to a phenomenon known as cross-reactivity.  Some unrelated compounds, but with some structural similarities may cause a positive result even though the target drug or compound is not actually found in the specimen.

LabSolutions performs quantitative analysis via UPLC/MS/MS, which is highly drug-specific and not subject to cross-reactivity, ensuring an accurate result.

How long are drugs detectable in the urine after ingestion?

The available window of time for drug detection depends on several factors, including the genetic makeup and behavioral patterns of the patient, the drug in question, and the length of time that the patient has been taking the drug.

Why should I test for Ethyl glucuronide (EtG) instead of ethanol?

Ethanol is detectable in urine for only a few hours after ingestion. Ethyl glucuronide (EtG) and Ethyl Sulfate (EtS) are detectable for several days after exposure. Thus, these metabolites provide for a better indication of ethanol exposure

Are all opiates the same? Will all opiates yield a positive result on the preliminary screen?

Opiates/opioids are a class of analgesic drugs often prescribed to provide relief from pain. Though they are related in their mechanism of action they all vary in their structure.  This affects the qualitative screen’s ability to detect or differentiate between many individual opiate drugs.  A standard Opiate screen may not detect many synthetic opioids, but confirmation can identify the specific drug

Are there any other causes of a positive opiate result, other than an opiate drug?

Ingestion of significant quantities of poppy seeds products may trigger a positive opiate result.

How can I tell if a benzodiazepine result is consistent with the prescription regimen?

Benzodiazepines are a class of drugs that provide relief from anxiety and induce sedation. While related in their actions, their reactivity with the screening immunoassay will vary from drug to drug. Therefore, the preliminary screen may be negative but LabSolutions quantitative analysis via UPLC/MS/MS will detect the specific drug.

Careful determination of benzodiazepine regimen compliance often requires careful review of results to determine both medication adherence and chronic use.  Benzodiazepines also have a complicated metabolic process that often involves conversion to other branded therapeutic drugs.  In many cases the answer will be obvious but if not, you may consult with one of our skilled toxicologists during normal business hours.

Does the detection of methamphetamine automatically mean that my patient was illicitly abusing the drug?

No. The unique structure of methamphetamine actually exists in two mirror images of each other, called stereoisomers.  One form, d-methamphetamine, is a strong central nervous system stimulant and is frequently associated with abuse.  The other form, l-methamphetamine, has less central nervous system stimulation or addictive properties of the d- isomer, but has greater peripheral vasoconstrictive properties, used in nasal inhalers.

There are several pharmaceutical products that will result in a positive methamphetamine finding:

  • Vicks®Nasal Inhaler – this product contains the I-methamphetamine isomer.
  • Deprenyl (Selegine®) – prescribed to treat Parkinson’s disease, this is also the l-methamphetamine isomer
  • Benzphetamine (Didrex®) – an anorectic drug that is metabolized by the body to form d-methamphetamine

Testing Procedures

 
Can I write in a specific test if it’s not already printed on the requisition?

You may request a test for a drug group or class of drugs to also be tested at any time. Simply write the test code and test name on one of the blank lines provided in the test requested section.

What are the different options available to receive test results?

Results may be forwarded to the provider by secure fax, mail, phone, email, or can be retrieved through our exclusive online specimen entry and results management software https://labsolutions.labsvc.net/labgen/

How do I order more testing supplies?

Please e-mail us at orders@labsolutions.com or call us and ask for account services at 404-228-5027 during normal business and one of our account services associates will gladly assist you.

What kind of expertise do you have on staff that I can ask for help or interpretation of results?

: At LabSolutions, we are committed to ensuring you have all the support needed to properly interpret results to inform your decision-making. Our skilled toxicologists have decades of experience and are available to answer any questions you have during normal business hours. Simply call 404-228-5027 to speak with any of our expert staff now!

What information MUST be on a specimen label so it will not be rejected?

To ensure that results are specific to a patient we require the patient’s full name and date of birth as minimum requirements for specimen labeling. Date and time of specimen collection are also required to ensure proper specimen integrity and record keeping. To help minimize rejections at the lab, please ensure that all specimens are properly labeled with all required patient information.

Why can’t the specimen be tested if the cup broke or leaked during transit?

Sample integrity is crucial to valid results and a broken transport cup could allow contamination of the specimen. A sample with compromised integrity may cause incorrect results and would not be valid for making sound medical decisions.

Do you store patient specimens for later testing/retesting if needed?

Yes. Specimens are retained for three months after testing is completed.

Billing and Privacy

 
What should I do if I need help paying my bill?

Patients who cannot afford to pay their bill or do not have insurance are encouraged to request financial assistance from LabSolutions before making any payment. LabSolutions will provide financial assistance to patients who meet certain financial criteria.

