Journal Article

Selection of an Immunoassay Screening Cutoff Concentration for Opioids in Oral Fluid

Margaux Garnier, Cynthia Coulter and Christine Moore

in Journal of Analytical Toxicology

Volume 35, issue 6, pages 369-374
Published in print July 2011 | ISSN: 0146-4760
Published online July 2011 | e-ISSN: 1945-2403 | DOI:
Selection of an Immunoassay Screening Cutoff Concentration for Opioids in Oral Fluid

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A retrospective analysis of data from oral fluid specimens was conducted in order to identify a relevant cutoff concentration for opiates and/or synthetic opiates in oral fluid. Previously proposed regulations from the Substance Abuse and Mental Health Services Administration (SAMHSA) have recommended 40 µg/L as a cutoff concentration. In this study, data from oral fluid specimens collected using the Quantisal™ device and screened with enzyme linked immunosorbent assays (ELISA) for both opiates and oxycodone were retrospectively assessed for screen positives > 20 µg/L and those between negative and 20 µg/L. Specimens identified at these concentrations were then analyzed using liquid chromatography with tandem mass spectral detection using a fully validated procedure. Overall, 156 positive specimens were identified using 40 µg/L; 191 specimens using 20 µg/L; and 241 specimens between negative and 20 µg/L. Specifically, the number of 6-acetylmorphine (6-AM) positives increased from 10 to 16; morphine 4 to 9; codeine from 11 to 19; oxycodone from 56 to 74; hydrocodone from 73 to 119; and hydromorphone from 2 to 4 when specimens with enzyme inhibition between negative and 20 µg/L were analyzed. For workplace testing where only codeine, morphine, and 6-AM are considered, the use of a lowered cutoff concentration produced significant increases in the positive rate.

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Subjects: Medical Toxicology ; Toxicology (Non-medical)

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