Method Comparison of the Ortho Vitros Fusion 5,1 Chemistry Analyzer and the Roche COBAS Integra 400 for Urine Drug Screen Testing in the Emergency Department

A sixty-eight-year-old male with a past medical history of recurrent cocaine use presented to the emergency department with recurrent diarrhea and was found to have a white blood cell (WBC) count of 1.9 × 109/L with agranulocytosis (absolute neutrophil count (ANC) of 95 cell/mm3). At admission, the patient disclosed that he used cocaine earlier during the day, and a urine drug screen tested positive for this. On hospital day one, the patient was found to have a fever with a maximum temperature of 313.6 K. After ruling out other causes and noting the quick turnaround of his neutropenia after four days of cocaine abstinence, the patient’s neutropenia was attributed to levamisole-adulterated cocaine.

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Does the U Stand for Useless? The Urine Drug Screen and Emergency Department Psychiatric Patients

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2017.12.054 ◽

2018 ◽

Vol 54 (4) ◽

pp. 500-506 ◽

Cited By ~ 5

Author(s):

Steven T. Riccoboni ◽

Michael A. Darracq

Keyword(s):

Emergency Department ◽

Psychiatric Patients ◽

Drug Screen ◽

Urine Drug Screen ◽

Urine Drug

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Urine drug screen trends from 1998 through 2011 among emergency department patients treated in a University Teaching Hospital

Toxicology Communications ◽

10.1080/24734306.2018.1468539 ◽

2018 ◽

Vol 2 (1) ◽

pp. 24-34

Author(s):

Nadejda Korneeva ◽

Urska Cvek ◽

Anna Leskova ◽

Kimberley Hutchinson ◽

Avery Callahan ◽

...

Keyword(s):

Emergency Department ◽

Teaching Hospital ◽

University Teaching ◽

Drug Screen ◽

Urine Drug Screen ◽

Urine Drug ◽

Emergency Department Patients

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Reduced Interference by Phenothiazines in Amphetamine Drug of Abuse Immunoassays

Archives of Pathology & Laboratory Medicine ◽

10.5858/2006-130-1834-ribpia ◽

2006 ◽

Vol 130 (12) ◽

pp. 1834-1838

Author(s):

Stacy E. F. Melanson ◽

Elizabeth Lee-Lewandrowski ◽

David A. Griggs ◽

William H. Long ◽

James G. Flood

Keyword(s):

Emergency Department ◽

False Positive ◽

Massachusetts General Hospital ◽

Parent Compound ◽

Drug Screen ◽

Urine Drug Screen ◽

Drug Of Abuse ◽

Positive Urine ◽

Urine Drug ◽

Positive Results

Abstract Context.—Emergency department physicians frequently request urine drug screens, but many are unaware of their limitations, including the potential for false-positive results. Promethazine, a phenothiazine derivative, is used for the treatment of allergies, agitation, nausea, and vomiting. Many patients taking promethazine are subject to urine drug screens and any potential interferences are important to recognize. Design.—During an 11-month period, all patients presenting to the Massachusetts General Hospital emergency department who had a finding of promethazine in their serum drug screen, and who also had a urine drug screen performed, were selected for inclusion in the study. The urine drug screen results (n = 22 patients/samples) were then studied. Objective.—To determine if promethazine use can cause false-positive urine amphetamine results in widely used drug of abuse immunoassays. Results.—Thirty-six percent of patients taking promethazine had false-positive test results for urine amphetamines using the EMIT II Plus Monoclonal Amphetamine/Methamphetamine Immunoassay. Sixty-four percent of patients showed cross-reactivity greater than 20% higher than the blank calibrator rate. In a separate, related study, no promethazine-induced false-positive results were seen with the EMIT II Plus, Triage, and TesTcard 9 amphetamine assays, or the Triage methamphetamine assay. Reduced chlorpromazine interference was also seen with these other assays. Conclusions.—False-positive urine amphetamine results can be obtained in patients taking promethazine. Promethazine metabolite(s), and not the parent compound, are the likely cause of these urine false-positive results obtained with EMIT II Plus Monoclonal Amphetamine/Methamphetamine Immunoassay. Immunoassays from different manufacturers can have very different “interference” profiles, which the pathologist and laboratory scientist must understand and relay to clinicians.

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216 Does the U Stand For Useless? Urine Drug Screen and Emergency Department Psychiatric Patients

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2016.08.230 ◽

2016 ◽

Vol 68 (4) ◽

pp. S84-S85

Author(s):

S.T. Riccoboni ◽

M.A. Darracq

Keyword(s):

Emergency Department ◽

Psychiatric Patients ◽

Drug Screen ◽

Urine Drug Screen ◽

Urine Drug

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Evaluation of an opioid risk mitigation initiative for veterans undergoing hip or knee arthroplasty at San Francisco Veterans Affairs Heath Care System

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa406 ◽

2020 ◽

Author(s):

Tessa Rife ◽

Christina Tat ◽

Mahsa Malakootian

Keyword(s):

San Francisco ◽

Knee Arthroplasty ◽

Risk Mitigation ◽

Opioid Therapy ◽

Veterans Affairs ◽

Drug Screen ◽

Urine Drug Screen ◽

Urine Drug ◽

Medication Disposal ◽

Urine Drug Screening

Abstract Purpose Guidelines recommend evaluating the risk of opioid-related adverse events prior to initiating opioid therapy. The orthopedic service at San Francisco Veterans Affairs Health Care System (SFVHCS) has not routinely used risk assessment tools such as the Stratification Tool for Opioid Risk Mitigation, prescription drug monitoring program data, and urine drug screening prior to opioid prescribing. A quality improvement project was conducted to evaluate the number of pharmacist-provided opioid risk mitigation recommendations implemented by orthopedic providers for patients who underwent total hip or knee arthroplasty at SFVHCS. Summary A pharmacist-led workflow for completing risk mitigation reviews was developed in collaboration with orthopedic providers, and urine drug screening was added to the preoperative laboratory testing protocol. The following recommendations were communicated via electronic medical record: limit postoperative opioids to a 7- or 14-day supply based on risk of suicide and/or overdose, offer naloxone and a medication disposal bag, and order a urine drug screen if not already completed. Risk reviews were completed for 75 patients. Among 64 patients with 2-month postdischarge data available, 88% (7 of 8) of 7-day and 79% (44 of 56) of 14-day opioid supply recommendations were implemented; 41% (26 of 59) of recommendations to issue a medication disposal bag, 17% (2 of 12) recommendations to order a missing urine drug screen, and 9% (5 of 55) of recommendations to offer naloxone were implemented. Conclusion Pharmacist-performed risk mitigation reviews paired with individualized recommendations led to high rates of orthopedic provider acceptance of limiting postdischarge opioid day supplies for patients who had total hip or knee arthroplasty. Alternative strategies may increase access to naloxone. Future research should examine the impact of risk mitigation tools in reducing prescribing of long-term opioid therapy and adverse events among orthopedic surgical patients.

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