Are your urines being observed? There is a chain of custody that cannot be broken with any specimen. Do you know what the chain of custody is and has your clinic been following one? ------ Are you aware that some medications purchased over-the-counter may cause your urine to test positive for opiates ? Are you aware that prescription medications prescribed by your physician can test positive for cocaine? Do you know that some of the products advertized for sale to help you pass your drug test can be detected now? Are you aware of what consequences you will suffer if you are caught using them? There are other questions, too. My intention is to lay at rest the confusion surrounding some of the questions that have surfaced lately.
Let's start at what our State Methadone Treatment Guidelines say along with CSAT Guidelines For The Accreditation of Opioid Treatment Programs.
CSAT Guidelines For The Accreditation of Opioid Treatment Programs
IX. D. Testing For Drug Use Click Here
|Click Above |
Programs collect all urine or other toxicological specimens in a therapeutic context that suggests trust and respect and minimizes falsification. Reliance on direct observation, video camera monitoring, one-way mirrors, although necessary for some patients, is either necessary nor appropriate for all patients. Temperature testing is minimally intrusive and highly effective in identifying "counterfeit" or altered urine specimens.
Georgia State Regulations 290 - 12.16 Drug-Screen Tests
290-9-12-.16 Drug-Screen Tests. The program shall develop and implement written policies and procedures for random drug-screen tests. These policies and procedures will be for the purposes of assessing the patient abuse of drugs and making decisions about the patient’s treatment. These policies and procedures must include the following provisions:
(a) Clinically appropriate drug-screen tests done in accordance with current and accepted standards of medical practice must be conducted initially upon admission and on a random basis bi-weekly for new patients during the first 30 days of treatment and at least monthly thereafter. However, patients on a monthly schedule who fail the drug-screen tests will be returned to a bi-weekly schedule for at least two weeks or longer if clinically indicated;
(b) Each sample collected must be screened for opiates, methadone, amphetamines, cocaine, benzodiazepines, THC, and other drugs as indicated by individual patient use patterns or that are heavily used in the locale of the patient; and
(c) Programs shall develop and enforce policies for the proper collection and handling of drug-screen test samples to ensure that samples collected from patients are properly handled, are actually collected from the patient being tested, and are unadulterated. Such policies may include random direct observation, which shall be conducted professionally, ethically, and in a manner that respects patients’ privacy.
Authority O.C.G.A. Sec. 26-5-2 et seq.
I believe the above guideline answers our first question as to whether our urines can be observed. It is necessary for some patients is not necessary nor appropriate for all patients. To clear up any confusion -- yes they can observe -- if they are suspicious and feel as if they have reason -- they are in their rights to observe. As they so stated --temperature testing is minimally intrusive and highly effective in identifying "counterfeit" or altered urine specimens.
Federal Methadone Treatment Guidelines
Currently regulations promulgating by FDA and NIDA (21 CFR 291) requires an admission analysis and eight random urine specimens for the presence of methadone and drugs of abuse during the first year of treatment . In subsequent years, at least quarterly urinalysis are required except for those patients who receive a 6-day supply of take home medication; those patients must have their urine taken and screened at least monthly. The Federal regulation requires that urine specimens be "collected in a manner that minimizes falsification."
21 CFR §291.505(d)(2) and that each urine be tested or analyzed for opiates, methadone, amphetamines, cocaine and barbiturates, as well as any drug(s) that have been determined by the program to be abused in that particular locality.
These are minimal standards for urinalysis, States may develop methadone maintenance treatment standards and regulations that can exceed Federal requirements; programs must adhere to stringent regulation, whether Federal or State.
In the matter of urine survelliance, some states require more frequent testing than does the Federal government.
The implications of this testing are widespread, with reputations and careers always at stake (Coffman and Fernandez 1991). Therefore the techniques employed in obtaining urine specimens and the accuracy and validity of testing methods are crit-ical (Schwartz et al.1991). Usually, sophisticated and expensive laboratory method-ologies such as radio-immunoassay (RIA) and gas chromatography/mass spectrometry (GCMS) are employed when the test result will be used to decide employment, partic-ipation in a major league competition, or the ability to practice law or medicine.
The initial test result is generally validated by a second confirmatory testing using a different, more sensitive test procedure. These methods allow the laboratory to verify positive or negative findings with specificity. In most cases, urine is obtained under direct observation and a chain of custody of the specimen is maintained to ensure that the tested specimen can be traced to the person to whom it belongs, that the results are quantitatively and qualitatively accurate, and that the results will stand up in a court of law.
