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Plattner S, Pavlic M, Pitterl F, Schubert B. Consumption of the Sugar Substitute Stevia Leads to Cross-Reactivity of CEDIA® Buprenorphine II Immunoassay. J Anal Toxicol 2021; 45:1052-1057. [PMID: 33104778 DOI: 10.1093/jat/bkaa167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 11/12/2022] Open
Abstract
Buprenorphine is a semisynthetic opioid that is often used in opiate maintenance therapy. For this purpose, regular toxicological analyses of urine samples are mandatory. For fast analytical results, analyses are commonly performed by immunoassay, for example, Thermo Scientific™ CEDIA® Buprenorphine or Buprenorphine II assay. One drawback of immunoassay-based methods is the possible cross-reaction with other substances. Several drugs have already been checked for cross-reactivity to CEDIA® Buprenorphine II immunoassay. In contrast, cross-reactivities have not been checked for any food additives. In the present study, a cross-reaction of CEDIA® Buprenorphine II assay to steviol glucuronide was investigated. Steviol glucuronide is a phase II metabolite of the sugar substitute stevia. For our study, 32 urine samples of patients in rehabilitation centers were collected. These samples were tested positive with the CEDIA® Buprenorphine II immunoassay. These findings were suspicious, because it was highly unlikely that the patients in those institutions had access to buprenorphine. The absence or presence of buprenorphine in urine samples was evaluated by a validated gas chromatography-mass spectrometry method. In order to determine the concentration of steviol glucuronide in urine samples, a liquid chromatography-tandem mass spectrometry method has been developed and fully validated according to the respective guidelines of the German Society of Toxicological and Forensic Chemistry. The cross-reactivity of steviol glucuronide in the CEDIA® Buprenorphine II immunoassay was observed at concentrations above 15,000 µg/L. These findings demonstrate that food additives should also be considered as compounds that may reduce the selectivity of immunoassays and emphasize the importance of confirming implausible results by selective analytical methods.
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Affiliation(s)
| | - Marion Pavlic
- Institute of Legal Medicine, Medical University of Innsbruck, Muellerstr. 44, 6020 Innsbruck, Austria
| | - Florian Pitterl
- Institute of Legal Medicine, Medical University of Innsbruck, Muellerstr. 44, 6020 Innsbruck, Austria
| | - Birthe Schubert
- Institute of Legal Medicine, Medical University of Innsbruck, Muellerstr. 44, 6020 Innsbruck, Austria
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Abou El Hassan M, Colantonio D, Likhodii S, Nassar BA. The analytical performance of six urine drug screens on cobas 6000 and ARCHITECT i2000 compared to LC-MS/MS gold standard. Clin Biochem 2021; 93:99-103. [PMID: 33844982 DOI: 10.1016/j.clinbiochem.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/16/2021] [Accepted: 04/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Immunoassays provide a rapid tool for the screening of drugs-of-abuse (DOA). However, results are presumptive and confirmatory testing is warranted. To reduce associated cost and delay, laboratories should employ assays with high positive and negative predictive values (PPVs and NPVs). Here, we compared the results of urine drug screens on cobas 6000 (cobas) and ARCHITECTi2000 (ARCHITECT) platforms for six drugs against LC-MS/MS to assess the analytical performance of these assays. METHODS Eighty nine residual urine specimens, which tested positive for amphetamine, THC-COOH, benzoylecgonine, EDDP, opiates and/or oxycodone during routine drug testing, were stored frozen until later confirmation by LC-MS/MS. Immunoassays were performed on cobas and ARCHITECT using a split sample. A third aliquot from these samples was tested by LC-MS/MS to assess the percentage of false positive, false negative, true positive and true negative results and calculate the PPVs and NPVs for each immunoassay. RESULTS The PPVs of THC-COOH and EDDP assays were 100% on both platforms. Suboptimal PPVs were achieved for oxycodone (cobas, 57.1% vs ARCHITECT, 66.7%), amphetamine (77.8 vs. 100%), opiates (80.0 vs. 84.6%) and benzoylecgonine (88.9 vs. 84.2%) assays. The NPV was 100% for cobas and ARCHITECT oxycodone assays. Lower NPVs were achieved for THC-COOH (cobas, 28.6% vs ARCHITECT, 25.0%), EDDP (72.7% for both assays), benzoylecgonine (74.4% vs 73.8%), amphetamine (83.3% vs 82.8%) and opiates (100% vs 85.3%). CONCLUSION Overall, cobas and ARCHITECT urine drug screens have comparable analytical performance. Confirmatory testing is warranted for positive test results especially for oxycodone, amphetamine, opiates and cocaine. Negative drug screen results must be interpreted with caution especially for THC-COOH, EDDP, benzoylecgonine, amphetamine and opiates.
