3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D Director: David J.

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1 Drug Adherence Assessment Report Prescribed Medications: NO MEDICATION LIST PROVIDED CONSISTENT RESULTS - REPORTED MEDICATION DETECTED (PARENT DRUG AND/OR METABOLITE) REPORTED PRESCRIPTION FLAG ANTICIPATED POSITIVE(S) TEST OUTCOME DETECTION WINDOW N/A N/A N/A N/A INCONSISTENT RESULTS - REPORTED MEDICATION NOT DETECTED (NEITHER PARENT DRUG NOR METABOLITE) REPORTED PRESCRIPTION FLAG ANTICIPATED POSITIVE(S) TEST OUTCOME DETECTION WINDOW N/A N/A N/A N/A INCONSISTENT RESULTS - ANALYTE DETECTED BUT NO CORESPONDING PRESCRIPTION REPORTED REPORTED PRESCRIPTION FLAG ILLICIT MEASURED RESULT CUTOFF TEST OUTCOME DETECTION WINDOW Hydromorphone No Negative 6 hrs (Plasma Half-Life: hrs) Oxycodone No > Positive 1-2 days (Plasma Half-Life: 3-6 hrs) Noroxycodone No Positive 1-2 days (Plasma Half-Life: 3-6 hrs) Oxymorphone No Negative 1-2 days (Plasma Half-Life: hrs) Morphine No Positive day (Plasma Half-Life: hrs) (-)-Cotinine No Positive 2-4 days (Plasma Half-Life: hrs) Caffeine No Positive Unknown (Plasma Half-Life: 5-6 hrs) SPECIMEN VALIDITY TESTING REPORTED PRESCRIPTION N/A TEST OUTCOME MEASURED RESULT UNITS REFERENCE RANGE N/A N/A N/A N/A ADDITIONAL MEDICATIONS REPORTED BUT NOT TESTED FOR IN THIS REPORT NO MEDICATION LIST PROVIDED Page: 1 of 9

2 ADDITIONAL DETECTED ANALYTES CAFFEINE (CAFCIT, ALERT), NICOTINE, OXYCODONE (ROXYCODONE, OXYCONTIN), MORPHINE (KADIAN, MS CONTIN, MS IR) Drug-Drug Interactions No drug-drug interactions can be provided within the scope of this report at this time. Either no current medications were provided for the patient or no significant risk of drug-drug interaction is present for the patient's current medications. It is highly recommended to reanalyze the risk of drug-drug interaction if the patient is prescribed a new drug. Unrecognized Medications: None SYMBOL LEGEND Highly elevated risk for indicated condition or adverse drug reaction. Medication can be prescribed with monitoring; alternative therapy may be needed. Moderately elevated risk for indicated condition or adverse drug reaction. Medication can be prescribed with monitoring; therapy ajustment may be needed. Typical risk for indicated condition or adverse drug reaction. Medication can be prescribed according to standard dosing guidelines. MODERATE Drug interactions of moderate severity. The clinician should assess the patient`s characteristics and take action as needed. SERIOUS Severe drug interaction or contraindicated drug combination which may produces serious consequences in most patients. This drug combination generally should not be dispensed or administered to the same patient. Action is required to reduce risk of severe adverse interaction. 1. ANALGESICS / OPIATES Acetaminophen Negative ng/ml No Buprenorphine Negative ng/ml No Butorphanol Negative ng/ml No EDDP Negative ng/ml No Fentanyl Negative ng/ml No Hydrocodone Negative ng/ml No Hydromorphone Negative ng/ml No Ketamine Negative ng/ml No Levorphanol Negative ng/ml No Meperidine Negative ng/ml No Methadone Negative ng/ml No Morphine Positive ng/ml No N-Desmethyl-Tramadol Negative ng/ml No Page: 2 of 9

3 Norbuprenorphine Negative ng/ml No Norfentanyl Negative ng/ml No Norhydrocodone Negative ng/ml No Norketamine Negative ng/ml No Noroxycodone Positive ng/ml No Norpropoxyphene Negative ng/ml No O-Desmethyl-Tramadol Negative ng/ml No Oxycodone Positive > ng/ml No Oxymorphone Negative ng/ml No Propoxyphene Negative ng/ml No Tapentadol Negative ng/ml No Tramadol Negative ng/ml No 2. BENZODIAZEPINES 7-Aminoclonazepam Negative ng/ml No Alpha-hydroxyalprazolam Negative ng/ml No Alpha-Hydroxymidazolam Negative ng/ml No Alpha-Hydroxytriazolam Negative ng/ml No Alprazolam Negative ng/ml No Chlordiazepoxide Negative ng/ml No Clobazam Negative ng/ml No Clonazepam Negative ng/ml No Desalkylflurazepam Negative ng/ml No Diazepam Negative ng/ml No Estazolam Negative ng/ml No Flunitrazepam Negative ng/ml No Flurazepam Negative ng/ml No Lorazepam Negative ng/ml No Midazolam Negative ng/ml No N-Desmethyl-Flunitrazepam Negative ng/ml No Norchlordiazepoxide Negative ng/ml No Nordiazepam Negative ng/ml No Oxazepam Negative ng/ml No Prazepam Negative ng/ml No Temazepam Negative ng/ml No Triazolam Negative ng/ml No Page: 3 of 9

4 3. ANTI-PSYCHOTICS 9-Hydroxyrisperidone Negative ng/ml No Chlorpromazine Negative ng/ml No Clozapine Negative ng/ml No Clozapine_N_oxide Negative ng/ml No Fluphenazine Negative ng/ml No Haloperidol Negative ng/ml No Olanzapine Negative ng/ml No Risperidone Negative ng/ml No Thioridazine Negative ng/ml No Ziprasidone Negative ng/ml No 4. ANTI-DEPRESSANTS / SSRI / SNRI / TCA Amitriptyline Negative ng/ml No Citalopram Negative ng/ml No Clomipramine Negative ng/ml No D-L-Kavain Negative ng/ml No Desipramine Negative ng/ml No Dihydrokavain Negative ng/ml No Duloxetine Negative ng/ml No Fluvoxamine Negative ng/ml No Imipramine Negative ng/ml No N-Desmethyl-Clomipramine Negative ng/ml No Nortriptyline Negative ng/ml No O-Desmethyl-Venlafaxine Negative ng/ml No Paroxetine Negative ng/ml No Sertraline Negative ng/ml No Trazodone Negative ng/ml No Venlafaxine Negative ng/ml No 5. DEPRESSANTS Zaleplon Negative ng/ml No Zolpidem Negative ng/ml No 6. ANTI-CONVULSANTS Gabapentin Negative ng/ml No Lamotrigine Negative ng/ml No Levetiracetam Negative ng/ml No Pregabalin Negative ng/ml No Tiagabine Negative ng/ml No Zonisamide Negative ng/ml No Page: 4 of 9

5 7. MUSCLE RELAXANTS Baclofen Negative ng/ml No Carisoprodol Negative ng/ml No Cyclobenzaprine Negative ng/ml No Meprobamate Negative ng/ml No 8. STIMULANTS / ADHD Amphetamine Negative ng/ml No Caffeine Positive ng/ml No Ephedrine Negative ng/ml No Lisdexamfetamine Negative ng/ml No Methylphenidate Negative ng/ml No Ritalinic Acid Negative ng/ml No 9. DECONGESTANTS Dextromethorphan Negative ng/ml No Pseudoephedrine Negative ng/ml No 10. APPETITE STIMULANTS Marinol Negative ng/ml No Phentermine Negative ng/ml No 11. ANTIDOTES Naloxone Negative ng/ml No Naltrexone Negative ng/ml No Page: 5 of 9

6 12. ILLICITS 5-Fluoro-NPB-22 Negative ng/ml Yes 5-MeO-DMT Negative ng/ml Yes 6-MAM (heroin metabolite) Negative ng/ml Yes 7-HydroxyMitragynine (Kratom) Negative ng/ml Yes AB-FUBINACA Negative ng/ml Yes Acetyl-Fentanyl Negative ng/ml Yes Alpha-PVP Negative ng/ml Yes AM2201 (Spice Cannabinoid) Negative ng/ml Yes Benzoylecgonine Negative ng/ml Yes Carfentanil Negative ng/ml Yes Cocaine Negative ng/ml Yes Didesmethyl-U Negative ng/ml Yes DMT Negative ng/ml Yes FDU-PB-22 Negative ng/ml Yes HU-210 (Spice Cannabinoid) Negative ng/ml Yes JWH-019 (Spice Cannabinoid) Negative ng/ml Yes JWH Hydroxybutyl (Spice Cannabinoid) Negative ng/ml Yes JWH-081 (Spice Cannabinoid) Negative ng/ml Yes JWH-122 (Spice Cannabinoid) Negative ng/ml Yes JWH-18-5-pentanoic acid (Spice Cannabinoid) JWH-18-5-pentanyl (Spice Cannabinoid) JWH-250-5OH-pentanyl (Spice Cannabinoid) Negative ng/ml Yes Negative ng/ml Yes Negative ng/ml Yes MDA Negative ng/ml Yes MDEA Negative ng/ml Yes MDMA Negative ng/ml Yes MDPV Negative ng/ml Yes Mephedrone Negative ng/ml Yes Methamphetamine Negative ng/ml Yes Methylone Negative ng/ml Yes Mitragynine (Kratom) Negative ng/ml Yes MMB-CHMICA Negative ng/ml Yes N-Desmethyl-U Negative ng/ml Yes Normephedrone Negative ng/ml Yes PCP Negative ng/ml Yes THC (Marijuana metabolite) Negative ng/ml Yes Page: 6 of 9

7 13. BARBITURATES Amobarbital Negative ng/ml No Butabarbital Negative ng/ml No Butalbital Negative ng/ml No Pentobarbital Negative ng/ml No Phenobarbital Negative ng/ml No Secobarbital Negative ng/ml No 14. DIRECT BIOMARKERS (-)-Cotinine Positive ng/ml No Ethyl Glucuronide (Ethanol) Negative ng/ml No Ethyl Sulfate (Ethanol) Negative ng/ml No Page: 7 of 9

8 Historical Result Data Comments: This test was performed at Alcala Testing and Analysis Services (CLIA# 05D ). Dried Blood Spot specimens are analyzed using CleanAssure TM (patent pending) technology. In contrast to urine, in dried blood spot specimens (CleanAssure TM DBS) detection may be reduced (compound-specific). E.g. Morphine and Fentanyl exhibiting short plasma half-lives may require a follow up test with a urine specimen. In dried blood spot specimens parent drugs are often detected in higher concentrations than their metabolites commonly observed in urine specimens. Morphine is a commonly detected metabolite among patients taking Codeine. Hydromorphone is a commonly detected metabolite among patients taking Hydrocodone and Morphine. An active molecule of OPANA, Oxymorphone is a commonly detected metabolite among patients taking Oxycodone. OPANA (Oxymorphone) will not metabolize to Noroxycodone or Oxycodone. Oxazepam is a commonly detected metabolite among patients taking Diazepam, Nor-Diazepam or Temazepam. Temazepam and Nor- Diazepam are commonly detected metabolites among patients taking Diazepam. Alprazolam, Alpha-OH-Alprazolam, Clonazepam, and 7- amino-clonazepam are not detected in patients taking Diazepam, Nor-diazepam, Lorazepam, Oxazepam, and Temazepam. Meprobamate is a commonly detected metabolite among patients taking Carisoprodol and its presence is consistent with the use of Carisoprodol. Nortrimipramine, the metabolite of Trimipramine, may cause a false positive result for Imipramine in this assay. Trimipramine (brand name Surmontil) and its metabolite are not part of this assay. Trimipramine will be differentiated from other tricyclics, but its metabolite may cause interference with Imipramine. An active (drug) or metabolite may be listed as a Negative Outcome, however, if either the active or any metabolite(s) are present (Positive), then the result is listed as Consistent for that reported prescribed medication. In case of patients consuming HYDROCODONE-containing medications: Norhydrocodone is the major metabolite of Hydrocodone indicating presence of Hydrocodone in urine. While Hydrocodone can also be metabolized to Hydromorphone, identification of just Hydromorphone by itself is not a confirmation of Hydrocodone being present, since recent studies suggest that urine specimens of patients taking Hydrocodone always show presence of Hydrocodone or Norhydrocodone in combination with Hydromorphone. Page: 8 of 9

9 FOR PATIENT RESULTS INDICATING JUST THE PRESENCE OF HYDROMORPHONE: THIS MAY BE DERIVED FROM MORPHINE- CONTAINING PRESCRIPTION DRUGS OR HYDROMORPHONE-ONLY PRESCRIPTIONS (FOR EXAMPLE, DILAUDID). Further reading: Valtier,S. and Bebarta,V.S. (2012) Excretion profile of hydrocodone, hydromorphone and norhydrocodone in urine following single dose administration of hydrocodone to healthy volunteers. J. Anal. Toxicol., 36, and Barakat,N.H., Atayee,R.S., Best,B.M. and Ma,J.D. (2014) Observations of Urinary Hydrocodone and Metabolite Distributions in Pain Patients. J. Anal. Toxicol., 38, ) REFERENCES for DRUG-DRUG-INTERACTIONS are available upon request. Notes: Saliva sample. No medication list provided. Results are consistent if the patient is prescribed CAFFEINE (CAFCIT, ALERT), NICOTINE, OXYCODONE (ROXYCODONE, OXYCONTIN), MORPHINE (KADIAN, MS CONTIN, MS IR). Reviewed By: 04/04/ :30 Date: Page: 9 of 9