Test Catalog

Test Id : BNZX

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Benzodiazepines Confirmation, Chain of Custody, Random, Urine

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Detecting drug use involving benzodiazepines such as alprazolam, chlordiazepoxide, clonazepam, diazepam, midazolam, oxazepam, temazepam, clobazam, flunitrazepam, flurazepam, lorazepam, prazepam, triazolam, and zolpidem, in urine specimens handled through the chain-of-custody process

 

Providing chain of custody for when the results of testing could be used in a court of law. Its purpose is to protect the rights of the individual contributing the specimen by demonstrating that it was always under the control of personnel involved with testing the specimen; this control implies that the opportunity for specimen tampering would be limited.

Additional Tests
Lists tests that are always performed, at an additional charge, with the initial tests.

Test Id Reporting Name Available Separately Always Performed
COCH Chain of Custody Processing No Yes
ADLTX Adulterants Survey, CoC, U Yes Yes

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Testing for adulterants will be performed on all chain-of-custody urine samples per regulatory requirements.

Method Name
A short description of the method used to perform the test

Immunoassay/Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Benzodiazepines Conf, CoC, U

Aliases
Lists additional common names for a test, as an aid in searching

7-Amino Flunitrazepam (Metabolite of Flunitrazepam) (Rohypnol)

7-Aminoclonazepam

Alprazolam (Xanax)

Ativan (Lorazepam)

Benzodiazepines

Chlordiazepoxide (Librium)

Clonazepam

Dalmane (Flurazepam)

Diazepam (Valium)

Flunitrazepam (Rohypnol)

Flurazepam (Dalmane)

Halcion (Triazolam)

Hydroxy-Ethyl Flurazepam (Metabolite of Flurazepam)

Librium (Chlordiazepoxide)

Lorazepam (Ativan)

Oxazepam (Serax)

Restoril (Temazepam)

Rohypnol (Flunitrazepam)

Serax (Oxazepam)

Temazepam (Restoril)

Triazolam (Halcion)

Valium (Diazepam)

Xanax (Alprazolam)

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Testing for adulterants will be performed on all chain-of-custody urine samples per regulatory requirements.

Specimen Type
Describes the specimen type validated for testing

Urine

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Supplies: Chain of Custody Kit (T282)

Container/Tube: Chain of custody kit containing the specimen containers, seals, and documentation required

Specimen Volume: 5 mL

Collection Instructions: Collect specimen in the container provided, seal, and submit with the associated documentation to satisfy the legal requirements for chain-of-custody testing.

Additional Information: Submitting less than 5 mL will compromise the ability to perform all necessary testing.

Forms

1. Chain of Custody Request is included in the Chain of Custody Kit (T282).

2. If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.

1 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Gross icterus Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Urine Refrigerated (preferred) 7 days
Frozen 14 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Detecting drug use involving benzodiazepines such as alprazolam, chlordiazepoxide, clonazepam, diazepam, midazolam, oxazepam, temazepam, clobazam, flunitrazepam, flurazepam, lorazepam, prazepam, triazolam, and zolpidem, in urine specimens handled through the chain-of-custody process

 

Providing chain of custody for when the results of testing could be used in a court of law. Its purpose is to protect the rights of the individual contributing the specimen by demonstrating that it was always under the control of personnel involved with testing the specimen; this control implies that the opportunity for specimen tampering would be limited.

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Testing for adulterants will be performed on all chain-of-custody urine samples per regulatory requirements.

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Benzodiazepines are any of a group of compounds having a common molecular structure and acting similarly as depressants of the central nervous system. As a class of drugs, benzodiazepines are among the most prescribed drugs in the western hemisphere because of their efficacy, safety, low addiction potential, minimal side effects, and high public demand for sedative and anxiolytic agents.

 

Chain of custody is a record of the disposition of a specimen to document each individual who collected, handled, and performed the analysis. When a specimen is submitted in this manner, analysis will be performed in such a way that it will withstand regular court scrutiny.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Negative

 

Immunoassay Screen: <100 ng/mL

 

Cutoff concentrations by liquid chromatography tandem mass spectroscopy:

Alprazolam: 10 ng/mL

Alpha-hydroxyalprazolam: 10 ng/mL

Chlordiazepoxide: 10 ng/mL

Clonazepam: 10 ng/mL

7-Aminoclonazepam: 10 ng/mL

Diazepam: 10 ng/mL

Nordiazepam: 10 ng/mL

Midazolam: 10 ng/mL

Alpha-hydroxy midazolam: 10 ng/mL

Oxazepam: 10 ng/mL

Temazepam: 10 ng/mL

Clobazam: 10 ng/mL

N-Desmethylclobazam by LC-MS/MS: 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

Prazepam: 10 ng/mL

Triazolam: 10 ng/mL

Alpha-hydroxy triazolam: 10 ng/mL

Zolpidem: 10 ng/mL

Zolpidem phenyl-4-carboxylic acid: 10 ng/mL

Interpretation
Provides information to assist in interpretation of the test results

Benzodiazepines are extensively metabolized, and the parent compounds are not detected in urine. This test screens for (and confirms) the presence of:

-Alprazolam

-Alpha-hydroxyalprazolam (metabolite of alprazolam)

-Chlordiazepoxide

-Clonazepam

-7-Aminoclonazepam (metabolite of clonazepam)

