Detecting benzodiazepines: immunoassays compared with negative chemical ionization gas chromatography/mass spectrometry.

We tested 231 urine samples by six immunoassay methods--EMIT d.a.u., EMIT II, Roche Abuscreen Online, Abbott TDx, Diagnostic Products Corp. (DPC) double-antibody radioimmunoassay (RIA), and Biosite Triage--and by negative chemical ionization gas chromatography/mass spectrometry to determine how the immunoassays performed on samples selected for suspected benzodiazepine use (n = 100) and in random urine drug screening (n = 131). In general, all of the assays were successful in detecting oxazepam and related metabolites, even at concentrations below the stated cutoffs. However, the negative predictive value of benzodiazepine immunoassays for samples selected for suspected benzodiazepine use ranged from 86% to 96%. A primary difference between the test kits was the ability of DPC RIA and Triage to detect lorazepam when other assays did not. Contrary to previous reports, pretreatment of specimens with glucuronidase was not necessary to detect oxazepam-related metabolites with these immunoassays.