Purple Book

Urinary Toxicology Interpretation

Test DrugDuration of DetectionPossible False Positives
Amphetamines2–3 daysAmantadine, bupropion, chlorpromazine, desipramine, fluoxetine, labetolol, methylphenidate, phentermine, phenylephrine, phenylpropanolamine, promethazine, pseudoephedrine, ranitidine, thioridazine, trazodone
Benzodiazepines3 days for short-acting Up to 30 days for long-actingOxaprozin, sertraline
Cocaine2–3 days with occasional use Up to 8 days with heavy useTopical anesthetics
Opiates1–3 daysDextromethorphan, diphenhydramine, fluorquinolones, poppy seeds, quinine, rifampin, verapamil
PCP7–14 daysDextromethorphan, diphenhydramine, ibuprofen, imipramine, ketamine, meperidone, thioridazine, tramadol, venlafaxine
Marijuana3–7 days with single use 5–7 days with 4x weekly use 10–15 days with daily use >30 days with chronic heavy useDronabinol, NSAIDs (ibuprofen, naproxen, sulindac), PPIs

Opioid and Stimulant Intoxication – Signs and Symptoms

Opioid IntoxicationStimulant Intoxication (cocaine, amphetamine, etc.)
Drowsiness
Slurred speech
Memory impairment
Shallow and slow respiration
Pupil constriction
Coma
Hypervigilance
Tachycardia or bradycardia
Pupillary dilation
Increased or decreased blood pressure
Cardiac arrhythmias
Psychomotor agitation or retardation
Nausea or vomiting

Opioid Withdrawal – Signs and Symptoms

Grade 1Grade 2Grade 3
YawningMydriasisInsomnia
SweatingPiloerectionIncreased pulse
LacrimationMuscle twitchingIncreased respiratory rate
RhinorrheaAnorexiaElevated blood pressure
  Abdominal cramps
  Vomiting
  Diarrhea Weakness

Opioid Pain Medication Conversions

NARCOTIC EQUIVALENTS
AnalgesicOral Dose (mg)Parenteral Dose (mg)
Meperidine (Demerol)15050
Codeine (Tylenol #3 x3)10060
Hydrocodone (Vicodin x3, Lortab x3)15N/A
Morphine (MSIR, Roxanol)155
Oxycodone (Percodan x2, Percocet x2, Tylox x2)10N/A
Methadone (Dolophine)105
Hydromorphone (Dilaudid)40.75
Levorphanol (Levo-Dromoran)21
FentanylN/A0.05

Benzodiazepine Equivalencies

Generic NameTrade NameComparative Dose (mg)Time to Peak Plasma Level (hours)Half-life (hours)
AlprazolamXanax0.51-29-20
ChlordiazepoxideLibrium251-424-100
ClonazepamKlonopin0.251-419-60
DiazepamValium51-230-200
FlurazepamDalmane150.5-140-250
LorazepamAtivan12-48-24
OxazepamSerax152-33-25
TemazepamRestoril102.53-24
TriazolamHalcion0.251-21.5-5