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HelpTest Code AMPMX Amphetamine-Type Stimulants Confirmation, Chain of Custody, Meconium
Useful For
Detecting in utero drug exposure up to 5 months before birth
Chain of custody is required whenever 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 under the control of personnel involved with testing the specimen at all times; this control implies that the opportunity for specimen tampering would be limited. Since the evidence of illicit drug use during pregnancy can be cause for separating the baby from the mother, a complete chain of custody ensures that the test results are appropriate for legal proceedings.
Additional Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| COCH | Chain of Custody Processing | No | Yes |
Reporting Name
Amphetamines Confirmation, CoC, MSpecimen Type
MeconiumSpecimen Required
Supplies: Chain of Custody Meconium Kit (T653) includes the specimen containers, seals, and documentation required.
Specimen Volume: 1 g (approximately 1 teaspoon)
Collection Instructions: Collect entire random meconium specimen.
Additional Information:
1. Specimen that arrives with a broken seal does not meet the chain of custody requirements.
2. The laboratory recommends sending chain-of-custody specimens by overnight shipment.
Specimen Minimum Volume
0.3 g (approximately 1/4 teaspoon)
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Meconium | Frozen (preferred) | 28 days | |
| Ambient | 28 days | ||
| Refrigerated | 28 days |
Reject Due To
| Grossly bloody | Reject; Pink OK |
Clinical Information
Several stimulants and hallucinogens chemically related to phenylethylamine are referred to collectively as the amphetamine-type stimulants (amphetamines). Generally, this refers to the prescription and illicit amphetamines including amphetamine; methamphetamine; 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy); 3,4-methylenedioxyamphetamine (MDA); and 3,4-methylenedioxyethylamphetamine (MDEA).(1) Methamphetamine has become a drug of choice among stimulant abusers because of its availability and ease of production.
The metabolism of amphetamine consists of hydroxylation and deamination followed by conjugation with glucuronic acid. Methamphetamine is metabolized to amphetamine; both should be present in urine after methamphetamine use. Both MDMA and MDEA are metabolized to MDA.(1)
The disposition of drug in meconium, the first fecal material passed by the neonate, is not well understood. The proposed mechanism is that the fetus excretes drug into bile and amniotic fluid. Drug accumulates in meconium either by direct deposition from bile or through swallowing of amniotic fluid.(2) The first evidence of meconium in the fetal intestine appears at approximately the 10th to 12th week of gestation, and slowly moves to the colon by the 16th week of gestation.(3) Therefore, the presence of drugs in meconium has been proposed to be indicative of in utero drug exposure up to 5 months before birth, a longer historical measure than is possible by urinalysis.(2)
Intrauterine drug exposure to amphetamines has been associated with maternal abruption, prematurity, and decreased growth parameters, such as low birthweight.(4) Some intrauterine amphetamine-exposed infants may develop hypertonia, tremors, and poor feeding and abnormal sleep patterns.(5)
Chain of custody is a record of the disposition of a specimen to document who collected it, who handled it, and who 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
Negative
Positives are reported with a quantitative liquid chromatography tandem mass spectrometry (LC-MS/MS) result.
Cutoff concentrations for LC-MS/MS testing:
Amphetamine: 20 ng/g
Methamphetamine: 20 ng/g
3,4-Methylenedioxyamphetamine: 20 ng/g
3,4-Methylenedioxyethylamphetamine: 20 ng/g
3,4-Methylenedioxymethamphetamine: 20 ng/g
Interpretation
The presence of any of the following: amphetamine; methamphetamine; 3,4-methylenedioxyamphetamine; 3,4-methylenedioxymethamphetamine; or 3,4-methylenedioxyethylamphetamine at more than 20 ng/g is indicative of in utero exposure up to 5 months before birth.
Cautions
No significant cautionary statements
Clinical Reference
1. Baselt RC: Disposition of Toxic Drugs and Chemical in Man. 8th ed. Biochemical Publications; 2008:83-86; 947-952; 993-999
2. Ostrea EM Jr, Brady MJ, Parks PM, Asensio DC, Naluz: Drug screening of meconium in infants of drug-dependent mothers: an alternative to urine testing. J Pediatr. 1989 Sep;115(3):474-477
3. Ahanya SN, Lakshmanan J, Morgan BL, Ross MG: Meconium passage in utero: mechanisms, consequences, and management. Obstet Gynecol Surv. 2005 Jan;60(1):45-56
4. Kwong TC, Ryan RM: Detection of intrauterine illicit drug exposure by newborn drug testing. National Academy of Clinical Biochemistry. Clin Chem. 1997 Jan;43(1):235-242
5. Dixon SD: Effects of transplacental exposure to cocaine and methamphetamine on the neonate. West J Med. 1989 Apr;150(4):436-442
6. Langman LJ Bechtel LK, Meier BM, Holstege C: Clinical toxicology. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:832-887
Method Description
Meconium is mixed with internal standard and extracted with methanol. The methanolic extract is further processed by solid phase extraction. The extract is analyzed by liquid chromatography tandem mass spectroscopy.(Unpublished Mayo method)
Day(s) Performed
Monday through Sunday
Report Available
2 to 3 daysSpecimen Retention Time
2 weeksPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
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
80324
80359
G0480 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| AMPMX | Amphetamines Confirmation, CoC, M | 69021-4 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 36136 | Amphetamine | 26959-7 |
| 36137 | Methamphetamine | 69022-2 |
| 36138 | 3,4-methylenedioxyamphetamine | 69023-0 |
| 36139 | 3,4-methylenedioxyethylamphetamine | 69024-8 |
| 36140 | 3,4-methylenedioxymethamphetamine | 69025-5 |
| 36141 | Interpretation | 69050-3 |
| 36142 | Chain of Custody | 77202-0 |
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Forms
1. Chain of Custody Request is included in the Chain-of-Custody Meconium Kit (T653).
2. If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.