Detection of benzodiazepines and tribenzazolams by TRIAGE: confirmation by solid-phase extraction utilizing...

A new point-of-care urine drugs-of-abuse testing device, the BIOSITE TRIAGE, was evaluated for detection of benzodiazepines (BNZs). TRIAGE utilizes a unique, competitive, visual immunoassay methodology to simultaneously detect seven classes of drugs of abuse. Because of the unique ASCEND Multimmunoassay technology, conflicting results may arise when TRIAGE is compared with conventional immunoassay techniques. Apparent TRIAGE BNZ false-positive results may occur when gas chromatographic-mass spectrometric (GC-MS) confirmation utilizes oxazepam as the analyte used to confirm the presence of BNZs. TRIAGE BNZ results were correlated with those of Syva EMIT, (n = 106, overall agreement 85%). Both negative and positive urine samples were tested by GC-MS for the following drugs: oxazepam, nordiazepam, desalkylflurazepam, OH-ethylflurazepam, lorazepam, temazepam, alpha-OH-alprazolam and alpha-OH-triazolam. Urine samples were extracted using the new ANSYS SPEC.3ML.MP3 solid-phase extraction microcolumn. The ANSYS procedure for BNZs was modified to include desalkylflurazepam, OH-ethylflurazepam, lorazepam, temazepam, alpha-OH-alprazolam, and alpha-OH-triazolam. Deuterated oxazepam and alpha-OH-alprazolam were used as internal standards. Limits of quantitation (LOQs) ranged from 25 to 100 ng/mL with a limit of detection of 25 ng/mL for all analytes. Individual analytes demonstrated within-run precision and between-run precision ranging from 0.9 to 4.7% CV and 1.3 to 16.9% CV, respectively. All analytes were linear from their LOQs to 1000 ng/mL.