It is critical to distinguish between these methods and those commonly used in methadone maintenance programs. Generally, methadone maintenance treatment programs employ collection and laboratory methods that provide routine urine screening, while the sophisticated collection and methodology described above are more aptly characterized as testing. The distinction between screening and testing is important in examining urinalysis in methadone maintenance treatment.
In most well-run MMTP's, urine is collected on a frequent and routine basis although not necessarily under direct observation. Rather, these urine specimens are obtained randomly from patients who must provide them upon request. Most clinics assign a staff member the responsibility of greeting the patient and determining if a urine specimen is required upon that visit, prior to the patient's receiving his or her medica-tion. The patient is sent to the bathroom to provide the specimen in a labeled container. Some programs monitor the bathroom to ensure that only one patient uses it at a time and that the patient does not bring packages or parcels into the bathroom.
The person collecting the urine specimen checks the container to determine whether it is a " fresh" urine. The specimen that is collected should be felt for warmth (freshly voided specimens are always body temperature, approximately 37°C). Some clinics use a thermometer strip; others use a collection device with a thermometer strip included.
Many treatment programs collect specimens under direct observation, while others use one-way mirrors and even video-tape to ensure reliable sample collection. In most cases, direct observation need not be employed in collecting urine specimens unless chain of custody is a main concern. If direct observation is used, it should be done ethically with respect for patient privacy and should be handled profes- sionally in a manner that does not damage the patient-clinic relationship.
Whichever method is used, specimens should be collected in a manner that minimizes falsification. Appropriate precautions for handling urine specimens (for example, the person collecting the specimen should always wear gloves) should always be taken. The package is then sent to the program laboratory for screening.
Most MMTP's, because of the volume and cost of urine surveillance, use thin-layer chromatography (TLC) or enzyme immunoassay (EIA) laboratory testing methods in conducting required urine screening.
TLC is one of the oldest methods and is still utilized as a practical technique for a comprehensive drug screening. A screen based on TLC technique scan detect amphetamines, benzodiazepines, barbiturates, methadone, propoxyphene, tricyclic antidepressants and nicotine. The most frequently used EIA method in this country is the EMIT system, which allows for short analysis time, can be automated for large-scale samples, and can be used on-site by small programs.(Hawks 1986; Manno 1986).
These efficient low-cost screening methods each have benefits and limitations, EIA provides a testing threshold that allows detection of extremely small quantities of abused substances but does not have the specificity to determine which drug in a class is present (Daistha and Tadrus 1975); Saxon et al. 1990). For example, this method can detect the presence of opiates but cannot distinguish between morphine (the metabolite of heroin excreted in urine), codeine, and other opiates, including poppy seeds commonly used in baked goods.
Yes, using EIA , it can detect extremely positive small quantities of abused substances but does not have the specificity to determine which drug in a class is present.
TLC can make the distinctions but can also produce false negative reports because it requires relatively larger amounts of abused drugs to be detected in the urine.
However, neither the TLC nor the EIA method can be referred to as urine testing because an isolated result, with or without confirmatory testing cannot be presented in a court of law and certified as accurate. These are urine screens, which in the context of regular, routine, and random surveillance, can yield a patient profile to be used in treatment planning, counseling, casework, and determining the adequacy of the patient's methadone dosage, particularly as patterns emerge during treatment.
Positive urine results should always be discussed with the patient, and the patient's response should be recorded in the case record. Some patients will adamantly deny substance use despite the positive result from the laboratory. Methadone maintenance treatment providers should take adamant denial seriously and not discount the patient as a manipulator or a liar.
A careful history of any prescribed or over-the-counter drugs used by the patient should be obtained. This history should be discussed with the laboratory pathologist or chemist to determine if these drugs can result in a positive screen or confound the result in any way. Wherever possible, the positive screen (if the positive screen is still available) should be retested and confirmed by another method. If this is not possible, future screens should be ordered with confirmation.
