1
|
Majumdar B, Chatterjee B. False-positive urine drug screen for oxycodone among opioid-dependent patients on oral naltrexone: A case series study. Asian J Psychiatr 2024; 94:103954. [PMID: 38350329 DOI: 10.1016/j.ajp.2024.103954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/01/2024] [Indexed: 02/15/2024]
Affiliation(s)
- Barnali Majumdar
- National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Biswadip Chatterjee
- National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| |
Collapse
|
2
|
Arthur J, Childers J, Del Fabbro E. Should Urine Drug Screen be Done Universally or Selectively in Palliative Care Patients on Opioids? J Pain Symptom Manage 2023; 66:e687-e692. [PMID: 37429531 DOI: 10.1016/j.jpainsymman.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
Urine drug screen (UDS) is a useful test conducted in patients receiving opioids for chronic pain to aid in validating patient adherence to opioid treatment and to detect any nonmedical opioid use (NMOU). One controversial topic regarding its use in palliative care is whether to conduct the test universally and randomly in all patients who are receiving opioids for chronic pain irrespective of their level of risk for NMOU, or to conduct the test selectively in only those with a high risk for engaging in NMOU behaviors. In this "Controversies in Palliative Care" article, 3 expert clinicians independently answer this question. Specifically, each expert provides a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. They all agreed that UDS has some utility in routine palliative care practice but acknowledged the insufficient existing evidence supporting its efficacy. They also underscored the need to improve clinician proficiency in UDS interpretation to enhance its utility. Two experts endorsed random UDS in all patients receiving opioids regardless of their risk profile while the other expert recommended targeted UDS until there is more clinical evidence to support universal, random testing. Use of more methodologically robust study designs in UDS research, examination of the cost-effectiveness of UDS tests, development of innovative programs to manage NMOU behaviors, and investigation of the impact of improved clinician proficiency in UDS interpretation on clinical outcomes, were important areas of future research that the experts identified.
Collapse
Affiliation(s)
- Joseph Arthur
- Department of Palliative Care (J.A.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Julie Childers
- Section of Palliative Care and Medical Ethics (J.C.), Section of Treatment, Research, and Education in Addiction Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Egidio Del Fabbro
- Division of Palliative Medicine (E.D.F.), Medical College of Georgia, Augusta University, Augusta, Georgia
| |
Collapse
|
3
|
Ali SA, Shell J, Harris R, Bedder M. Naloxone prescriptions among patients with a substance use disorder and a positive fentanyl urine drug screen presenting to the emergency department. Harm Reduct J 2023; 20:144. [PMID: 37798673 PMCID: PMC10552257 DOI: 10.1186/s12954-023-00878-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Over 109,000 people in the USA died from a drug overdose in 2022. More alarming is the amount of drug overdose deaths involving synthetic opioids other than methadone (SOOM), primarily fentanyl. From 2015 to 2020, the number of drug overdose deaths from SOOM increased 5.9-fold. SOOM are commonly being found in many other drugs without the user's knowledge. Given the alarming number of overdose deaths from illicit drugs with SOOM, naloxone should be prescribed for all persons using illicit drugs regardless of if they knowingly use opioids. How often providers prescribe naloxone for these patients remains unknown. The aim of this study is to determine the rate of naloxone prescriptions given to patients with any substance use disorder, including when the patient has a urine drug screen positive for fentanyl. Secondary aims include determining what patient factors are associated with receiving a naloxone prescription. METHODS The design was a single-center retrospective cohort study on patients that presented to the Augusta University Medical Center emergency department between 2019 through 2021 and had an ICD-10 diagnosis of a substance use disorder. Analyses were conducted by logistic regression and t-test or Welch's t-test. RESULTS A total of 10,510 emergency department visits were by 6787 patients. Naloxone was prescribed in 16.3% of visits with an opioid-related discharge diagnosis and 8.4% of visits with a non-opioid substance use-related discharge diagnosis and a urine drug screen positive for fentanyl. Patients with a fentanyl positive urine drug screen had higher odds of receiving a naloxone prescription (aOR 5.80, 95% CI 2.76-12.20, p < 0.001). Patients with a psychiatric diagnosis had lower odds of being prescribed naloxone (aOR 0.51, p = 0.03). Patients who received naloxone had a lower number of visits (mean 1.23 vs. 1.55, p < 0.001). Patients with a urine drug screen positive for cocaine had higher odds of frequent visits (aOR 3.07, p = 0.01). CONCLUSIONS Findings should remind providers to prescribe naloxone to all patients with a substance use disorder, especially those with a positive fentanyl urine drug screen or a co-occurring psychiatric condition. Results also show that cocaine use continues to increase healthcare utilization.