-Diazepam (separate prescribable drug and metabolite of medzazepam)

-Nordiazepam (metabolite of clorazepate, halazepam, prazepam, diazepam and medazepam)

-Midazolam

-Alpha-hydroxy midazolam (metabolite of midazolam)

-Oxazepam (separate prescribable drug and metabolite of clorazepate, halazepam, prazepam, medazepam, temazepam, and diazepam)

-Temazepam (separate prescribable drug and metabolite of medazepam and diazepam)

-Clobazam

-N-Desmethylclobazam (metabolite of clobazam)

-Flunitrazepam

-7-Aminoflunitrazepam (metabolite of flunitrazepam)

-Flurazepam

-2-Hydroxy ethyl flurazepam (metabolite of flurazepam)

-Lorazepam

-Prazepam

-Triazolam

-Alpha-hydroxy triazolam (metabolite of triazolam)

-Zolpidem

-Zolpidem phenyl-4-carboxylic acid (metabolite of zolpidem)

 

The clearance half-life of long-acting benzodiazepines is more than 24 hours. It takes 5 to 7 half-lives to clear 98% of a drug dose. Therefore, the presence of a long-acting benzodiazepine greater than the limit of quantification indicates exposure within a 5 to 20-day interval preceding specimen collection. Following a dose of diazepam, the drug and its metabolites appear in the urine within 30 minutes. Peak urine output is reached between 1 and 8 hours. For additional information including metabolism, clearance (half-life), and approximate detection times, see Optimize Urine Drug Monitoring for CNS Depressants.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

No significant cautionary statements

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Gudin JA, Mogali S, Jones JD, Comer SD. Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. Postgrad Med. 2013;125(4):115-130. doi:10.3810/pgm.2013.07.2684

2. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. 2022;71(3):1-95

3. Baselt RC. Disposition of Toxic Drugs and Chemical in Man. 12th ed. Biomedical Publications; 2020

4. Langman LJ, Bechtel LK, Holstege C. Clinical toxicology. In: Rifai N, Chiu RWK, Burnham CD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 43

Method Description
Describes how the test is performed and provides a method-specific reference

Preliminary screen is performed by immunoassay.

 

The benzodiazepine assay is based on the kinetic interaction of microparticles in a solution as measured by changes in light transmission. In the absence of sample drug, soluble drug conjugates bind to antibody-bound microparticles causing the formation of particle aggregates. As the aggregation reaction proceeds in the absence of sample drug, the absorbance increases. When a urine sample contains the drug in question, this drug competes with the drug derivative conjugate for microparticle-bound antibody. Antibody bound to sample drug is no longer available to promote particle aggregation, and subsequent particle lattice formation is inhibited. The presence of sample drug diminishes the increasing absorbance in proportion to the concentration of drug in the sample. Sample drug content is determined relative to the value obtained for a known cutoff concentration of drug.(Package insert: BNZ2. Roche Diagnostics; V 2.0, 04/2024)

 

Benzodiazepines are extensively metabolized by the liver and subsequently exist in the urine primarily as conjugated esters (-glucuronides). The conjugated metabolites are cleaved during a mild hydrolysis utilizing the enzyme glucuronidase. Stable isotope forms of the compounds are added as internal standards to account for extraction losses. An aliquot of the hydrolyzed sample is diluted and the analytes are separated by liquid chromatography tandem mass spectroscopy and analyzed by multiple reaction monitoring.(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

3 to 6 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

14 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

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
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

80347

G0480 (if appropriate)

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
BNZX Benzodiazepines Conf, CoC, U 90890-5
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
608452 Benzodiazepines Immunoassay Screen 14316-4
608280 Alprazolam by LC-MS/MS 59615-5
608281 Alpha-Hydroxyalprazolam by LC-MS/MS 16348-5
608282 Chlordiazepoxide by LC-MS/MS 20522-9
608283 Clonazepam by LC-MS/MS 16229-7
608284 7-aminoclonazepam by LC-MS/MS 51776-3
608285 Diazepam by LC-MS/MS 16227-1
608286 Nordiazepam by LC-MS/MS 16228-9
608287 Midazolam by LC-MS/MS 16233-9
608288 Alpha-Hydroxy Midazolam by LC-MS/MS 59590-0
608289 Oxazepam by LC-MS/MS 16201-6
608290 Temazepam by LC-MS/MS 20559-1
608291 Clobazam by LC-MS/MS 59635-3
608292 N-Desmethylclobazam by LC-MS/MS 97160-6
608293 Flunitrazepam by LC-MS/MS 20528-6
608294 7-aminoflunitrazepam by LC-MS/MS 51777-1
608295 Flurazepam by LC-MS/MS 16231-3
608296 2-Hydroxy Ethyl Flurazepam by LC-MS/MS 97159-8
608297 Lorazepam by LC-MS/MS 17088-6
608298 Prazepam by LC-MS/MS 17479-7
608299 Triazolam by LC-MS/MS 16232-1
608300 Alpha-Hydroxy Triazolam by LC-MS/MS 49876-6
608301 Zolpidem by LC-MS/MS 72770-1
608302 Zolpidem Phenyl-4-Carboxylic acid by LC-MS/MS 72768-5
608449 Benzodiazepines Interpretation 69050-3
608450 Chain of Custody 77202-0

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports