Buprenorphine not detected on urine drug screening in supervised treatment

2021 ◽  
Vol 17 (7) ◽  
pp. 69-76
Author(s):  
Nazila Jamshidi, MBBS, FRACP, FAChAM, BPharm (hons), PhD ◽  
Akshay Athavale, MBBS, FRACP, BPharm (hons), MMed ◽  
Bridin Murnion, MBChB, FRACP, FFPMANZCA, FAChAM
Keyword(s):  
Cytochrome P450 ◽  
Child Protection ◽  
Drug Testing ◽  
Addiction Treatment ◽  
Clinical Decision ◽  
Gas Chromatography Mass Spectrometry ◽  
Cytochrome P450 3A4 ◽  
Opioid Agonist ◽  
Detection Rates ◽  
Urine Drug

Introduction: Urine drug screens (UDS) assist in clinical planning and assessment of adherence in opioid agonist treatment (OAT). Urine drug screens may also be used in criminal justice and child protection settings. Buprenorphine (BPN) UDS testing is complex. Immunoassay often does not detect BPN and gas chromatography-mass spectrometry (GC-MS) is needed. A limited understanding of testing can negatively influence UDS interpretation and clinical decision making.Objectives: The primary aim was to determine detection rates of BPN in UDS in participants on BPN or buprenorphine/naloxone (BNX) treatment. The secondary aim was to identify if comorbidities, sex, co-prescribed medications, or dosing site and observation were associated with BPN detection.Setting: Public outpatient clinic in a specialist addiction treatment service.Design/participants: In this retrospective observational study, records of clients on supervised BPN/BNX treatment between September 2017 and 2018 were reviewed.Measures: Data extracted included UDS results, age, sex, indication for BPN, frequency of observed doses, dose of BPN, dosing site, co-morbid medical conditions, and medications.Results: One hundred and sixty-one medical records were reviewed. Ninety-seven (60 percent) underwent screening urine immunoassay. Of these 97, 51 (53 percent) had further GC-MS testing for BPN of which 22 (43 percent) did not detect BPN despite directly observed OAT. Co-prescription of medications known to interact with cytochrome P450 3A4 was associated with nondetection of BPN (p 0.05). No significant association between median dose, dosing site, and observed dosing and BPN detection was identified.Conclusion: Urine drug testing for BPN is complex. Failure to detect BPN does not betoken nonadherence to treatment and is associated with co-prescription of drugs interacting with cytochrome P450 3A4.

A Prediction Model for Positive Infant Meconium and Urine Drug Tests

2020 ◽  
Author(s):  
Elizabeth A. Simpson ◽  
David A. Skoglund ◽  
Sarah E. Stone ◽  
Ashley K. Sherman
Keyword(s):  
Prediction Model ◽  
Drug Testing ◽  
Clinical Decision Making ◽  
Drugs Of Abuse ◽  
Clinical Decision ◽  
P Value ◽  
Test Characteristics ◽  
Drug Test ◽  
Urine Drug ◽  
Urine Drug Test

Objective This study aimed to determine the factors associated with positive infant drug screen and create a shortened screen and a prediction model. Study Design This is a retrospective cohort study of all infants who were tested for drugs of abuse from May 2012 through May 2014. The primary outcome was positive infant urine or meconium drug test. Multivariable logistic regression was used to identify independent risk factors. A combined screen was created, and test characteristics were analyzed. Results Among the 3,861 live births, a total of 804 infants underwent drug tests. Variables associated with having a positive infant test were (1) positive maternal urine test, (2) substance use during pregnancy, (3) ≤ one prenatal visit, and (4) remote substance abuse; each p-value was less than 0.0001. A model with an indicator for having at least one of these four predictors had a sensitivity of 94% and a specificity of 69%. Application of this screen to our population would have decreased drug testing by 57%. No infants had a positive urine drug test when their mother's urine drug test was negative. Conclusion This simplified screen can guide clinical decision making for determining which infants should undergo drug testing. Infant urine drug tests may not be needed when a maternal drug test result is negative. Key Points

Analytical and technical aspects of testing for drug abuse: confirmatory procedures.

1988 ◽  
Vol 34 (3) ◽  
pp. 471-473 ◽  
Author(s):  
M A Peat
Keyword(s):  
Drug Testing ◽  
Analytical Procedure ◽  
Gas Chromatography Mass Spectrometry ◽  
Technical Aspects ◽  
Governmental Agencies ◽  
Accuracy And Precision ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Chemical Technique ◽  
Layer Chromatography

Abstract Many laboratories are now performing urine drug testing for employers, governmental agencies, and other institutions. It is now recognized that presumptive positive screening results have to be confirmed by an analytical procedure based on a different chemical technique with greater than or equal sensitivity to the screening test. Thin-layer chromatography has been widely used for this; however, it is relatively insensitive for certain drugs, and it cannot satisfy the accuracy and precision requirements needed to determine threshold concentrations reliably. Gas chromatography-mass spectrometry is able to satisfy these threshold requirements and has become the method of choice for confirming initial immunoassay results.

scholarly journals Adulteration of Urine by “Urine Luck”

1999 ◽  
Vol 45 (7) ◽  
pp. 1051-1057 ◽  
Author(s):  
Alan HB Wu ◽  
Ben Bristol ◽  
Karen Sexton ◽  
Gina Cassella-McLane ◽  
Verena Holtman ◽  
...  
Keyword(s):  
Drug Testing ◽  
Drugs Of Abuse ◽  
Spot Test ◽  
Gas Chromatography Mass Spectrometry ◽  
Pyridinium Chlorochromate ◽  
Urine Drug ◽  
Chain Of Custody ◽  
Drug Assays ◽  
Workplace Drug Testing

Abstract Background: In vitro adulterants are used to invalidate assays for urine drugs of abuse. The present study examined the effect of pyridinium chlorochromate (PCC) found in the product “Urine Luck”. Methods: PCC was prepared and added to positive urine controls at concentrations of 0, 10, 50, and 100 g/L. The controls were assayed for methamphetamine, benzoylecgonine (BE), codeine and morphine, tetrahydrocannabinol (THC), and phencyclidine (PCP) with the Emit II (Syva) and Abuscreen Online (Roche) immunoassays, and by gas chromatography/mass spectrometry (GC/MS). Two tests were also developed to detect PCC in urine: a spot test to detect chromate ions using 10 g/L 1,5-diphenylcarbazide as the indicator, and a GC/MS assay for pyridine. We tested 150 samples submitted for routine urinalysis, compliance, and workplace drug testing for PCC, using these assays. Results: Response rates decreased at 100 g/L PCC for all Emit II drug assays and for the Abuscreen morphine and THC assays. In contrast, the Abuscreen amphetamine assay produced apparently higher results, and no effect was seen on the results for BE or PCP. The PCC did not affect the GC/MS recovery of methamphetamine, BE, PCP, or their deuterated internal standards, but decreased GC/MS recovery of the opiates at both intermediate (50 g/L) and high (100 g/L) PCC concentrations and apparent concentrations of THC and THC-d3 at all PCC concentrations. Two of 50 samples submitted for workplace drug testing under chain-of-custody conditions were positive for PCC, whereas none of the remaining 100 specimens submitted for routine urinalysis or compliance drug testing were positive. Conclusions: PCC is an effective adulterant for urine drug testing of THC and opiates. Identification of PCC use can be accomplished with use of a spot test for the oxidant.

Trends in drug use from urine drug testing of addiction treatment clients

2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Kenneth L. Kirsh, PhD ◽  
Howard A. Heit, MD ◽  
Angela Huskey, PharmD, CPE ◽  
Jennifer Strickland, PharmD, BCPS ◽  
Kathleen Egan City, MA, BSN, RN ◽  
...  
Keyword(s):  
Drug Use ◽  
Drug Testing ◽  
Addiction Treatment ◽  
National Laboratory ◽  
Prescription Medication ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Liquid Chromatography Tandem Mass ◽  
Testing Company ◽  
National Trends

Objective: Urine drug testing (UDT) can play an important role in the care of patients in recovery from addiction, and it has become necessary for providers and programs to utilize specific, accurate testing beyond what immunoassay (IA) provides.Design: A database of addiction treatment and recovery programs was sampled to demonstrate national trends in drug abuse and to explore potential clinical implications of differing results due to the type of testing utilized.Setting: Deidentified data was selected from a national laboratory testing company that had undergone liquid chromatography tandem mass spectrometry (LCMS/MS).Patients/Participants: A total of 4,299 samples were selected for study.Interventions: Descriptive statistics of the trends are presented. Results: In total, 48.5 percent (n = 2,082) of the samples were deemed in full agreement between the practice reports and the results of LC-MS/MS testing. The remaining 51.5 percent of samples fell into one of seven categories of unexpected results, with the most frequent being detection of an unreported prescription medication (n = 1,097).Conclusions: Results of UDT demonstrate that more than half of samples yield unexpected results from specimens collected in addiction treatment. When comparing results of IA and LC-MS/MS, it is important to consider the limits of IA in the detection of drug use by these patients.

FDA/DEA/PDMP/UDT: Alphabet soup or sensible and integrated risk management?

2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Steven D. Passik, PhD ◽  
Kenneth L. Kirsh, PhD ◽  
Robert K. Twillman, PhD
Keyword(s):  
Risk Management ◽  
Drug Testing ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Management Approach ◽  
Prescription Drug Monitoring Programs ◽  
Integrated Risk ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Liquid Chromatography Tandem Mass

Objective: Both prescription drug monitoring programs (PDMP) and urine drug testing (UDT) are recommended as parts of an ongoing risk management approach for controlled substance prescribing. The authors provide an editorial and commentary to discuss the unique contributions of each to promote better clinical decision making for prescribers.Design: A commentary is employed along with brief discussion comparing four states with an active PDMP in place to three states without an active PDMP as it relates back to findings on UDT in those states from a laboratory conducting liquid chromatography tandem mass spectrometry.Conclusions: The commentary focuses on the place of both tools (UDT and PDMP) in risk management efforts. The argument is made that relying on a PDMP alone would lead to clinical decisions that may miss a great deal of problematic or aberrant behaviors.

Lowering the federally mandated cannabinoid immunoassay cutoff increases true-positive results

1994 ◽  
Vol 40 (5) ◽  
pp. 729-733 ◽  
Author(s):  
M A Huestis ◽  
J M Mitchell ◽  
E J Cone
Keyword(s):  
Mass Spectrometry ◽  
Human Services ◽  
Drug Testing ◽  
Gas Chromatography Mass Spectrometry ◽  
True Positive ◽  
Health And Human Services ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Sensitivity Specificity ◽  
Positive Results

Abstract Proposed changes to the Health and Human Services Guidelines for forensic urine drug testing will lower the required cannabinoid immunoassay cutoff concentration from 100 to 50 micrograms/L. We investigated the effect of this change on the sensitivity, specificity, and efficiency of eight cannabinoid immunoassays: Syva Emit d.a.u. 100; Syva Emit II 100; Syva Emit d.a.u. 50; Syva Emit II 50; Roche Abuscreen Online; Roche Abuscreen radioimmunoassay; Diagnostic Reagents; and Abbott ADx. All specimens also were assayed by gas chromatography/mass spectrometry. Lowering the cutoff concentration from 100 to 50 micrograms/L increased efficiencies and sensitivities for all immunoassays, with minor decreases in specificity (1.0-2.6%). There was a 23.2-53.6% increase in the number of true-positive specimens identified. Thus, lowering the cannabinoid immunoassay cutoff concentration from 100 to 50 micrograms/L resulted in detection of a substantial number of additional true-positive specimens, with an accompanying small increase in unconfirmed positive results.

scholarly journals Mitotane Therapy in Adrenocortical Cancer Induces CYP3A4 and Inhibits 5α-Reductase, Explaining the Need for Personalized Glucocorticoid and Androgen Replacement

2013 ◽  
Vol 98 (1) ◽  
pp. 161-171 ◽  
Author(s):  
Vasileios Chortis ◽  
Angela E. Taylor ◽  
Petra Schneider ◽  
Jeremy W. Tomlinson ◽  
Beverly A. Hughes ◽  
...  
Keyword(s):  
Cytochrome P450 ◽  
Reductase Activity ◽  
Gas Chromatography Mass Spectrometry ◽  
Adrenal Tumors ◽  
Cytochrome P450 3A4 ◽  
Male Hypogonadism ◽  
Limited Information ◽  
Adjuvant Setting ◽  
Strong Inhibition ◽  
The Impact

Abstract Context: Mitotane [1-(2-chlorophenyl)-1-(4-chlorophenyl)-2,2-dichloroethane] is the first-line treatment for metastatic adrenocortical carcinoma (ACC) and is also regularly used in the adjuvant setting after presumed complete removal of the primary tumor. Mitotane is considered an adrenolytic substance, but there is limited information on distinct effects on steroidogenesis. However, adrenal insufficiency and male hypogonadism are widely recognized side effects of mitotane treatment. Objective: Our objective was to define the impact of mitotane treatment on in vivo steroidogenesis in patients with ACC. Setting and Design: At seven European specialist referral centers for adrenal tumors, we analyzed 24-h urine samples (n = 127) collected from patients with ACC before and during mitotane therapy in the adjuvant setting (n = 23) or for metastatic ACC (n = 104). Urinary steroid metabolite excretion was profiled by gas chromatography/mass spectrometry in comparison with healthy controls (n = 88). Results: We found a sharp increase in the excretion of 6β-hydroxycortisol over cortisol (P < 0.001), indicative of a strong induction of the major drug-metabolizing enzyme cytochrome P450 3A4. The contribution of 6β-hydroxycortisol to total glucocorticoid metabolites increased from 2% (median, interquartile range 1–4%) to 56% (39–71%) during mitotane treatment. Furthermore, we documented strong inhibition of systemic 5α-reductase activity, indicated by a significant decrease in 5α-reduced steroids, including 5α-tetrahydrocortisol, 5α-tetrahydrocorticosterone, and androsterone (all P < 0.001). The degree of inhibition was similar to that in patients with inactivating 5α-reductase type 2 mutations (n = 23) and patients receiving finasteride (n = 5), but cluster analysis of steroid data revealed a pattern of inhibition distinct from these two groups. Longitudinal data showed rapid onset and long-lasting duration of the observed effects. Conclusions: Cytochrome P450 3A4 induction by mitotane results in rapid inactivation of more than 50% of administered hydrocortisone, explaining the need for doubling hydrocortisone replacement in mitotane-treated patients. Strong inhibition of 5α-reductase activity is in line with the clinical observation of relative inefficiency of testosterone replacement in mitotane-treated men, calling for replacement by 5α-reduced androgens.

Forensic Testing for Drugs of Abuse

2000 ◽  
Vol 13 (3) ◽  
pp. 226-235 ◽  
Author(s):  
Peter D. Anderson ◽  
Kimmy Naik ◽  
Chenery Kinemond ◽  
Anne ImObersteg
Keyword(s):  
Drug Testing ◽  
Drugs Of Abuse ◽  
Drunk Driving ◽  
Gas Chromatography Mass Spectrometry ◽  
Confirmatory Test ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Chain Of Custody ◽  
Control Procedures ◽  
Forensic Testing

Forensic urine drug testing (FUDT) is a tool of many employers to assess drug use in employees. Collegiate and professional sports test for banned substances. Immunoassays are often the screening test. Gas chromatography/mass spectrometry is the confirmatory test. Numerous foods and medications interfere with test results. Safeguards in FUDT include chain of custody procedures, certification of laboratories and personnel, cutoff values, quality assurance and quality control procedures, and medical review officers. Breath analysis is used in drunk-driving cases. Blood and hair can also be analyzed for substances of abuse. Pharmacists can be an asset in drug testing issues.

Sign in / Sign up

Export Citation Format

Share Document