You may also contact a Customer Service Representative at 404-228-5027, Mon – Fri: 9:00 a.m. – 5:00 p.m. (ET).

Please submit a letter explaining your financial hardship to:

LabSolutions, LLC
1451 Northside Drive
Atlanta, GA 30318

You should expect to receive a response from LabSolutions regarding your Financial Assistance within thirty (30) days of submission. If you do not qualify for assistance, or the assistance is not sufficient, we will make every effort to develop a plan that works for you.

Please let us know if you need financial assistance before making any payments on your account; once a payment is made, money cannot be refunded.

What is the difference between an Explanation of Benefits (EOB) and a bill?

An Explanation of Benefits (EOB) is a form or document that may be sent to you by your insurance company after you have had laboratory services (a urine drug monitoring test, for example) that were paid by the insurance company. You should get an EOB if you have private health insurance, a health plan from your employer, or Medicare. An EOB is not a bill.

Your bill will come from LabSolutions (not from the insurance company) and will include all payments made by your insurance company, and any other discounts. Your bill will identify any balance you may owe. You must pay the balance to LabSolutions. Information about how to pay will be listed directly on the bill.

In some cases, your insurance company may send you a check directly as payment for the laboratory services you received from LabSolutions. If you receive a check for these services, the check is provided for payment of LabSolutions services. Please promptly endorse the check and send it to LabSolutions as payment. The check should be mailed to the address below:

LabSolutions, LLC
1451 Northside Drive
Atlanta, GA 30318

What if my Explanation of Benefits (EOB) Patient Responsibility Amount is different than the bill I received from LabSolutions

Our Customer Service staff will work with you to straighten this out. Please contact a Customer Service Representative at 404-228-5027, Mon – Fri: 9:00 a.m. – 5:00 p.m. (ET)

What if my insurance information has changed or it wasn’t correctly entered into the system?

Please contact a Customer Service Representative at 404-228-5027 and give them your correct insurance information as soon as possible. Incorrect or missing insurance information may cause you to be charged an incorrect bill amount.

What if I have other questions regarding my bill?

If you have questions or concerns regarding an LabSolutions bill, please contact a Customer Service Representative at 404-228-5027, Mon – Fri: 9:00 a.m. – 5:00 p.m.
(ET).

Will my medical information be kept confidential, and how can I get access to it?

: LabSolutions is committed to protecting the privacy of your personal and health information, including individual laboratory test results and other patient protected health information that we collect or create as part of our testing activities. Should you have any questions about our privacy practices, please call us at 404-228-5027, or send an email to cs@LabSolutions.com, or write to us at the following address:

Attention Privacy Officer
LabSolutions LLC
1451 Northside Dr
Atlanta, GA 30318

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FAQ

 
Where is Labsolutions located?
Labsolutions is located in Atlanta, GA. See contact page for exact address (insert hyperlink).
If i’m out of state will that prevent LabSolutions from getting me my results in time?
No, LabSolutions provides overnight shipping and will return your results within 72 hours.
What testing methodology does Labsolutions use to perform initial drug screening?
Labsolutions performs initial drug screening using immunoassay. An immunoassay is a test that uses antibodies to detect the presence of drugs and other substances in urine. The initial screening process does not measure the specific amount of drug present in urine samples. It provides either a positive or negative result, indicating the presence or absence of detectable drug.
What is GC/MS?
GC/MS is the abbreviation for gas chromatography/mass spectrometry, the testing methodology Labsolutions uses to confirm presumptive positive drug screen specimens. GC/MS provides identification of the molecule(s) based on characteristic fragmentation patterns at specific retention times. GC/MS is a tandem technology, utilizing a gas chromatograph coupled to a mass spectrometer.
Why are screening and confirmation cut-off levels different?
Simply stated, screening and confirmation testing are performed using different testing methodologies that precipitate different cut-off levels. The immunoassay tests used to perform initial drug screening are designed to detect a wide range of chemically similar compounds that react with the antibodies which are at the core of the chemistry making up the tests. In contrast, GC/MS confirmatory testing detects specific metabolites that provide identification and quantification of a specific drug.
To what does ng/mL refer?
LabSolutions performs initial drug screening using immunoassay. An immunoassay is a test that uses antibodies to detect the presence of drugs and other substances in urine. The initial screening process does not measure the specific amount of drug present in urine samples. It provides either a positive or negative result, indicating the presence or absence of detectable drug.