Collapse
Affiliation(s)
- Shawkut Amaan Ali
- Psychiatry and Health Behavior, Augusta University, 997 St. Sebastian Way, Augusta, GA, 30912, USA.
| | - Jasmine Shell
- Psychiatry and Health Behavior, Augusta University, 997 St. Sebastian Way, Augusta, GA, 30912, USA
| | - Raymond Harris
- Carl R. Darnall Army Medical Center, 36065 Santa Fe Ave, Fort Cavazos, TX, 76544, USA
| | - Marshall Bedder
- Psychiatry and Health Behavior, Augusta University, 997 St. Sebastian Way, Augusta, GA, 30912, USA
| |
Collapse
|
4
|
Ruglass LM, Shevorykin A, Zhao Y, Killeen TK, Bauer AG, Morgan-López AA, Back SE, Fitzpatrick S, López-Castro T, Norman SB, Saavedra LM, Hien DA. Self-report and urine drug screen concordance among women with co-occurring PTSD and substance use disorders participating in a clinical trial: Impact of drug type and participant characteristics. Drug Alcohol Depend 2023; 244:109769. [PMID: 36696843 PMCID: PMC9987239 DOI: 10.1016/j.drugalcdep.2023.109769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/17/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Self-report measures are important in substance use assessment, yet they are susceptible to reporting errors. Urine drug screens (UDS) are often considered a more valid alternative. However, collecting in-person UDS may not always be feasible, contributing to the need to understand factors that influence the validity of self-reported substance use. METHODS In this secondary analysis of data from 295 women with co-occurring PTSD and substance use disorders (SUD) who participated in a clinical trial testing behavioral interventions, we examined concordance and discordance between self-reported drug use and associated UDS results. Generalized linear mixed models were used to examine the impact of treatment type and participant characteristics on the associations between self-reported drug use and UDS results. RESULTS Findings revealed higher disagreement between self-report and UDS for opioids and sedatives (ranging from.77 to.90) and lower disagreement rates for cannabis and cocaine (ranging from.26 to.33). Treatment type was not a significant moderator of the associations between self-report and UDS across all drugs. Among those with a positive opioid UDS, those who reported employment in the past three years were more likely to self-report no opioid use compared to their counterparts without employment in the past three years. CONCLUSIONS Findings add to the literature that supports the validity of self-reported cannabis and cocaine use. The greater discrepancies between self-report and UDS test results of opioids and sedatives suggest adjunctive UDS may be required, although a variety of factors other than inaccurate self-report may be associated with this discrepancy.
Collapse
Affiliation(s)
- L M Ruglass
- Department of Psychology, The City College of New York, CUNY, USA; Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, USA.