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Affiliation(s)
- Mohamed Abou El Hassan
- Clinical Chemistry Division, Provincial Laboratory Services, Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Canada; Department of Pathology, Dalhousie University, Halifax, NS, Canada.
| | - David Colantonio
- Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Sergei Likhodii
- Department of Laboratory Medicine, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Bassam A Nassar
- Department of Pathology, Dalhousie University, Halifax, NS, Canada; Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
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Schubert B, Pitterl F, Saxl B, Pavlic M. A Novel Enzyme Immunoassay for the Detection of Buprenorphine, Norbuprenorphine and Their Glucuronides in Urine. J Anal Toxicol 2019; 43:364-368. [PMID: 30753557 DOI: 10.1093/jat/bkz003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/28/2018] [Accepted: 01/09/2019] [Indexed: 12/15/2022] Open
Abstract
Buprenorphine is a commonly used opioid in pain therapy as well as in opiate maintenance therapy. Immunoassays are quick and cost-effective methods for the necessary toxicological urine analysis of maintenance therapy patients. In this study a novel enzymatic immunoassay, the Thermo Fisher Scientific CEDIA Buprenorphine II assay (Bup2) was evaluated for the detection of buprenorphine, norbuprenorphine and their conjugated metabolites in human urine samples. The Bup2 assay has a cut-off of 10 ng/mL with ±25% controls, whereas the existing CEDIA Buprenorphine assay (Bup1) has a cut-off of 5 ng/mL and ±40% controls. Both assays were analyzed on a Thermo Scientific Indiko Plus benchtop analyzer. Seven-day precision studies of Bup2 assay demonstrated excellent precision of 7.2-10.6%. No crossover between control samples and the cut-off level were observed. Urine samples of 120 patients undergoing opiate maintenance therapy were collected. Immunoassay results of Bup1 and Bup2 were confirmed by gas chromatography mass spectrometry (GC/MS) for buprenorphine and norbuprenorphine as well as for their glucuronides. Comparison showed a specificity of 0.99 between the Bup2 assay and GC/MS, whereas the Bup1 assay had a specificity 0.70 due to 21 false positive samples. The reason is a known cross-reactivity of the Bup1 assay to opiate compounds. The Bup2 assay revealed one false positive result close to the cut-off value; no specific candidate possibly causing a cross-reaction was detected by GC/MS and liquid chromatography tandem mass-spectrometry (LC/MS/MS) methods. The data presented demonstrate an excellent correlation of the Bup2 assay to GC/MS, showing improved specificity and sensitivity when compared to the Bup1 assay. Thus, the Bup2 assay is highly suitable for urine testing, even for opiate maintenance patients receiving high doses of morphine.
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Affiliation(s)
- Birthe Schubert
- Institute of Legal Medicine, Medical University of Innsbruck, Muellerstrasse 44, Innsbruck, Austria
| | - Florian Pitterl
- Institute of Legal Medicine, Medical University of Innsbruck, Muellerstrasse 44, Innsbruck, Austria
| | - Barbara Saxl
- Institute of Legal Medicine, Medical University of Innsbruck, Muellerstrasse 44, Innsbruck, Austria
| | - Marion Pavlic
- Institute of Legal Medicine, Medical University of Innsbruck, Muellerstrasse 44, Innsbruck, Austria
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Saleem M, Martin H, Tolya A, Coates P. Do all screening immunoassay positive buprenorphine samples need to be confirmed? Ann Clin Biochem 2017; 54:707-711. [PMID: 28121168 DOI: 10.1177/0004563216688489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Interference from opiates in the Microgenics CEDIA® Buprenorphine assay is known to produce false-positive buprenorphine screening immunoassay results necessitating confirmatory buprenorphine testing by chromatography/mass spectrometry methods. Method We reviewed data on falsely positive buprenorphine immunoassay screen (cut-off ≥ 5 µg/L) but negative for buprenorphine by gas chromatography mass spectrometry (cut-off ≥ 5 µg/L) and had a positive opiate immunoassay result (cut-off ≥ 300 µg/L). The results were collected over three months, and the data were evaluated to determine whether there is an opiate immunoassay screen concentration below which a false-positive buprenorphine result will not occur. Results We found that cross-reactivity in the CEDIA® buprenorphine immunoassay by opiates at concentrations <2000 µg/L will not cause a false-positive buprenorphine result. After changing our practice to not proceed with confirmatory buprenorphine gas chromatography mass spectrometry assay when the opiate screening concentration is below an even more conservative cut-off of <1500 µg/L, we estimate a potential cost-saving of AU$ 17,810 per year without compromising clinical care. Conclusion Samples with CEDIA® opiate immunoassay result <2000 µg/L and a positive CEDIA® buprenorphine immunoassay screen do not require confirmatory testing for buprenorphine.
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Affiliation(s)
- Mohamed Saleem
- Chemical Pathology Directorate, South Australia Pathology, Adelaide, Australia
| | - Helen Martin
- Chemical Pathology Directorate, South Australia Pathology, Adelaide, Australia
| | - Anne Tolya
- Chemical Pathology Directorate, South Australia Pathology, Adelaide, Australia
| | - Penny Coates
- Chemical Pathology Directorate, South Australia Pathology, Adelaide, Australia
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Berg JA, Schjøtt J, Fossan KO, Riedel B. Cross-reactivity of the CEDIA buprenorphine assay in drugs-of-abuse screening: influence of dose and metabolites of opioids. Subst Abuse Rehabil 2015; 6:131-9. [PMID: 26604854 PMCID: PMC4630205 DOI: 10.2147/sar.s88935] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The cloned enzyme donor immunoassay (CEDIA) for buprenorphine is applied for both urine drugs-of-abuse screening and compliance monitoring. Sensitivity, specificity, and optimal cutoff of this assay have differed between studies. This may indicate that cross-reactivity has to be taken into account during assay evaluation. We therefore investigated the performance of the CEDIA buprenorphine assay for use in our patient population and explored the impact of cross-reactivity on assay accuracy. METHODS The CEDIA buprenorphine assay and high-performance liquid chromatography-tandem mass spectrometry were employed to analyze drugs-of-abuse in urine samples from a healthy drug-naïve male volunteer after intake of two tablets of a prescription drug containing 400 mg paracetamol +30 mg codeine phosphate, and in urine samples (n=2,272) from drug-addicted patients. Receiver operating characteristic analyses were performed to express the diagnostic accuracy of the CEDIA buprenorphine assay. RESULTS CEDIA buprenorphine was positive in one urine sample from the drug-naïve person after intake of the prescription drug. Twenty-five (1.1%) of the patient urine samples were positive for buprenorphine by CEDIA, but negative by high-performance liquid chromatography-tandem mass spectrometry. Codeine, morphine, and their respective metabolites were prevalent in samples that were false positive for buprenorphine. The specificity of the CEDIA buprenorphine assay increased to 99.7% when the cutoff was increased from 5 ng/mL to 10 ng/mL. CONCLUSION Intake of a therapeutic dose of codeine can yield a false-positive CEDIA buprenorphine result. Additive effects from metabolites of codeine contribute to cross-reactivity in concentrations much lower than listed in the manufacturer's cross-reactivity guide. Raising the cutoff from 5 ng/mL to 10 ng/mL increased the diagnostic accuracy. Clinicians should be informed about the risk of false-positive results with the CEDIA buprenorphine assay.
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Affiliation(s)
- Jon Andsnes Berg
- Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Jan Schjøtt
- Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway ; Faculty of Medicine and Dentistry, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kjell O Fossan
- Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Bettina Riedel
- Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway ; Faculty of Medicine and Dentistry, Department of Clinical Science, University of Bergen, Bergen, Norway
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Abstract
Urine drug screening has become standard of care in many medical practice settings to assess compliance, detect misuse, and/or to provide basis for medical or legal action. The antibody-based enzymatic immunoassays used for qualitative analysis of urine have significant drawbacks that clinicians are often not aware of. Recent literature suggests that there is a lack of understanding of the shortcomings of these assays by clinicians who are ordering and/or interpreting them. This article addresses the state of each of the individual immunoassays that are most commonly used today in order to help the reader become proficient in the interpretation and application of the results. Some literature already exists regarding sources of "false positives" and "false negatives," but none seem to present the material with the practicing clinician in mind. This review aims to avoid overwhelming the reader with structures and analytical chemistry. The reader will be presented relevant clinical knowledge that will facilitate appropriate interpretation of immunoassays regardless of practice settings. Using this review as a learning tool and a reference, clinicians will be able to interpret the results of commonly used immunoassays in an evidence-based, informed manner and minimize the negative impact that misinterpretation has on patient care.
