544 Substance-Related and Addictive Disorders
a substance use disorder but may themselves be genetically determined. Peer factors may
relate to genetic predisposition in terms of how an individual selects his or her environ-
ment. 
Culture-Related Diagnostic Issues
Despite small variations regarding individual criterion items, opioid use disorder diag-
nostic criteria perform equally well across most race/ethnicity groups. Individuals from
ethnic minority populations living in econom ically deprived area s have been overrep-
resented among individuals with opioid use disorder. However, over time, opioid use
disorder is seen more often among white middle-class individuals, especially females,
suggesting that differences in use reflect the availability of opioid drugs and that other so-
cial factors may impact prevalence. Medical personnel who have ready access to opioids
may be at increased risk for opioid use disorder. 
Diagnostic Markers
Routine urine toxicology test re sults are often positive for opioid drugs in individuals with
opioid use disorder. Urine test results remain positive for most opioids (e.g., heroin, mor-
phine, codeine, oxycodone, propoxyphene) for 12–36 hours after administration. Fentanyl
is not detected by standard urine tests but can be identified by more specialized proce-
dures for several days. Methadone, buprenorphine (or buprenorphine/naloxone combi-
nation), and LAAM ( L-alpha-acetylmethadol) have to be specifically tested for and will not
cause a positive result on routine tests for opiates. They can be detected for several days up
to more than 1 week. Laboratory evidence of the presence of other substances (e.g., co-
caine, marijuana, alcohol, amphetamines, benzodiazepines) is common . Screening test re-