| | - A Shevorykin
- Department of Health Behavior, Roswell Comprehensive Cancer Center, USA
| | - Y Zhao
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, USA; School of Nursing, Columbia University, USA; Department of Psychiatry, Yale University School of Medicine, USA
| | - T K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA
| | - A G Bauer
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, USA
| | | | - S E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA
| | | | - T López-Castro
- Department of Psychology, The City College of New York, CUNY, USA
| | - S B Norman
- National Center for PTSD, White River Junction, VT, USA; Department of Psychiatry, University of California, San Diego, USA
| | | | - D A Hien
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, USA
| |
Collapse
|
5
|
Weiss ST, Veach LJ, McGill W, Brent J. Rates and types of urine drug screen false negative results compared with confirmatory toxicology testing in major trauma patients. Clin Toxicol (Phila) 2022; 60:1122-1129. [PMID: 36069771 DOI: 10.1080/15563650.2022.2117052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Trauma centers are required to screen patients for alcohol use, and if necessary, intervene and refer to treatment (SBIRT). Similar screening for illicit drug use is recommended but not required. Urine drug screening (UDS) underestimates problematic substance use. This study aimed to estimate the types and rates of UDS false negatives (FN) compared to comprehensive testing by liquid chromatography-mass spectrometry (LC-MS) in trauma patients. METHODS We performed a prospective cohort study of deidentified urine samples from adult trauma and burn activation patients. Both UDS and LC-MS comprehensive testing of >200 analytes were performed by a reference laboratory on all samples. Iatrogenic medications were excluded from the FN count. Crosstab analyses were conducted for UDS versus LC-MS outcomes to establish FN types and rates. We dichotomized the results by creating an "intentionality" variable (intentional injuries by self/others versus accidental injuries). A series of crosstabs with odds ratios considered intentionality by substance class and demographics. Statistically significant variables by Chi-Square were assessed by logistic regression. RESULTS Psychoactive FN were detected in 56/100 urine samples analyzed; the most frequent included anticonvulsants (primarily gabapentin, N = 13), opioid agonists (N = 12), antihistamines (primarily diphenhydramine, N = 10), and phenethylamines (primarily bupropion, N = 5). Nonpsychoactive FN were detected in 70/100 samples; the most common were nicotine (N = 33), caffeine (N = 23), acetaminophen (N = 22), and antidepressants (N = 12). Of substance classes included in the UDS and also tested by LC-MS, FN occurred for opiates (3%), amphetamines (5%) and opioids (25%). Polypharmacy was associated with fall injuries in elderly patients. Cocaine (p = 0.015) and cannabinoids (p = 0.002) were significantly associated with intentionality. CONCLUSIONS Our results indicate that FN for potentially important psychoactive and nonpsychoactive substances are common when toxicologic testing is limited to routine UDS in trauma patients. We recommend expanding SBIRT in this patient population to include misuse of tobacco products, prescription analgesics, and over-the-counter antihistamines.
Collapse
Affiliation(s)
- Stephanie T Weiss
- Addiction Medicine Research Fellowship Program, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Translational Addiction Medicine Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Laura J Veach
- Addiction Medicine Research Fellowship Program, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Jeffrey Brent
- Departments of Medicine and Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO, USA.,Toxicology Associates, Littleton, CO, USA
| |
Collapse
|
6
|
Affiliation(s)
- Dominick Shelton
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| |
Collapse
|
7
|
Sobel HG, Warrington JS, Francis-Fath S, Crocker AM, Berger CA. A Descriptive analysis of urine drug screen results in patients with opioid use disorder managed in a primary care setting. Addict Sci Clin Pract 2021; 16:59. [PMID: 34593036 PMCID: PMC8482571 DOI: 10.1186/s13722-021-00264-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urine drug screening (UDS) is commonly used as part of treatment for opioid use disorder (OUD), including treatment with buprenorphine-naloxone for OUD in a primary care setting. Very little is known about the value of UDS, the optimum screening frequency in general, or its specific use for buprenorphine treatment in primary care. To address this question, we thought that in a stable population receiving buprenorphine-naloxone in the primary care setting it would be useful to know how often UDS yielded expected and unexpected results. METHODS We present a descriptive analysis of UDS results in patients treated with buprenorphine-naloxone for OUD in a primary care setting over a two-year period. An unexpected test result is: 1. A negative test for buprenorphine and/or 2. A positive test for opioids, methadone, cocaine and/or heroin. RESULTS A total of 161 patients received care during the study period and a total of 2588 test results were analyzed from this population. We found that 64.4% of the patient population (n = 104 patients) demonstrated both treatment adherence (as measured by buprenorphine positive test results) and no apparent unexpected test findings, as defined by negative tests for opioids, methadone, cocaine and heroin. Of the 161 patients, 20 results were positive for opioids, 5 for methadone, 39 for heroin and 2 for cocaine. Analysis at the UDS level demonstrated that, of the 2588 test results, 38 (1.5%) results did not have buprenorphine. Of the 2588, 28 (1.1%) test results were positive for opioids, 8 (0.3%) were positive for methadone, 39 (1.5%) for cocaine and 2 (0.1%) for heroin. CONCLUSION Given that the majority of patients in our study had expected urine results, it may be reasonable for less frequent urine testing in certain patients.
