{"id":28776,"date":"2026-07-06T11:31:40","date_gmt":"2026-07-06T10:31:40","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=28776"},"modified":"2026-07-07T11:09:41","modified_gmt":"2026-07-07T10:09:41","slug":"drug-toxicology","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/drug-toxicology\/","title":{"rendered":"Drug Toxicology"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\"><strong><span style=\"text-decoration: underline\">Sample type<\/span><\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">The RIE Clinical Biochemistry department provides a pan-Lothian testing service. Testing can be carried out on oral fluid swabs and urine samples. Oral fluid swabs are the test of choice and recommended by the specialist services. They are quicker and have the advantage of witnessed collection which avoids sample swapping or adulteration.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is useful to indicate on the request form which relevant drugs the patient is prescribed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Oral fluid<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">How to collect saliva using the Sarstedt Salivette device:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Remove the top cap of the tube to expose the round sponge. Do not remove the holder that the sponge sits in.<\/li>\n\n\n\n<li>Place the sponge in your mouth by tipping the tube so the sponge falls into your mouth. Do not touch the sponge with your fingers.<\/li>\n\n\n\n<li>Keep the sponge in your mouth. Very gently chew and roll the sponge around your mouth for 1-2 minutes. Spit the sponge back into the inner sleeve of the tube. Do not touch the sponge with your fingers.<\/li>\n\n\n\n<li>Replace the cap. Make sure cap is on tightly.<\/li>\n\n\n\n<li>GPOC \/ ICE orders can be found under Common Tests, Drug Screening. Otherwise, label the Salivette tube with the patient&#8217;s full name, date of birth and date of collection. Complete all details on the request form, including full name, date of birth, CHI or registration number, postcode (if CHI not available), requesting location and clinician, time\/date of collection and specimen type, requesting a drug screen.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Note<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Testing requires 50\u00b5l of saliva. Approximately 4% of received samples are insufficient so it is important that the swab is gently chewed for 2 full minutes to ensure sufficient saliva is collected.<\/li>\n\n\n\n<li>Samples should not be collected within an hour of a drug being administered orally since these can contaminate the oral mucosa leading to extremely high concentrations in the sample which can cause analytical issues both for this, &amp; subsequent, samples. This is particularly relevant for all oral buprenorphine preparations.<\/li>\n\n\n\n<li>If a patient has very recently taken medication or another drug orally, consider postponing the test or sending a fresh urine sample instead.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Urine<\/strong><\/em><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Take a spot urine sample into a white top, plain universal container.<\/li>\n\n\n\n<li>GPOC \/ ICE orders can be found under Common Tests, Drug Screening. Otherwise, label the Salivette tube with the patient&#8217;s full name, date of birth and date of collection. Complete all details on the request form, including full name, date of birth, CHI or registration number, postcode (if CHI not available), requesting location and clinician, time\/date of collection and specimen type, requesting a drug screen.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Note<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>An advantage of urine testing is the relatively longer duration of detectability since drug metabolites are often the compounds of interest.<\/li>\n\n\n\n<li>Sample integrity checks include creatinine measurement to determine if pale samples are dilute (&lt;2.0 mmol\/L) and therefore prone to false negative results. Dilute samples will be highl<em>i<\/em>ghted on the report.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong><span style=\"text-decoration: underline\">Drug repertoire<\/span><\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">The toxicology lab currently tests for approximately 25 drugs and metabolites in oral fluid and urine in every sample. Please note that cannabis can be tested in urine but is not part of the core panel of drugs and must be ordered separately (on GP ICE \u2018Urinary drugs of abuse + cannabis\u2019 or with a hand written form)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Toxicology reports<\/strong> contain 10 core groups. These include recently added ketamine, xylazine and nitazene groups:<\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><thead><tr><th><strong>Group<\/strong><\/th><th><strong>Notes<\/strong><\/th><\/tr><\/thead><tbody><tr><td><strong>Opiate group <\/strong><strong><\/strong><\/td><td>Morphine, codeine and 6MAM (heroin metabolite) <br>Dihydrocodeine, oxycodone (individual drugs only