Both codeine and heroin are opiates that get metabolized to morphine. Most immunoassays for opiates (non-synthetic, natural opiates) use antibodies to morphine to set the threshold for a positive versus negative screen. For example, long-acting benzodiazepines may be detected up to 30 days, whereas short-acting benzodiazepines may be detected for up to three days. 1 This can vary significantly between drugs of the same class and is important to consider when interpreting a UDS.
Detection time is the time since ingestion during which the drug or its metabolites will be detected by the immunoassay. A positive result means the immunoassay has detected a substance of a similar chemical structure to the screening target. A negative result doesn’t necessarily mean the drug is absent, it means the amount present is below the cut-off level for detection. Overview The UDS commonly used in the acute care setting is an immunoassay, which uses antibodies to detect a drug and/or its metabolites. Therefore, it is important to understand the diagnostic characteristics and interpretation of the UDS to make the best possible clinical decisions for the patient.
Hospitalists also work collaboratively with outpatient prescribing clinicians regarding the ongoing prescription of opioids or sedative-hypnotic drugs. Emergency department (ED) clinicians may use the UDS in the initial assessment of patients presenting with a severe overdose, acute encephalopathy, psychosis, and other toxidromes. Hospitalists safely transition patients from their early management of a suspected overdose back to the outpatient setting through careful medication reconciliation and the diagnosis of substance use disorders. The UDS is frequently used in the acute care setting.
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