Collapse
Affiliation(s)
- Halle G Sobel
- University of Vermont, Robert Larner College of Medicine, VT, Burlington, USA. .,Department of General Internal Medicine, Larner College of Medicine University of Vermont, VT, Burlington, USA.
| | - Jill S Warrington
- University of Vermont, Robert Larner College of Medicine, VT, Burlington, USA.,Department of Pathology, Larner College of Medicine University of Vermont, VT, Burlington, USA
| | - Samuel Francis-Fath
- University of Vermont, Robert Larner College of Medicine, VT, Burlington, USA.,, South Burlington, VT, Averheatlh, USA
| | - Abigail M Crocker
- University of Vermont, Robert Larner College of Medicine, VT, Burlington, USA.,Department of Mathetmatics and Statistics College of Engineering and Mathematical Sciences, University of Vermont, VT, Burlington, USA
| | - Claudia A Berger
- University of Vermont, Robert Larner College of Medicine, VT, Burlington, USA.,Department of General Internal Medicine, Larner College of Medicine University of Vermont, VT, Burlington, USA
| |
Collapse
|
8
|
Leap KE, Chen GH, Lee J, Tan KS, Malhotra V. Identifying Prevalence of and Risk Factors for Abnormal Urine Drug Tests in Cancer Pain Patients. J Pain Symptom Manage 2021; 62:355-363. [PMID: 33276043 PMCID: PMC9364695 DOI: 10.1016/j.jpainsymman.2020.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022]
Abstract
CONTEXT Opioids have become a mainstay treatment for severe cancer pain. Although opioid prescribing has decreased, opioid mortality continues to rise. Utilizing urine drug tests (UDT) can help monitor medication adherence and identify use of unprescribed or illicit substances. OBJECTIVES To identify the prevalence of abnormal UDT among oncologic pain patients, associated demographic and clinical factors, and the most common abnormal substances. METHODS A retrospective chart review of 2472 patients with a cancer diagnosis and documented UDT in a single center was conducted from January 1, 2018 to February 15, 2020. Multivariable analyses were conducted for 10 baseline patient factors on each of the two primary outcomes-illicit drugs excluding tetrahydrocannabinol and amphetamines and detected-not-prescribed. RESULTS Of the 2472 patients, 840 patients (34%) had abnormal results. For illicit drugs, the significant factors (incidence rate ratio [95% CI]) were age (45-54 vs. ≥ 65 years: 7.27 [2.27-23.23]), race (black vs. white: 2.99 [1.39-6.42]), smoking status (current vs. former: 2.63 [1.41-4.90]); never vs. former: 0.27 (0.10-0.76), and benzodiazepine use (use vs. no use: 2.06 [1.03-4.12]). For detected-not-prescribed, the significant factors (incidence rate ratio [95% CI]) were race (black vs. white: 1.37 [1.01-1.85]), smoking status (current vs. former: 1.27 [1.00-1.62]); never vs. former: 0.82 (0.67-1.00), log-transformed morphine milligram equivalence (1.04 [1.01-1.07]), and benzodiazepine use (use vs. no use: 1.64 [1.35-1.98]). CONCLUSIONS This study demonstrates that oncologic pain patients are not a risk-free population for abnormal UDT, thus recommends a UDT with initial opioid prescriptions and annually thereafter, with more frequent tests for patients suspected to be at higher risk for misuse.