reported when group is positive<\/td><\/tr><tr><td><strong>Amphetamine<\/strong><strong><\/strong><\/td><td>&nbsp;<\/td><\/tr><tr><td><strong>Cocaine<\/strong><strong><\/strong><\/td><td>Or metabolite, benzoylecgonine, in urine<\/td><\/tr><tr><td><strong>Methadone<\/strong><strong><\/strong><\/td><td>Or metabolite (EDDP) in urine<\/td><\/tr><tr><td><strong>Benzodiazepine <\/strong><strong><\/strong> <strong>group<\/strong><strong><\/strong><\/td><td>Includes diazepam, temazepam, nitrazepam, nordiazepam (metabolite of diazepam and chlordiazepoxide) and 7-aminoclonazepam (urine only) Individual drugs are not reported<\/td><\/tr><tr><td><strong>Gabapentin<\/strong><strong><\/strong><\/td><td>&nbsp;<\/td><\/tr><tr><td><strong>Pregabalin<\/strong><strong><\/strong><\/td><td>&nbsp;<\/td><\/tr><tr><td><strong>Buprenorphine<\/strong><strong><\/strong><\/td><td>Or norbuprenorphine (buprenorphine metabolite) in urine<\/td><\/tr><tr><td><strong>Ketamine<\/strong><strong><\/strong><\/td><td>Norketamine (ketamine metabolite) will be measured but not reported<\/td><\/tr><tr><td><strong>Xylazine<\/strong><strong><\/strong><\/td><td>&nbsp;<\/td><\/tr><tr><td><strong>Nitazene group<\/strong><strong><\/strong><\/td><td>Includes Isotonitazene, Metonitazene, N-Pyrrolidino Etonitazene, Protonitazene<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">The following drugs are tested in every sample but only reported when positive ie. if these are not listed on the report, a negative result can be assumed.<\/p>\n\n\n\n<figure class=\"wp-block-table aligncenter is-style-stripes\"><table><thead><tr><th>DRUG<\/th><th>Notes<\/th><\/tr><\/thead><tbody><tr><td><strong>MDMA<\/strong><strong><\/strong><\/td><td>Ecstasy<strong><\/strong><\/td><\/tr><tr><td><strong>Methamphetamine<\/strong><strong><\/strong><\/td><td>&nbsp;<\/td><\/tr><tr><td><strong>Tramadol<\/strong><strong><\/strong><\/td><td>&nbsp;<\/td><\/tr><tr><td><strong>\u2018Street\u2019 Benzodiazepines<\/strong><strong><\/strong><\/td><td>Includes Alprazolam (Xanax), Etizolam, Bromazolam<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Opiate metabolism &#8211; points to note:<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Morphine may be derived from morphine preparations (e.g. MST or Oramorph), heroin or codeine.<\/li>\n\n\n\n<li>6MAM is derived <strong>only<\/strong> from heroin, so indicates heroin use.<\/li>\n\n\n\n<li>Dihydrocodeine does<strong> not<\/strong> metabolise to, or from, codeine.<\/li>\n\n\n\n<li>Oxycodone may be derived from drugs containing it (e.g. OxyNorm, OxyContin).<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong><span style=\"text-decoration: underline\">Interpreting and acting on results<\/span><\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Results are normally available within 7 days and often after 3-4 days.&nbsp; Contact the laboratory if results are required sooner but quicker turnaround time cannot be guaranteed.<\/li>\n\n\n\n<li>Inconsistent or unexpected results should always be interpreted in view of other clinical information and should not be treated as definitive in isolation.<\/li>\n\n\n\n<li>If an unexpected positive or negative result is received, contact the laboratory as soon as possible &#8211; further review and\/or repeat analysis may clarify the situation.<\/li>\n\n\n\n<li>Results should not be used for medicolegal purposes.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Positive and negative results \u2013 General points to note:<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Many prescribed and illicit drugs can be misused, but not all can be identified by current testing due to the rapidly evolving nature of novel psychoactive substances.&nbsp; Drugs may be present in the sample but not reported as positive because the drug is not included in the panel.<\/li>\n\n\n\n<li>The method is mass spectrometry based which is highly specific for the drugs included in the panel and therefore not prone to false positives. There is a very high degree of assurance positive results are reliable due to the nature of the method and quality checking processes.<\/li>\n\n\n\n<li>A negative result may occasionally be reported at low doses of methadone (less than 10-15 mg\/day), in pregnancy or if the patient is a fast metaboliser of methadone.<\/li>\n\n\n\n<li>Negative results can be seen in some patients on low dose (8 mg\/day) buprenorphine particularly if the sample is collected more than 10 hours after a dose.<\/li>\n\n\n\n<li>Long-acting injectable buprenorphine (Buvidal) may produce false negative results on oral fluid testing, especially at relatively low dose.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Duration of Detectability<\/u><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Drugs have a duration (or \u2018window\u2019) of detectability which is the period after drug administration that would be expected to produce a positive result on testing. These should only be used as a rough guide and vary depending on a number of criteria including the drug type, dose, pattern of consumption, route of administration, sample type and individual pharmacokinetics (metabolism, saliva pH).