DRUG DETECTION TIMES

 
What is the detection time for drugs in urine?
See the Drugs of Abuse Reference Guide for general guidelines of drug detectability in urine.
What is methamphetamine "D" and "L" isomer testing?
Methamphetamine is available in two forms: “d” and “l.” These compounds are stereoisomers (chemical mirror images). They have the same chemical formula and similar chemical properties. The “d” form is a prescription stimulant and appetite suppressant. The “l” form is available over-the-counter as the active ingredient of the Vick’s inhaler and is a metabolite of certain prescription medications. Both “d” and “l” test positive by both immunoassay and most GC/MS assays.

AMPHETAMINE TESTING

What is the drug MDMA/Ecstasy?
Ecstasy is a commonly used street-name for MDMA (3,4-methylenedioxymethamphetamine). MDMA is an illegal drug with characteristics of both stimulants and hallucinogens. In the mid 1980s, MDMA was being used at all night dance parties, now referred to as “raves.” In 1985, the US Drug Enforcement Administration moved the drug to Schedule 1 status with no accepted medical use.
Why isn't MDMA detected in my standard amphetamine screen?
MDMA is a synthetic amphetamine structure and does cross-react with existing amphetamine assays. However, the cut-offs established for amphetamine by the government do not pick up concentrations of MDMA in urine that are typically there following exposure. To enable detection of MDMA following normal exposures, Labsolutions uses reagents developed specifically for MDMA detection.

OPIATE TESTING

What is 6-acetylmorphine?
6-acetylemorphine (6-AM) is an intermediate metabolite between heroin and morphine. Generally, 6-AM is present for a short time after use of heroin.
What tests does Labsolutions offer to detect synthetic opiates?
Labsolutions offers an opiate 4 test that is designed to detect codeine, morphine, hydrocodone, and hydromorphone. Additionally, Labsolutions offers a screening and confirmation test specifically designed to detect oxycodone.
What are OxyContin® and oxycodone?
OxyContin® tablets are a controlled-release oral formulation of oxycodone hydrochloride generally indicated for the management of moderate to severe pain when a continuous, around-the-clock analgesic is needed for an extended period. Oxycodone is a semisynthetic narcotic analgesic classified by the US Drug Enforcement Administration as a Schedule II controlled substance with an abuse liability similar to morphine.

SPECIMEN VALIDITY TESTING

What is specimen validity testing?
Specimen validity testing (SVT) is performed on a drug screen specimen to detect substitution, adulteration, or dilution. See the Drugs of Abuse Reference Guide for additional information on SVT. • Substitution – Submission of a specimen that is not characteristic of human urine. Typically, this may be water or water with salt in it and is identified by extreme creatinine and specific gravity results. • Adulteration – Adding a substance to a specimen after it has been collected. The product added is designed to mask the presence of, or chemically destroy, the drug or drug metabolite that the specimen may contain. An adulterant product may be added with the intention of adversely affecting the testing reagents. • Dilution – Result of ingestion of large amounts of water typically just before urine donation or as a result of physiological conditions. Specimens meeting dilute specifications typically are not considered questionable donations.
Does the lab conduct SVT before screening for drugs?
No, specimen validity testing is performed simultaneously with the initial drug screens. Depending upon the drug screen and the specimen validity results, the laboratory will release (1) both the drug screen and the specimen validity test results, (2) the specimen validity test results only, or (3) the drug screen results only.
Is the nitrite test threshold based on body functions, or does it allow for infection, food ingestion with high nitrates, and water consumption with high nitrites?
The nitrite threshold level established by the Federal Government is 500ug/mL. This is based on the level at which a drug screen may be impacted by this adulterant and by which no normal physiological level has been detected.
How would a drug test be evaluated when nitrates are 490 ng/mL?
The nitrite result would be negative, as this level would not interfere with our testing process. The drug test(s) ordered would be conducted and reported following standard operating procedures.

GENETIC TESTING

 
What does Labsolutions Test For?
The Labsolutions test is used to find out which types of genes you have in your body. If you have certain genes, it can mean you have a higher risk of getting a disease or passing a genetic condition on to your children. Also, it can mean certain prescription medicines may not work as well for you or could give you serious complications. The only way to know what genes you have is with a genetic test like the Labsolutions test.
Who should get a genetic test?
Anyone who wants to learn about their genes should consider getting a Labsolutions test. In particular, people who are concerned about their health, people who have started or are considering taking certain prescription medicines, and people who are planning to have children or expecting a baby may benefit the most from a Labsolutions test.
How does the genetic test work?
The Labsolutions test uses advanced technology to look at your genes and discover which type you have. Taking the test is simple—you rub a cotton swab across the inside of your cheek. You don’t have to give blood and there are no needles involved. Learn exactly what’s involved on The Labsolutions Test page.
Who can I contact for more information or help?
Visit our Help page or call us at 404-228-5027.

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