More accurate testing methods such as RIA or GC/MS can also be used to verify the laboratory report. Urine can be collected under direct observation and a chain of custody can be maintained to assure the patient that every effort is being made to prevent laboratory error and to respond to the patient's denial.
| Another critical issue|
is the reliability of the
(Blanke 1986; Morgan
1984) Properly train
and educate staff
about the tests and
procedures used so
their benefits and
limitations can be
Programs have argued that frequent screening or use of the results in treatment decisions is not warranted because the results are not reliable. While it is important to understand the difference between the various methods laboratories use and the limitations of some of the tests, urine screening is basically reliable, particularly if a program monitors for trends and does not act on a single isolated screen. It is important to understand that accuracy depends on the choice of laboratory; use of proper equipment and me-thodology, quality control, and use of high-quality standards by all evolved in screening. In all laboratory testing, human errors, confounding results, chain of custody of the sample, and other problems can occur. Informed decisions by programs can reduce these problems markedly.
The literature on the accuracy of urine toxicology in MMTP's is sparse; however, several studies have been done to measure the accuracy of the screening techniques generally used. In the main, the studies report an accuracy level for screening techniques that is at least 70% of that of the RIA or GC/MS, depending on the technique used. On the basis of the vast differences in cost, the techniques used are adequate for methadone maintenance treatment. When results are contested or confusing, confirming tests should be used. For example, when EIA is used and patients deny any drug use, con-firmation TLC can be useful. These confirmations help offset the limitations ofthe screening techniques, though in general practice, confirmations are not necessary
|Program staff should not make decisions about take--home privileges based solely on these reports. |
LIST OF PRESCRIPTION AND NONPRESCRIPTION DRUGS THAT COULD AFFECT A DRUG TEST
TOXICOLOGY LAB TECHNICAL BRIEF FROM DR. JOSEPH GRAAS, Ph.D.
The following list of drugs that could affect a drug test has been compiled by this office for informational purposes only. We have assumed that the testing incliudes both an initial immunoassay screening test and a confirmatory gas chromatography/mass spectrometry test including the HHS established testing levels for each drug class.
Note: If a non-regulated workplace drug testing program uses only an immunoassay screening test, there may be other substances that could cause a presumptive positive response on the immunoassay test.
Amphetamines (Methamphetamine and Amphetamine)
Prescription medications that contain either d-amphetamine or racemic d, l-amphetamine (i.e. equal amounts of d- and l-amphetamine):
Prescription medication that contains d-methamphetamine:
Substances known to metabolize to methamphetamine (and amphetamine):
Selegiline (Deprenyl, Elderpryl®)
Substances known to metabolize to amphetamine:
Clobenzorex (Dinintel®, Finedal®)
Nonprescription medication that contains l-methamphetamine:
Note: Although one would expect to see 100% l-methamphetamine following Vicks Inhaler use, there may be a trace amount of d-isomer present because a very slight amount of d-methamphetamine may be present as a contaminant in the Vicks Inhaler.
Over-the-counter cold and allergy remedies that contain ephedrine, pseudoephedrine, propylephedrine, phenylephrine, or deoxyephedrine: Nyquil, Contact, Sudafed, Allerest 12 Hour, A.R.M., Triaminic 12;Ornade, Tavist-D, Dimetapp, Neosynephrine, Actifed, Bayer Select Maximum Strenght Sinus Pain Relief Caplets, Contact Non-Drowsy Formula Sinus Caplets, Maximum Strength, Dristan Cold Caplets, Maximum Strength Sudafed Sinus Tablets, Dristan Cold Tablets, Maximum Strength Sine-Aid Tablets, Maximum Strength Sinus Gelcaps, No Drowsiness Sinarest Tablets, Sinus Excedrin Extra Strength Caplets, Cheracol Sinus, Drixoral Cold and Flu, Efidac/24, Phenergan -D, Robitussin Cold And Flu, Vicks Nyquil,
Over-the-counter diet aids containing Phenylpropanolamine: Dexatrim®, Accutrim®
Over-the-counter Nasal Sprays that contains l-Methamphetamine
Vicks Inhaler®, Afrin®
Asthma Medication: Marax®, Bronkaid Tablet®s, Primatene Tablets®
Prescription medications that contain barbiturates:
Phenobarbital: Pentobarbital: Secobarbital:
Acro-Lase Plus® Nembutal Sodium, Seconal Sodium
Antrocol Elixor® Pentobarbital Sodium, Secobarbital Sodium Bellergal-S®
Prescription medications that contain benzodiazepines:
Diazepam: Valium® Valrelease®
Clonazepam Klonopin® Rivotril®
Chlordiazepoxide Librium® Libritab®
Chlordiazepoxide 5mg & Amitriptyline 12.5mg Limbitrol®
| This is only a partial list of benzodiazepines. It is impossible to list |
each and everyone of them. Please ask if you think you are pres-
cribed one before you test positive for them.
