Will Vicodin (hydrocodone and acetaminophen) test positive on a Department of Transportation (DOT) urine drug screen?

From the Guidelines

Vicodin (hydrocodone and acetaminophen) will test positive on a Department of Transportation (DOT) urine drug screen because it contains hydrocodone, an opioid that is specifically tested for in the standard DOT 5-panel drug test under the opiates/opioids category. According to the guidelines for urine drug testing 1, initial testing can be performed with a relatively inexpensive immunoassay panel for commonly prescribed opioids and illicit drugs. Hydrocodone is a commonly prescribed opioid that can be detected by these panels.

When interpreting urine drug test results, it is essential to consider the specific opioids and metabolites that are included in the testing panel. For example, a positive "opiates" immunoassay detects morphine, which might reflect patient use of morphine, codeine, or heroin, but this immunoassay does not detect synthetic opioids (e.g., fentanyl or methadone) and might not detect semisynthetic opioids (e.g., oxycodone) 1. However, many laboratories use an oxycodone immunoassay that detects oxycodone and oxymorphone.

In the case of Vicodin, which contains hydrocodone, the test may also detect its metabolite, hydromorphone. If you are taking Vicodin with a valid prescription, you should inform the Medical Review Officer (MRO) before your test and bring your prescription documentation with you. The MRO will verify your legitimate medical use, which can prevent the test from being reported as positive to your employer.

Some key points to consider:

• Vicodin typically remains detectable in urine for 2-4 days after last use, though this can vary based on dosage, frequency of use, metabolism, and other individual factors.
• DOT regulations prohibit safety-sensitive functions while using medications that may impair performance, so your employer may still have policies regarding working while using prescribed opioids.
• Clinicians should use unexpected results to improve patient safety, such as changing the pain management strategy or offering naloxone 1.

It is crucial to follow the guidelines for urine drug testing and to have a plan for responding to unexpected results. Clinicians should discuss unexpected results with the local laboratory or toxicologist and with the patient to provide an opportunity for patients to provide information about changes in their use of prescribed opioids or other drugs 1.

From the Research

Urine Drug Screening for Vicodin (Hydrocodone and Acetaminophen)

• The Department of Transportation (DOT) urine drug screen is designed to detect the presence of certain drugs, including opioids like hydrocodone 2.
• Hydrocodone is a semi-synthetic opioid that can be detected in urine using immunoassay tests, but the sensitivity of these tests can vary 3.
• Studies have shown that hydrocodone can be detected in urine at concentrations as low as 50 ng/mL using gas chromatography-mass spectrometry (GC-MS) 3, 4.
• However, the presence of hydrocodone in urine does not necessarily indicate abuse or misuse, as it can also be a minor metabolite of codeine 4.
• The detection of hydrocodone in urine can be influenced by various factors, including the dose and duration of use, individual metabolism, and the sensitivity of the testing method 3, 5.

Factors Affecting Hydrocodone Detection in Urine

• The sensitivity of the testing method: Different testing methods can have varying levels of sensitivity for detecting hydrocodone in urine 3.
• The dose and duration of use: Higher doses and longer durations of use can increase the likelihood of detecting hydrocodone in urine 5.
• Individual metabolism: Hydrocodone is metabolized by the liver and excreted in urine, but individual variations in metabolism can affect the concentration of hydrocodone in urine 5.
• The presence of other substances: The presence of other substances, such as codeine, can affect the detection of hydrocodone in urine 4.

Clinical Interpretation of Urine Drug Test Results

• Clinicians should be aware of the limitations and potential pitfalls of urine drug testing, including false-positive and false-negative results 2.
• The interpretation of urine drug test results should take into account the individual's medical history, prescription medication use, and other relevant factors 2.
• The detection of hydrocodone in urine should not be automatically assumed to indicate abuse or misuse, but rather should be considered in the context of the individual's overall clinical presentation 4.