Collapse
Affiliation(s)
- Kelly E Leap
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
| | - Grant H Chen
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jasme Lee
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vivek Malhotra
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
9
|
Doriety LJ, Farrington EA. Urine Drug Screening: What Pediatric Clinicians Need to Know to Optimize Patient Care. J Pediatr Health Care 2021; 35:449-455. [PMID: 34243846 DOI: 10.1016/j.pedhc.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/02/2020] [Accepted: 12/22/2020] [Indexed: 10/20/2022]
|
10
|
Pope JD, Black MJ, Drummer OH, Schneider HG. Urine toxicology screening by liquid chromatography time-of-flight mass spectrometry in a quaternary hospital setting. Clin Biochem 2021; 95:66-72. [PMID: 33989561 DOI: 10.1016/j.clinbiochem.2021.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Validation of a non-targeted method for urine drug screening (UDS) by liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF), and comparison to an established GC-MS method in a hospital setting. METHODS 217 UDS specimens sent to a quaternary hospital pathology department, were analysed by a CEDIA® immunoassay screen (six drug panels; amphetamines, barbiturates, benzodiazepines, cocaine metabolites, cannabinoids and opiates) on an Abbott Architect instrument. Specimens were subsequently analysed by an established non-targeted qualitative GC-MS method and results compared with a general unknown screening method by LC-QTOF that was under evaluation as a replacement method. RESULTS 42 selected drugs were evaluated; limits of identification ranged from 2 to 100 µg/L and most drugs (n = 39) were stabile for 24 h after preparation. Matrix effects greater than 25% were observed in seven of the selected drugs. 87% of the specimens tested positive to 1 or more drug panels in a CEDIA® screen. A total of 537 positive drug findings were identified by GC-MS compared to 1,267 positive findings by LC-QTOF. On average, each GC-MS screen identified 2.5 ± 1.8 drugs and the LC-QTOF screen identified 5.8 ± 3.2 drugs. No drugs were identified in 11.3% of the GC-MS screens, whereas drugs were detected in 99% of these by the LC-QTOF. In almost all instances, the LC-QTOF screen could provide mass spectrometric confirmatory results of positive immunoassay screens and was able to identify a wider range of additional drugs and drug metabolites. CONCLUSIONS The described general unknown screening (non-targeted, qualitative) LC-QTOF method can detect a larger range of drugs encountered in a hospital setting. The method has been shown to be suitable for comprehensive toxicology screening in a clinical toxicology laboratory.
Collapse
Affiliation(s)
- Jeffrey D Pope
- Clinical Biochemistry, Alfred Health, 55 Commercial Rd, Melbourne 3004, Australia; School of Public Health and Preventative Medicine, Commercial Rd, Melbourne 3004, Monash University, Australia.
| | - Marion J Black
- Clinical Biochemistry, Alfred Health, 55 Commercial Rd, Melbourne 3004, Australia
| | - Olaf H Drummer
- School of Public Health and Preventative Medicine, Commercial Rd, Melbourne 3004, Monash University, Australia; Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank 3006, Australia
| | - Hans G Schneider
- Clinical Biochemistry, Alfred Health, 55 Commercial Rd, Melbourne 3004, Australia; School of Public Health and Preventative Medicine, Commercial Rd, Melbourne 3004, Monash University, Australia
| |
Collapse
|
11
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
12
|
Puthenpura V, Gueye-Ndiaye S, Joshi S, Puvabanditsin S, Carayannopoulos MO. Social and legal implications of urine drug screen analysis in the neonate: A case of suspected specimen mishandling. Clin Chim Acta 2020; 511:104-106. [PMID: 33002470 DOI: 10.1016/j.cca.2020.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The legal implications associated with illicit drug use during pregnancy are significant, as providers are required to notify child protective services when a drug-exposed infant is identified. CASE REPORT The case presented involves possible specimen mishandling in two infants at risk for in utero drug exposure and describes alternative methodologies available to confirm specimen identity. CONCLUSIONS It is critical that institutions establish and adhere to stringent procedures when screening newborns.