Prescription medications that contain cocaine:
More prescription medications that will cause you to test false-positive for cocaine:
|Most Antibiotics |
|Tonic Water |
Note: The medical community uses TAC (tetracaine, epinephrine, cocaine) as a topical preparation prior to various surgical procedures and may use cocaine by itself as a topical vasocontrictive anesthetic for various ear, nose, throat, and bronchoscopy procedures.
Note: Cocaine is structurally unique and does not resemble any of the other topical analgesics, such Novocaine®, Xylocaine® (lidocaine), benzocaine, etc. Although these compounds have analgesic properties, there is no structural similarity to cocaine or its metabolite (benzoylecgonine).
LYSERIC ACID DIETHYLAND
Migraine medications:: ergotamine, Ergostat®, Cafergot®, Wigraine®, Imitrex Hydergine®, bromocriptine/Parlodel®, methysergide/Sansert®, lisuride/Dopergin®, Lysergol, benzatropine/Artane®, Triprolidine, amitriptyline/ Elavil®, dicyclomine (Bentyl)® .
Antinausea medications that contain promethazine: Phenergan®, Promethagan®.
Prescription medication that contains delt-9-tetrahydrocannabinol (THC):
Note: Marinol ® may be used for stimulating appetite and preventing weight loss in patients with a confirmed diagnosis of AIDS and treating nausea and vomiting associated with cancer chemotherapy. Additionally, some individuals have been permitted by a court order to use THC for the management of glaucoma. There are no other prescription medications that contain cannabinoids or any other substance that might be identified as or metabolized to THC.
Opiates (Heroin, Morphine, Codeine)
Prescription medications that contain morphine:
Astramoprh PF ®
MS Contin Tablets®
Prescription medications that contain codeine:
Actifed with Codeine Cough Syrup®
Aspirin with Codeine
Capital and Codeine Oral Solution
Dimetane-DC Cough Syrup ®
Emprin with Codeine®
Fioricet with Codeine®
Fiorinal with Codeine®
Phenaphen with Codeine®
Phenergan with Codeine®
Promethazine VC with Codeine
Soma with Codeine
Triaminic Expectorant with Codeine®
Tylenol (acetaminophen) with Codeine®
Tylenol with Codeine (#1, 2, 3, or 4) ®
Note: List is only a representative sample of the prescription medications that contain codeine or morphine.
Nonprescription products that contain opium (i.e., morphine):
Infantol Pink ®
Kaodene with Paregoric®
Nonprescription product that contains codeine:
Kaoden with Codeine®
Note: The listed nonprescription products are used as antidiarrheals. They are generally availableover-the-counter; however, nonprescription sale is prohibited in some states. Paregoric alone is a Schedule III prescription drug, but in combination with other substances in a Schedule V over-the-counter product.
Substance that metabolizes to morphine:
Note: There are a number of synthetic or semisynthetic opiates available including, but not limited to:
Hydromorphone (Dilaudid®) Oxymorphone (Numorphan®)
Hydrocodone Bitartrate& Homatropine Methylbromide (Hycodan®)
Dihyrocodeine (Paracodine®) (Synalgos DC®) Oxycodone (Percodan®)
Propoxyphene (Darvon®) Methadone (Dolophine®)
Buprenorphine (Buprenex®) Hydrocodone (Vicodin ES®)
These drugs do not metabolize to either codeine, morphine, or 6-acetyl-morphine. When a doctor presents a prescription for a narcotic analgesic, the MRO should verify that it does not contain codeine or morphine and, therefore, cannot metabolize to codeine, morphine, or 6-acetylmorphine.
Food item that contains morphine:
Note: Eating normal dietary amounts of poppy seeds can cause a urine speci-men to test positive for morphine and (possibly) codeine. The concentration of morphine can be substantial, with usually very low concentrations or no detect-able codeine.
