Contents

Search

drug of abuse test

Indications: - altered state of consciousness - evaulation of drug abuse Clinical significance: - drugs commonly included in qualititative drug abuse screen: - amphetamine+methamphetamine* - barbiturates - benzodiazepines - cannabinoids (THC metabolites)* - cocaine metabolite (benzoylecgonine* - methadone - methaqualone - opiates (morphine, codeine)* - phencyclidine (PCP)* - propoxyphene * testing mandated by SAMHSA for federal employees False-positives on screening [2] 1) dependent on manufacturer's assay 2) need to be ruled-out with qunatitative confirmation test 3) amphetamine: pseudoephedrine, ephedrine, phenylzine, cough & cold medications 4) opioid: rifampin,levofloxacin - poppy seeds contain codeine & morphine a) typical muffin with poppy seeds will NOT yield a positive test b) concentrated poppy seeds in 2 pastries can be detected 5) cannabinoids, cocaine, benzodiazepines, barbiturates: none Persistence of drugs & drug metabolites [2] 1) a single dose of amphetamine or heroin can generally be detected for 1-3 days after use 2) marijuana & phencyclidine (PCP) are generally detectable for about a week (longer with chronic use) 3) exposure to SECOND-HAND marijuana smoke is NOT likely yield a positive test Laboratory: - see ARUP consult [4] Notes: - no foolproof way to beat drug screen - home urine drug tests are available [2,3] - also see blood alcohol - California' proposition 46 (Nov 2014) would mandate hospitals to test physicians for drugs & alcohol [6] - positive results would lead to immediate suspension of a physician's license, with no timetable specified for an investigation & hearing - punitive approach - - test results may be available for civil or criminal litigation - no provisions for rehabilitation of impaired physicians

Related

substance abuse & mental health services administration (SAMHSA)

Specific

2-Ethylidene-1,5-Dimethyl-3,3-Diphenylpyrrolidine (EDDP) in urine 6-monoacetylmorphine (6-MAM) in specimen amphetamine in specimen amphetamines in specimen barbiturate in urine benzodiazepine in urine buprenorphine in specimen cannabinoid in specimen cocaine in specimen cocaine or metabolite in body fluid codeine in urine dihydrocodeine in urine ethanol in specimen fenetylline in urine lysergate diethylamide (LSD) measurement methamphetamine in specimen methaqualone in specimen methylenedioxyamphetamine in specimen methylenedioxyethylamphetamine in specimen methylenedioxymethamphetamine in specimen opiates measurement; opiates in specimen phencyclidine in specimen trans-3-hydroxycotinine in specimen

General

toxicology/drug test

References

  1. Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
  2. Prescriber's Letter 12(3): 2005 Drug Abuse Urine Tests: False-positive Results Detail-Document#: 210310 (subscription needed) http://www.prescribersletter.com
  3. QuickScreen At Home Drug Test http://www.phamatech.com - Peace of Mind 5 Panel Home Drug Test http://www.adldrugtest.com - Accu-Stat Drugs of Abuse Home Test Cup http://www.accu-stat.com - ADC Advantage Marijuana and Cocaine Home Test www.advantagediagnostics.com
  4. ARUP Consult: Drug Testing The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/pain-and-addiction-management
  5. ARUP Consult: Newborn Drug Testing - Meconium and Umbilical Cord Tissue The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/newborn-drug-testing - Newborn Drug Testing Algorithm https://arupconsult.com/algorithm/newborn-drug-testing-algorithm
  6. Young K, Fairchild DG California's Prop. 46 Could Lead to Mandatory Drug Testing of Physicians. Physician's First Watch, Sept 30, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Pham JG, Pronovost PJ California's Proposition 46: A Wolf in Sheep's Wool. Ann Intern Med. Published online 30 September 2014 PMID: 25265344 http://annals.org/article.aspx?articleid=1910340 - Ejnes YD California's Proposition 46 and Mandatory Physician Drug Testing: A Cause for Concern. Ann Intern Med. Published online 30 September 2014 PMID: 25265244 http://annals.org/article.aspx?articleid=1910339