Collapse
Affiliation(s)
- Vidya Puthenpura
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Seyni Gueye-Ndiaye
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Sonali Joshi
- Robert Wood Johnson University Hospital, New Brunswick, NJ, United States
| | - Surasak Puvabanditsin
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Mary O Carayannopoulos
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
| |
Collapse
|
13
|
Caricasole V, Spagnolo G, Di Bernardo I, Cirnigliaro G, Piccoli E, Dell'Osso B. Aripiprazole causing false positive urine amphetamine drug screen in an adult patient with bipolar disorder. Compr Psychiatry 2019; 94:152126. [PMID: 31518847 DOI: 10.1016/j.comppsych.2019.152126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022] Open
Abstract
There has been only a few reports regarding aripiprazole causing false positive urine amphetamine drug screens, exclusively on children accidently ingesting aripiprazole. Herein, we present the first reported case of a 40 year old woman affected by Bipolar I Disorder, treated with aripirazole at therapeutic oral dose ranging from 15 mg/day to 30 mg/day, in the context of a depressive episode with mixed and psychotic features, showing a false positive urine amphetamine drug screen. We document the relationship between aripiprazole-dose, plasma concentration and amphetamines values in toxicologic urine examinations over time. Awareness of potential false positive urine amphetamine drug screens during aripiprazole treatment can condition therapeutic choices and prevent legal implications.
Collapse
|
14
|
Uljon S, Kataria Y, Flood JG. Vortioxetine use may cause false positive immunoassay results for urine methadone. Clin Chim Acta 2019; 499:1-3. [PMID: 31469980 DOI: 10.1016/j.cca.2019.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/17/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Urine immunoassays are frequently employed for methadone screening because they are relatively inexpensive and widely available. However, immunoassays are notoriously prone to false positives. We report that the use of vortioxetine (Trintellix® in the USA and Canada, Brintellix® worldwide) could cause false positives in the Roche KIMS Methadone II Urine immunoassay (MDN2). METHODS We performed a spiking study using a parent drug vortioxetine concentration of 7500 ng/ml. RESULTS Urine specimens from seven patients on typical vortioxetine doses tested positive for methadone in the Roche assay but negative for methadone in a confirmatory (GC/MS) assay and two other immunoassay platforms. Because of the pharmacokinetics of vortioxetine and the high cross-reactivity of a metabolite in the MDN2 assay, routine use of the drug could cause false positives even without detectible parent drug in the urine. CONCLUSIONS Vortioxetine is commonly prescribed for mood disorders, which have high prevalence in patients treated for opioid addiction. For that reason, it is important that clinicians are aware of this interference.
Collapse
Affiliation(s)
- Sacha Uljon
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States of America.
| | - Yachana Kataria
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, MA, United States of America
| | - James G Flood
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States of America
| |
Collapse
|
15
|
Kim E, Murray BP, Salehi M, Moran TP, Carpenter JE, Koch DD, Ritchie JC, Schindler JM, Morgan BW. Does Lidocaine Cause False Positive Results on Cocaine Urine Drug Screen? J Med Toxicol 2019; 15:255-261. [PMID: 31264143 DOI: 10.1007/s13181-019-00720-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/05/2019] [Accepted: 06/10/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Individuals who have tested positive for cocaine have claimed that lidocaine, or its primary metabolite, norlidocaine (monoethylglycinexylidide (MEGX)), have caused false positive results for the cocaine metabolite benzoylecgonine (BE) on urinary immunoassay testing. OBJECTIVE The goal of the study was to determine if lidocaine exposure from routine medical procedures can result in false positives on a commercially available cocaine immunoassay urine drug screen (UDS). METHODS We performed a cross-sectional observational study of patients receiving lidocaine as part of their regular care. Standard immunoassay drug screens and confirmatory liquid chromatography-mass spectrometry (LC-MS) were performed on all urine samples to assess for MEGX and BE. RESULTS In total, 168 subjects were enrolled; 121 samples positive for lidocaine were ultimately included for analysis. One hundred fourteen of the 121 were also positive for MEGX. None of the 121 were positive for cocaine/BE on the UDS (95% CI), 0-3.7% for the full sample and 0-3.9% for the 114 who tested positive for MEGX. CONCLUSION The present study found no evidence that lidocaine or norlidocaine are capable of producing false positive results on standard cocaine urine immunoassays.