Over-The Counter NSAIDS: Advil®, Nuprin®, Medipren®, Motrin®, Bayer Select Pain Relief Formula®, Excedrin IB Caplets®, Genpril®, Haltran®, Ibuprofen®, Midol 200, Pamprin®, Trendar Cramp Relief Formula®, Cramp End Tablets® Rufin®, Naprosyn®, Aleve®, Ketoprofen®, Orudis KT®
Prescription NSAIDS, Anaprox®, Tolectin®, Ifenoprofen®, Fluriprofen®, oxaprozin®, Ansaid®, Clinoril®, Dolobid®, Feldene®, Indocin®, Lodine®, Meclomen®, Motrin®, Nalfon®, Naprosyn ®, Orudis®, Relafen ®, Voltaren®
Over-The-Counter allergy preparations, sleep-aids and anti-nausea medications that contain promethazine, Phenergan®, Promethagan®
Riboflavin (vitamin B2), Dronabad®, Edecrin ®
Prescription medications that contain PCP:
Note: There are no legal medical uses of PCP or any other substances that can be misidentified as PCP.
Department of Health & Human Services
Substance Abuse and Mental Health
Rockville, MD 20857
Date: October 21, 1996
From: Drug Testing Section
Division of Workplace Programs
Rev: January 8, 2004
References: San Diego Reference Laboratory 6122 Nancy Ridge Driveway SanDiego, California 92121 Phone: 1-800-677-7995 Fax: 1-656-677-7998 http://www.sdrl.com
We also have many customers that do not use illegal drugs but use our products because of concerns about false positives. Pain aids, sleeping aids, cold and flu medications and many other over the counter medications will cause a false positive. We also help homeless shelters where doctors go in on a volunteer basis and administer help with cuts, wounds, dental and other medical condi-tions that may occur. Many medications are donated by the community where a loved one has passed away and their medications that are left over are distribut- ed by these doctors to patients who do not have insurance or the capability of obtaining medical help. Most are homeless. These people do not get written prescriptions, because all is done on a volunteer basis and the doctors assume no liability.
We also help people who use on a recreational basis. Without our masking products many would have to wait upwards of 90 days to be able to test clean of all drugs on their own. During this waiting period many would fall back into their drug use pattern because they don't have anything else to do like a job that would have kept keep them occupied. Many could lose their homes, unable to make monthly payments on their bills and only get deeper in the downward spiral. People need to be given a chance. We do not screen calls or save personal information. We feel by keeping people on all sides of the spectrum employed we are giving them a chance to have a better life and a means of supporting their families as well as building their self esteem.
Many people use high dosages of over the counter medications because they do not have insurance or can not afford the medications even with the insurance. Many use certain illegal drugs because they are able to function better on them than on many prescription medication, which have the lingering side effects as well as the damage most do to your internal organs. We feel one should be judged by their performance and the type of person they are, not by their urine, hair, blood or saliva. Marijuana, opiate, methadone, amphetamines, benzo-diazepines and barbiturates and many other drugs are legal if you have a prescription. If you can not afford the medical care or prescriptions then they become illegal. All drugs are good if not abused or used for the wrong reason, it just depends on how they are used and for what reason.
Nuclear power is good unless used in a way that hurts others, guns are used for hunting and law enforcement, all good unless used in an abusive way. One should be judged by their actions as an employee or as an individual whichever the case may be, not what one does in the privacy of their own home, or for medical reasons.
The blood drug tests are not common forms of drug testing. If you are asked to take a blood drug test, the best way to detox and prepare is drinking plain water and perspiring. Especially for those with high toxin levels and THC users. Toxins are stored in your fatty tissue which is your skin. Drinking water and sweating is the only way to get clean or lower your drug metabolite count making it easier to mask whatever toxins are left. How fast you get clean depends on your fatty tissue count, speed of your metabolism, strength and amount of toxins ingested and for how long the toxins were ingested.
The saliva drug test is a very common form of drug testing. If you are asked to take a saliva drug test, the best way to detox and prepare is drinking plain water and perspiring. Especially for those with high toxin levels and THC users. Toxins are stored in your fatty tissue which is your skin. Drinking water and sweating is the only way to get clean or lower your drug metabolite count making it easier to mask whatever toxins are left. How fast you get clean depends on your fatty tissue count, speed of your metabolism, strength and amount of toxins ingested and for how long the toxins were ingested.
The urine drug test is the most popular form of drug test. If you are up against a urine drug test your best form of detox and preparation for the drug test is drinking water and perspiring. DO NOT waste money on teas and diuretics. The best diuretic is organic cranberry juice. NOT $40.00 herbs and teas. Toxins are stored in your fatty tissues which is actually your skin. Drinking water and sweating is the only way to get clean or lower your drug metabolic count making it easier to mask what toxins are left. Especially for those with high toxin levels and THC users. How fast you get clean depends on your fatty tissue count, speed of your metabolism, strength and amount of toxins ingested and for how long the toxins were ingested.