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Affiliation(s)
- Zachary J Nelson
- University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | - Samuel J Stellpflug
- Region's Hospital Clinical Toxicology, Department of Emergency Medicine, St. Paul, MN, USA
| | - Kristin M Engebretsen
- Region's Hospital Clinical Toxicology, Department of Emergency Medicine, St. Paul, MN, USA
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Affiliation(s)
| | - Stacy E F Melanson
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Saitman A, Park HD, Fitzgerald RL. False-positive interferences of common urine drug screen immunoassays: a review. J Anal Toxicol 2014; 38:387-96. [PMID: 24986836 DOI: 10.1093/jat/bku075] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Urine drug screen (UDS) immunoassays are a quick and inexpensive method for determining the presence of drugs of abuse. Many cross-reactivities exist with other analytes, potentially causing a false-positive result in an initial drug screen. Knowledge of these potential interferents is important in determining a course of action for patient care. We present an inclusive review of analytes causing false-positive interferences with drugs-of-abuse UDS immunoassays, which covers the literature from the year 2000 to present. English language articles were searched via the SciFinder platform with the strings 'false positive [drug] urine' yielding 173 articles. These articles were then carefully analyzed and condensed to 62 that included data on causes of false-positive results. The discussion is separated into six sections by drug class with a corresponding table of cross-reacting compounds for quick reference. False-positive results were described for amphetamines, opiates, benzodiazepines, cannabinoids, tricyclic antidepressants, phencyclidine, lysergic acid diethylamide and barbiturates. These false-positive results support the generally accepted practice that immunoassay positive results are considered presumptive until confirmed by a second independent chemical technique.
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Affiliation(s)
- Alec Saitman
- Department of Pathology, Center for Advanced Laboratory Medicine, University of California, San Diego Health Systems, San Diego, CA 92121, USA
| | - Hyung-Doo Park
- Department of Pathology, Center for Advanced Laboratory Medicine, University of California, San Diego Health Systems, San Diego, CA 92121, USA Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Robert L Fitzgerald
- Department of Pathology, Center for Advanced Laboratory Medicine, University of California, San Diego Health Systems, San Diego, CA 92121, USA
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Belsey SL, Couchman L, Flanagan RJ. Buprenorphine Detection in Urine Using Liquid Chromatography–High-Resolution Mass Spectrometry: Comparison with Cloned Enzyme Donor Immunoassay (ThermoFisher) and Homogeneous Enzyme Immunoassay (Immunalysis). J Anal Toxicol 2014; 38:438-43. [DOI: 10.1093/jat/bku060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Snyder ML, Darragh A, Flood JG, Jones J, Ropar K, Jarolim P, Melanson SE. Improved Buprenorphine Immunoassay Performance After Urine Treatment with β-Glucuronidase. J Anal Toxicol 2014; 38:375-9. [DOI: 10.1093/jat/bku045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Birch MA, Couchman L, Pietromartire S, Karna T, Paton C, McAllister R, Marsh A, Flanagan RJ. False-Positive Buprenorphine by CEDIA in Patients Prescribed Amisulpride or Sulpiride. J Anal Toxicol 2013; 37:233-6. [DOI: 10.1093/jat/bkt016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Lin HR, Chen CL, Huang CL, Chen ST, Lua AC. Simultaneous determination of opiates, methadone, buprenorphine and metabolites in human urine by superficially porous liquid chromatography tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2013; 925:10-5. [PMID: 23507455 DOI: 10.1016/j.jchromb.2013.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/19/2013] [Accepted: 02/20/2013] [Indexed: 11/16/2022]
Abstract
For monitoring compliance of methadone or buprenorphine maintenance patient, a method for the simultaneous determination of methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), buprenorphine, norbuprenorphine, opiates (morphine, codeine, 6-monoacetylmorphine) in urine by superficially porous liquid chromatography tandem mass spectrometry was developed and validated. After enzyme digestion and liquid-liquid extraction, reverse-phase separation was achieved in 5.2 min and quantification was performed by multiple reaction monitoring. Chromatographic separation was performed at 40 °C on a reversed phase Poroshell column with gradient elution. The mobile phase consisted of water and methanol, each containing 0.1% formic acid, at a flow rate of 0.32 mL/min. Intra-day and inter-day precision were less than 12.1% and accuracy was between -9.8% and 13.7%. Extraction efficiencies were more than 68%. Although ion suppression was detected, deuterated internal standards compensated for these effects. Carryover was minimal, less than 0.20%. All analytes were stable at room temperature for 16 h, 4 °C for 72 h, and after three freeze-thaw cycles. The assay also fulfilled compound identification criteria in accordance with the European Commission Decision 2002/657/EC. We analyzed 62 urine samples from patients received maintenance therapy and found that 54.8% of the patient samples tested were detected for morphine, codeine, or 6-monoacetylmorphine. This method provides a reliable and simultaneous quantification of opiates, maintenance drugs, and their metabolites in urine samples. It facilitates the routine monitoring in individuals prescribed the drug to ensure compliance and help therapeutic process.