Collapse
Affiliation(s)
| | - Brian Patrick Murray
- Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA.
| | | | - Tim P Moran
- Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA
| | - Joseph E Carpenter
- Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA
| | | | | | - Joanna M Schindler
- Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA
| | - Brent W Morgan
- Emory University School of Medicine, 50 Hurt Plaza, Suite 600, Atlanta, GA, 30303, USA
| |
Collapse
|
16
|
Chung C, Salottolo K, Tanner A, Carrick MM, Madayag R, Berg G, Lieser M, Bar-Or D. The impact of recreational marijuana commercialization on traumatic injury. Inj Epidemiol 2019; 6:3. [PMID: 30714081 PMCID: PMC6360194 DOI: 10.1186/s40621-019-0180-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The medical legalization of marijuana has been shown to result in an increased risk of motor vehicle injuries. In Colorado, commercialization of recreational marijuana (initiation of retail sales) occurred on January 1, 2014, resulting in the rapid proliferation of its availability. The objective of this study was to determine whether the proportion of injured patients testing positive for marijuana and other drugs changed two years before and two years after commercialization of recreational marijuana in Colorado. METHODS This retrospective multi-institutional cohort study included all patients admitted with a traumatic injury to six trauma centers (three centers in Colorado and three centers in states without permissive marijuana laws) from 2012 to 2015. The primary outcome was the rate (%) of a positive urine drug screen (UDS) for marijuana. Generalized linear regression models were used to examine the rate of change over time in the pre-commercialization period relative to the post- commercialization period (via an interaction effect), separately for states with and without recreational marijuana legalization. RESULTS There were 40,591 trauma admissions. In Colorado, the rate of marijuana detected with UDS decreased over time pre-commercialization; this trend reversed post-commercialization, when marijuana detection rates increased significantly over time (interaction p = 0.004). At non-Colorado hospitals, the rate over time of marijuana detection was significantly reduced post-commercialization relative to the pre-commercialization period (p < 0.001). CONCLUSION There was an overall increased rate over time of marijuana detected among trauma patients at Colorado hospitals but not at non-Colorado hospitals, suggesting an increased use of marijuana or an increased risk of injury while using marijuana following the commercialization of recreational marijuana in Colorado.
Collapse
Affiliation(s)
- Christine Chung
- Trauma Research Department, Swedish Medical Center, Englewood, CO, 80113, USA
| | - Kristin Salottolo
- Trauma Research Department, Swedish Medical Center, Englewood, CO, 80113, USA.,Trauma Research Department, Penrose-St Francis Health Services, Colorado Springs, CO, USA.,Trauma Research Department, Medical City Plano, Plano, TX, USA.,Trauma Research Department, St. Anthony Hospital, Lakewood, CO, USA.,Trauma Research Department, Wesley Medical Center, Wichita, KS, USA.,Trauma Research Department, Research Medical Center, MO, Kansas City, US, USA
| | - Allen Tanner
- Trauma Research Department, Penrose-St Francis Health Services, Colorado Springs, CO, USA
| | | | - Robert Madayag
- Trauma Research Department, St. Anthony Hospital, Lakewood, CO, USA
| | - Gina Berg
- Trauma Research Department, Wesley Medical Center, Wichita, KS, USA
| | - Mark Lieser
- Trauma Research Department, Research Medical Center, MO, Kansas City, US, USA
| | - David Bar-Or
- Trauma Research Department, Swedish Medical Center, Englewood, CO, 80113, USA. .,Trauma Research Department, Penrose-St Francis Health Services, Colorado Springs, CO, USA. .,Trauma Research Department, Medical City Plano, Plano, TX, USA. .,Trauma Research Department, St. Anthony Hospital, Lakewood, CO, USA. .,Trauma Research Department, Wesley Medical Center, Wichita, KS, USA. .,Trauma Research Department, Research Medical Center, MO, Kansas City, US, USA.