Hair leaves the best trail or track, but hair drug test will only go back as long as your hair is. Let me explain; hair grows at about 1/64 inch per day. So if you have two inches of hair you will have approximately a 128 day history. You can not test what is not there. You can only go back 6 to 8 months if your hair is that long. NOW. Many companies say they will CLEAN your hair. WRONG!! For a simple example, consider hair to be like a plant. If that plant is grown in a toxic environment it will grow with this toxin or toxins as part of its molecular structure and makeup. You CAN NOT change what it is made of and you CAN NOT remove or clean a portion of this molecular structure which would be the toxins it is made of. YOU CAN ONLY SOAK AND MASK. Some companies also say they can clean your hair forever. WRONG. Your skin which is actually your fatty tissue is where most toxins are stored. When your body gives of skin oil or sweat your are releasing toxins that will touch and be absorbed back into your hair. Now you are toxic again. Also you must be very careful after masking toxins in your hair that you do not contaminate your hair before the test. DO NOT use a comb, brush or towel that has not been thoroughly cleaned with hot water, soap and bleach. Especially if it is THC or nicotine as they are oil based toxins. Also do not apply any hair gels or hair spray and do not blow dry. This will weaken the treatment. Hair drug test shampoo treatments should not cost more than about $40.00 per treatment.
EXTRA! EXTRA! READ ALL ABOUT IT--- KNOW THE TRUTH. INFORM YOUR COUNSELOR BEFORE YOU ARE GIVEN A DRUG TEST OF WHAT DRUGS YOU ARE TAKING -- BOTH PRESCRIPTION AND OVER-THE-COUNTER MEDICATIONS.
Acccording to a report by The Los Angeles Times News Service,a study of 161 prescription and over-the-counter medications showed that 65 of them produced false positive results in the most widely administered urine tests. Ronald Siegel,a psycho-pharmacologist at UCLA said,"The widespread testing and reliance on tell-tale drugs is simply a panic reaction invoked because the normal techniques for controlling drug use haven't worked very well." The next epidemic will be trusting abuse.
Byrd Labs has in its possession an internal document from the Syva Company, makers of the widely used EMIT test. This document, leaked by a disillusioned company em- ployee lists more than 250 over-the-counter nedications that can cause false positives --- (this is only a partial listing).
*****Pain relievers such as Advil®,Nuprin®,Motrin® and menstrual cramp medications like Midol® and Trendar®. All drugs containing the widely used pain reliever,ibuprofen, are known to cause positive samples for Marijuana. Non-steroidal anti-inflammatories like Naproxyn has cross-reacted in blind tests. These are often prescribed for runners, sport injuries to joints,and those suffering from Arthritis.
Syva labs has recently reworked its Cannabanoid test and claims to have eliminated this problem. But a Science Magazine article (July 8,1988) lists ibuprofen across-reactive. Under the new government guidelines THC testing levels will be reduced 50 nanograms Many more THC false positives can be expected.
*****Dristan Nasal Spray, Neosynephrine, Vicks Nasal Spray,Sudafed and others containing ephedrine or phenylpropanolamine. Over the counter appetite suppressants which propranolamine. Most common nasal decongestant can cause a reading for amphetamines; amphetamine false positives are the most common. Recent articles in the Journal of Clinical Chemistry, Vol.38,No.12,1992 and Vol 39, No.3,1993 warn that medications contaning chlopromazine, fluspirilene and others may yield a positive result when tested for ampheta-mines.
*****Vicks Formula 44M containing Dextromethorphan,and Primatene -M containing pyrilamine as well as the pain reliever Demerol,and prescription anti-depressant Elavil® test positive for opiates up to three days. Even quinine water can also cause a positive reading.
*****Poppy Seeds such as on the Burger King roll, on a bagel from your favorite deli, etc. The journal of Clinical Chemistry Vol. 33 No. 6, 1987 reports: "the quantities of poppy seed ingested in this study (25 and 40 g) may be expected to be contained in one or two servings of poppy seed cake. therefore, poppy seeds represent a potentially serious source of falsely positive results in testing opiate abuse." Clinical Chemistry goes on to conclude: Not only is it difficult to distinguish heroin or morphine abuse from codeine, but dietary poppy seeds can give a strong positive result for urinary opiate of several days duration that is confirmed by GC/MS analysis".
• Nyquil Nighttime Cold Medicine will test positive for Methadone up to two days.