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The table below shows approximate durations of detectability (NB published evidence in this area is limited):<\/p>\n\n\n\n<figure class=\"wp-block-table aligncenter is-style-stripes\"><table class=\"has-border-color has-standard-black-border-color\" style=\"border-width:1px\"><tbody><tr><td rowspan=\"2\"><strong>Drug<\/strong><\/td><td colspan=\"2\"><strong>Approximate duration of detectability<\/strong><\/td><\/tr><tr><td><strong>Oral fluid<\/strong><strong><\/strong><\/td><td><strong>Urine<\/strong><strong><\/strong><\/td><\/tr><tr><td>Opiates*<\/td><td>24 hours<\/td><td>48 hours<\/td><\/tr><tr><td>Cocaine*<\/td><td>24-48 hours<\/td><td>48-72 hours<\/td><\/tr><tr><td>Benzodiazepines**<\/td><td>&lt; 7days<\/td><td>7 days<\/td><\/tr><tr><td>Methadone<\/td><td>&lt;7 days<\/td><td>7 days<\/td><\/tr><tr><td>Buprenorphine<\/td><td>&lt;4 days<\/td><td>4-6 days<\/td><\/tr><tr><td>Amphetamine Metamphetamine MDMA (\u2018Ecstasy\u2019)<\/td><td>24 hours<\/td><td>48 hours<\/td><\/tr><tr><td>Gabapentin Pregabalin<\/td><td>&lt;48 hours<\/td><td>48 hours<\/td><\/tr><tr><td>Tramadol<\/td><td>&lt;48 hours<\/td><td>48 hours<\/td><\/tr><tr><td>Cannabis<\/td><td>N\/A<\/td><td>4 weeks or longer in chronic, heavy use<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">*Some studies have suggested that 6MAM (heroin metabolite) and cocaine may be detectable up to 5 days in oral fluid (longer than in urine) in high dose, long term users.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">**Clearance rates of benzodiazepines vary (\u2018long-acting\u2019 diazepam and chlordiazepoxide may be detected for up to 7 days whereas \u2018short-intermediate acting\u2019 drugs such as alprazolam and etizolam may be present for only 24-48 hours).<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Other resources and contacts<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Further details for users of the drug toxicology service is available via the NHS Lothian<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Laboratory Medicine website:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Oral fluid swab<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/edinburghlabmed.co.uk\/node\/2299\" target=\"_blank\" rel=\"noreferrer noopener\">Test Directory | Edinburgh and Lothians Laboratory Medicine (edinburghlabmed.co.uk)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Urine sample<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/edinburghlabmed.co.uk\/node\/1981\" target=\"_blank\" rel=\"noreferrer noopener\">Test Directory | Edinburgh and Lothians Laboratory Medicine (edinburghlabmed.co.uk)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Requests for advice on specific cases are welcome and can be discussed: <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u260e01312426879<br>\u2709<a href=\"mailto:BiochemAdvice@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">BiochemAdvice@nhs.scot<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.M &amp; H.H &#8211; 6-7-26<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Sample type The RIE Clinical Biochemistry department provides a pan-Lothian testing service. Testing can be carried out on oral fluid swabs and urine samples. Oral fluid swabs are the test of choice and recommended by the specialist services. They are quicker and have the advantage of witnessed collection which avoids sample swapping or adulteration. It<\/p>\n","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[656,1402],"class_list":["post-28776","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-guidelines-alcoholanddruguse","category-https-apps-nhslothian-scot-refhelp-drug-toxicology"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"mariamazoysaavedra","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/mariamazoysaavedra\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/https-apps-nhslothian-scot-refhelp-guidelines-alcoholanddruguse\/\" rel=\"tag\">Alcohol and Drug Use<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/https-apps-nhslothian-scot-refhelp-guidelines-alcoholanddruguse\/https-apps-nhslothian-scot-refhelp-drug-toxicology\/\" rel=\"tag\">Drug Toxicology<\/a>","rttpg_excerpt":"Sample type The RIE Clinical Biochemistry department provides a pan-Lothian testing service. Testing can be carried out on oral fluid swabs and urine samples. Oral fluid swabs are the test of choice and recommended by the specialist services. They are quicker and have the advantage of witnessed collection which avoids sample swapping or adulteration. It","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28776","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=28776"}],"version-history":[{"count":3,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28776\/revisions"}],"predecessor-version":[{"id":28779,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/28776\/revisions\/28779"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=28776"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=28776"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}