| |
Collapse
|
17
|
Rauenzahn S, Sima A, Cassel B, Noreika D, Gomez TH, Ryan L, Wolf CE, Legakis L, Del Fabbro E. Urine drug screen findings among ambulatory oncology patients in a supportive care clinic. Support Care Cancer 2017; 25:1859-64. [PMID: 28120116 DOI: 10.1007/s00520-017-3575-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Professional organizations provide no guidelines regarding assessment and management of opioid abuse risk in cancer. Universal precautions (UP) developed for non-cancer pain, include assessments for aberrant behavior, screening questionnaires, and urine drug screens (UDS). The role of UDS for identifying opioid abuse risk in cancer is uncertain. Our aim is to characterize inappropriate UDS, and identify a potential role for UDS in therapeutic decision-making. METHODS An observational retrospective chart review of 232 consecutive supportive care clinic patients were seen during the study. Twenty-eight of the two hundred thirty-two did not meet inclusion criteria. One hundred fifty of the two hundred four had active cancer, while 54 had no evidence of active disease. Clinicians ordered UDS based on their clinical judgment of patients' substance misuse risk. Edmonton symptom assessment scores, history of substance abuse, alcohol use, tobacco use, aberrant behavior, and morphine equivalent daily dose (MEDD) were obtained. RESULTS Pain scores and MEDD were higher (p = 0.021; p < 0.001) in the UDS group vs non-UDS. Forty percent of the patients (n = 82/204) had at least one UDS and 70% (60/82) had an inappropriate result. Thirty-nine percent (32) were inappropriately negative, showing no prescribed opioids. Forty-nine of the eighty-two were positive for non-prescribed opioids, benzodiazepine, or illicit substance. Eleven of the forty-nine had only cannabis metabolites in their urine. There were no significant differences between appropriate and inappropriate UDS groups regarding pain scores, MEDD or referral to psychology, psychiatry, or substance abuse specialists. CONCLUSIONS UDS on the 82 oncology patients at high risk for substance misuse were frequently positive (46%) for non-prescribed opioids, benzodiazepines or potent illicit drugs such as heroin or cocaine, and 39% had inappropriately negative UDS, raising concerns for diversion.
Collapse
|
18
|
Wilcox CE, Bogenschutz MP, Nakazawa M, Woody G. Concordance between self-report and urine drug screen data in adolescent opioid dependent clinical trial participants. Addict Behav 2013; 38:2568-74. [PMID: 23811060 DOI: 10.1016/j.addbeh.2013.05.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/15/2013] [Accepted: 05/25/2013] [Indexed: 10/26/2022]
Abstract
Objective measures of drug use are very important in treatment outcome studies of persons with substance use disorders, but obtaining and interpreting them can be challenging and not always practical. Thus, it is important to determine if, and when, drug-use self-reports are valid. To this end we explored the relationships between urine drug screen results and self-reported substance use among adolescents and young adults with opioid dependence participating in a clinical trial of buprenorphine-naloxone. In this study, 152 individuals seeking treatment for opioid dependence were randomized to a 2-week detoxification with buprenorphine-naloxone (DETOX) or 12weeks of buprenorphine-naloxone (BUP), each with weekly individual and group drug counseling. Urine drug screens and self-reported frequency of drug use were obtained weekly, and patients were paid $5 for completing weekly assessments. At weeks 4, 8, and 12, more extensive assessments were done, and participants were reimbursed $75. Self-report data were dichotomized (positive vs. negative), and for each major drug class we computed the kappa statistic and the sensitivity, specificity, positive predictive value, and negative predictive value of self-report using urine drug screens as the "gold standard". Generalized linear mixed models were used to explore the effect of treatment group assignment, compensation amounts, and participant characteristics on self-report. In general, findings supported the validity of self-reported drug use. However, those in the BUP group were more likely to under-report cocaine and opioid use. Therefore, if used alone, self-report would have magnified the treatment effect of the BUP condition.
Collapse
|