• Antibiotics. Certain newly developed antibiotics have cause positive samples urine tests. Ampicillin is suspect. Amoxicillin has caused positives for cocaine.
•Diazepam found in Valium, tests positive for PCP as well as the ingredient in some cough medicines, Dextromethorophan.
• Your own enzymes. A small fraction of the population have excrete large amounts of certain enzymes in their urine which can produce a positive drug test. Dr. John Morgan of the Dept. of Pharmacology of New York City Univ. write: "A false positive test could occur in some individuals because they excrete unusually large amounts of endogenous lysozyme or malate dehydrogenase." Dr. Morgan judges that natural enzyme interference may run as high as 10% of positive samples.
• Black Skin. This is not a joke! Those of African origin, certain Orientals, or pacific Islanders might test positive for marijuana. Dr. James Woodford, a toxicologist associated with Emory University labs hypothesized pigment melanin which protects the skin from the sun, approximates the molecular structure of the THC metabolite to cross react on the marijuana urine test. Dark skinned Caucasians such as those from the sub-continent of India could also read positive on the marijuana test. The body eliminates some melanin in a dark person's urine sample.
• Passive marijuana inhalation. If you attend a rock concert or ride in a car where marijuana is smoked nearby, even if you do not partake, the second hand marijuana that you might inhale can give your test a positive result for several days.
|""Most drug offenders are white. Five times as many whites use drugs as blacks. Yet blacks comprise the great majority of drug offenders sent to prison.The solution to this racial inequity is not to incarcerate more whites, but to reduce the use of prison for low-level drug offenders and to increase the availability of substance abuse treatment. " Source: Human Rights Watch, Racial Disparities in the War on Drugs. |
Are Urine Toxicology Tests Accurate? Can False Positives Occur?
| Antibiotics cause |
alse Positives on
Heroin Test !
ANTIBIOTICS CAUSE FALSE POSITIVES ON HEROIN TEST.
In a Journal of the American Medical Association article (JAMA 2001;286:3115-3119)Caution Re: Interpretation of Urine Toxicology (Dec 2001) and in an article also covered in a Reuters news wire piece on 25 Dec 2001, the headline says it all: Excerpts of this report follow:
Researchers of Harvard Medical School came across a patient in their practice who tested positive for opiates, and who was also taking an antibiotic called levofloxacin. “The patient was nearly kicked out from a drug treatment center because of the result, which later proved to be false.”
Two antibiotics, levofloxacin and ofloxacin, caused a strong positive result on four of the five tests. Most of the other antibiotics also caused a positive result on at least two or three of the five tests. For example, Cipro, the drug given to thousands of people to fight possible anthrax exposure, resulted in a positive test in one out of the five tests.
In their study, Baden and colleagues tested 13 different types of antibiotics, including levofloxacin and Cipro, all belonging to a class of chemicals called quinolones, to see what effect they would have on commercial opiate tests. They diluted the antibiotics to concentrations that would be expected to occur in urine and then tested the antibiotic samples.
According to Baden, it is possible that people have suffered consequences of a false positive test, because "a positive drug test is often assumed true, while the protestations of the person being tested are looked at as self-serving."
It is rarely, if ever, appropriate to place reliance on ANY laboratory test without clinical findings that support it. Lab tests serve only 2 purposes: to assist in diagnosis by confirming a clinical impression and/or narrow down the pathophysiology that causes it, OR as a screening tool suggesting that there MAY be a problem that requires further clinical assessment.
In any event, while common practice, it is difficult to comprehend the logic in “kicking out” patients from a medical program for the sole reason that they demonstrate the signs and symptoms of the condition being treated.
Urine tests are unreliable. The public is told that they are scientific. But in operation they can't stand up to scrutiny. Don't trust their results.
A test of the testers conducted by the government's Center for Disease Control in Atlanta found: "...one of thirteen labs given cocaine-spiked urine gave totally correct results. Five of thirteen failed to find the drug in any of 34 spiked samples that each lab received. On the other hand, the labs somehow detected cocaine in as many as 6%, and amphetamines in up to 37% of urine specimens that were 'blank' - those containing no drugs at all."
In the April 26, 1985 edition of the Journal of the American Medical Association, Dr. Hugh Hansen reported shocking results from blind tests conducted for the Center for Disease Control and the National Institute on Drug Abuse. By sending in blind samples spiked with drugs the following results were obtained from samples sent to thirteen labs. FALSE NEGATIVES: Barbiturates best lab 11% error rate, worst lab 94% error rate. Amphetamines 19% to 100%. Methadone 0% to 33%. Cocaine 0% to 100%. Codeine 0% to 100%. Morphine false negative error rate ranged from 0% to 100%.