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Affiliation(s)
- Huei-Ru Lin
- Institute of Medical Biotechnology, Tzu Chi University, Hualien, Taiwan.
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Melanson SEF, Snyder ML, Jarolim P, Flood JG. A New Highly Specific Buprenorphine Immunoassay for Monitoring Buprenorphine Compliance and Abuse. J Anal Toxicol 2012; 36:201-6. [DOI: 10.1093/jat/bks003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Comparison of 3 Point-of-Care and 2 Automated Urine Buprenorphine Assays for Screening Patients Treated for Chronic Pain. POINT OF CARE 2011. [DOI: 10.1097/poc.0b013e31821c699a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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‘False-positive’ and ‘false-negative’ test results in clinical urine drug testing. Bioanalysis 2009; 1:937-52. [DOI: 10.4155/bio.09.81] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The terms ‘false-positive’ and ‘false-negative’ are widely used in discussions of urine drug test (UDT) results. These terms are inadequate because they are used in different ways by physicians and laboratory professionals and they are too narrow to encompass the larger universe of potentially misleading, inappropriate and unexpected drug test results. This larger universe, while not solely comprised of technically ‘true’ or ‘false’ positive or negative test results, presents comparable interpretive challenges with corresponding clinical implications. In this review, we propose the terms ‘potentially inappropriate’ positive or negative test results in reference to UDT results that are ambiguous or unexpected and subject to misinterpretation. Causes of potentially inappropriate positive UDT results include in vivo metabolic conversions of a drug, exposure to nonillicit sources of a drug and laboratory error. Causes of potentially inappropriate negative UDT results include limited assay specificity, absence of drug in the urine, presence of drug in the urine, but below established assay cutoff, specimen manipulation and laboratory error. Clinical UDT interpretation is a complicated task requiring knowledge of recent prescription, over-the-counter and herbal drug administration, drug metabolism and analytical sensitivities and specificities.
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Wu MY, Wang YS, Lin CC, Lin DL, Su LW, Huang MH, Liu RH. An empirical study on the selection of analytes and corresponding cutoffs for immunoassay and GC–MS in a two-step test strategy—buprenorphine example. Analyst 2009; 134:1848-56. [DOI: 10.1039/b902137j] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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False negative result for amphetamines on the Triage® Drug of Abuse panel? Int J Legal Med 2008; 123:247-52. [DOI: 10.1007/s00414-008-0304-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 11/14/2008] [Indexed: 10/21/2022]
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Twigger S, Fox E, Allen K. Measurement of buprenorphine in urine: immunoassay versus LC-MS/MS. Ann Clin Biochem 2008; 45:339. [DOI: 10.1258/acb.2008.007250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shirley Twigger
- Department of Clinical Biochemistry, Leeds Teaching Hospitals, Britannia House, Morley, Leeds LS27 0DQ, UK
| | - Elizabeth Fox
- Department of Clinical Biochemistry, Leeds Teaching Hospitals, Britannia House, Morley, Leeds LS27 0DQ, UK
| | - Keith Allen
- Department of Clinical Biochemistry, Leeds Teaching Hospitals, Britannia House, Morley, Leeds LS27 0DQ, UK
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Teske J, Weller JP, Larsch K, Tröger HD, Karst M. Fatal outcome in a child after ingestion of a transdermal fentanyl patch. Int J Legal Med 2006; 121:147-51. [PMID: 17115172 DOI: 10.1007/s00414-006-0137-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 09/25/2006] [Indexed: 01/01/2023]
Abstract
The case history and toxicological findings of a fatal fentanyl intoxication due to ingestion of a transdermal patch are presented. A 1-year-old otherwise healthy girl was put to bed and 2 h later she was found dead. The autopsy revealed a 25-microg/h (4.2 mg) transdermal fentanyl patch in the stomach. Toxicological analysis by liquid chromatography-tandem mass spectrometry with positive electrospray ionization yielded fentanyl and norfentanyl concentrations in the peripheral blood of 5.6 and 5.9 ng/ml, heart blood 19.0 and 8.9 ng/ml, and liver 235 and 26 ng/g, respectively. The cause of death was determined to be a fentanyl overdose. The investigation established that the child has unintentionally swallowed the patch, which had been lying on the floor.
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Affiliation(s)
- Jörg Teske
- Institute of Legal Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
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