The range of FALSE POSITIVE error rates were: Barbiturates 0% to 6%. Amphetamines 0% to 37%. Methadone 0% to 66%. Cocaine 0% to 6%. Codeine 0% to 7%. Morphine 0% to 10%. An official for the Center for Disease Control commented, "If these labs dumped the samples down the sink or tossed a coin, they would have come up with the same reliability in their test results." In the May 1987 edition of Laboratory Medicine, Dr. T.P. Moyer of the Mayo Clinic concluded in testing for marijuana on the EMIT test, 15% of the positives would be false.
Who would be more sensitive to drug testing errors than physicians? In the August 22, 1990 volume of the Journal of the American Medical Association, Dr. David Orentlicher draws a distinction between impairment and positive drug tests results. He writes: "It is not clear, however, that adequate justification exists for the use of random urine testing to detect physician impairment from drugs of abuse. ..there may be only a weak correlation between positive urine tests and impairment by drugs."
The November 1992 issue of the Archives of Internal Medicine, printed this surprising result. In a survey of 272 Michigan doctors 38 per cent said they didn't believe drug tests were accurate.
Urine testing is less accurate that the lie detector tests that have been banned from the work place. Employers who rush into urine testing, wouldn't dream of giving every worker a lie detector test. Dr. David Greenblatt, Chief of clinical pharmacology at Tufts medical center called the most widely used tests "essentially worthless."
Because many employers do not want to pay the $100 plus lab price for the sophisticated confirmation tests, many falsely accused people are fired, or never hired, rather than retested. BEWARE ! New job applicants are usually given the EMIT(r) test, with no follow up. If you fail, you're not informed. You're are just not hired.
The most basic rule if you take a urine test and it comes back positive is to admit nothing. The prudent person, whatever the circumstances, should insist that a positive test result is impossible.
An employer should be asked the following questions with the clear understanding that if the matter is not dropped and the results expunged from your employment file that you will proceed to exercise your legal rights.
Pertinent questions include: What test was I given? By whom? Was your test sent to another lab? How much time elapsed between the taking of the sample and the test? Could you have a copy of the "chain of custody" - those who had control of your sample at all times? What precautions were taken to insure that you weren't a victim of false positive results? What confirmatory test was taken? By whom?
Remember, if you are a victim of false test results and you lose your job, you may have a million dollar liability suit. Given the information in this pamphlet, what do you think a reasonable jury would decide if you lost your job, your reputation, your standing in your community, because you were forced to take a urine drug test which your employer and testing laboratory knew to be inaccurate? Over the next few years, damage verdicts against employers and laboratories will probably do more than anything else to stop dragnet approach to drug testing.
U.S. District Judge A.J. McNamara of New Orleans forced the Southern Pacific Railroad to stop testing when the company was caught using a video camera. Judge McNamara wrote this is absolutely outrageous conduct when employees are forced to urinate under the direct observation of a camera."
In an important test case, Plainfield, New Jersey officials arrived at a city firehouse at 6:30 AM, locked the doors and urine tested the firefighters. Sixteen of 103 firefighters tested positive, were terminated and criminal charges were filed against them. In the subsequent trial before US District Judge H. Lee Sarokin, the firefighters were reinstated with back pay. Judge Sarokin wrote in his decision:
"The sweeping manner in which the officials set about to accomplish their goals violated the firefighters individual liberties. ..The City of Plainfield essentially presumed the guilt of each person tested."
"If we choose to violate the rights of the innocent in order to discover and act against the guilty, then we have transformed our country into a police state and abandoned one of the fundamental tenets of a free society. In order to win the war on drugs, we must not sacrifice the life of the constitution in the battle."
Don't be a screw-up! Ask questions if yours cones back positive! What test was I given? My guess is Emit (r) which is only a drug screen. By Whom? How much time elapsed between the taking of the sample and the test? Could you have a copy of the chain of custody? What precautions were taken to insure you weren't a victim of false positive results? What confirmatory test was taken? By Whom? Exercise your rights -- you have a right to these answers. If you seriously want to know more-- and become wiser -continue to read. Knowledge is power.
By: Jeffrey Nightbyrd
Modified: July 2, 2005