Drug Enforcement Association. Narcotics Opioids. Hydrocodone and Acetaminophen Overdose. Updated October 8, Hydrocodone Combination Products. Updated September 28, Acetaminophen overdose. Forensic Sci Rev. American Addiction Centers. Updated October 19, Vicodin Withdrawal Timeline, Symptoms and Treatment. Updated April 17, Rzasa lynn R, Galinkin JL. Naloxone dosage for opioid reversal: current evidence and clinical implications. Ther Adv Drug Saf. Your Privacy Rights. To change or withdraw your consent choices for VerywellMind.
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We and our partners process data to: Actively scan device characteristics for identification. I Accept Show Purposes. Understanding Opioid Overdoses. Was this page helpful? Thanks for your feedback! Sign Up. What are your concerns? Many substances that are prescribed for pain management and other legitimate indications are found to be taken incorrectly either inadvertently or purposefully , shared, sold, or otherwise misdirected.
In addition, many substances are available for illicit use, including prescription substances eg, opioids, Adderall, Xanax and nonprescription drugs eg, heroin, methamphetamines. To ensure safe and effective therapy, current practice guidelines recommend monitoring patients for adherence to prescribed medications and abstinence from nonprescribed drugs through periodic drug tests.
However, drug testing strategies and testing methods are not standardized, which adds challenges to the selection of the right test, collection of the appropriate specimen, and interpretation of test results.
Urine is preferred because its collection is noninvasive and inexpensive, and drugs and their metabolites tend to concentrate in the urine over time. Saliva oral fluid is also noninvasive to collect but is associated with higher costs.
Drug concentrations and the time course for detection in saliva more closely approximate concentrations and the detection window in blood than in urine. However, not all drugs are detectable in saliva, and both urine and saliva are susceptible to adulteration or substitution by the donor. Blood serum or plasma is the preferred specimen for correlating signs and symptoms with drug concentrations in a real-time acute setting.
Blood collection is an observed procedure, which lowers the likelihood of specimen adulteration or substitution. A confirmation test should be considered when a screen result is inconsistent with the expectation eg, patient history and when that result will impact patient care decisions.
If screen results match expectations, it is not necessary to confirm results positive or negative or to perform other, secondary testing. Confirmation testing should also be considered if quantitative results are required to interpret the result.
Most confirmation tests produce quantitative results, which are useful when evaluating abnormal patterns of results eg, no metabolites present, an unexpected pattern of metabolites , or to verify elimination kinetics. Most drugs are detected in urine for hours after the last use. Some drugs are detected for shorter durations eg, methylphenidate, some benzodiazepines and others for much longer eg, methadone, marijuana.
Contact the laboratory for estimates on detection periods for a specific drug, or consult the Drug Plasma Half-Life and Urine Detection Window chart.
Quantitative urine THC metabolite testing may help with the interpretation of an unexpected positive cannabis IA. Creatinine normalization may be useful to evaluate whether a patient has abstained from new use of marijuana.
If a patient has abstained from new use of marijuana, the concentrations in urine of the creatinine-normalized deltatetrahydrocannabinol THC metabolite, THC acid THCA , should decrease over time.
To demonstrate elimination of THCA decreasing concentration or new use of marijuana increasing concentration of THCA , an appropriate testing interval is no more than once per week. To determine a creatinine-normalized THC concentration, creatinine testing should be ordered or performed at the same time a urine specimen is collected for THC testing. It is best if the same creatinine and THC methods are utilized for serial samples collected from the same patient.
To calculate a normalized concentration, use the following formula:. It is important to investigate the active components of any drug that a patient is prescribed or has otherwise been administered when interpreting a positive drug test. There are dozens of different trade names and formulations of popular drugs that may contribute legitimately to a positive drug test. There are also some drugs that are recognized to cause analytical interference and may contribute to a false-positive drug test.
For example, cyclobenzaprine can cause false-positive results in tricyclic antidepressant immunoassay IA screens, and phentermine can cause false-positive results in amphetamine IA screens refer to the table, Compounds That May Produce False-Positive IA Screen Results , for more examples. Poppy seeds contain morphine and codeine. Ingesting large amounts of poppy seeds or products that contain poppy seeds eg, cake, bagels, salad dressing can cause a positive urine opiate test result.
Patients should abstain from consuming poppy seeds for 3 days prior to a urine drug test. Positive results would also be expected with other matrices eg, blood after poppy seed consumption.
There are, however, subtle but important differences between them. Note that opiates are also opioids. Examples include hydrocodone, oxycodone, and methadone. The interpretation of results may be complicated by several factors, including timing of sample collection and drug impurities. For more information about these challenges or for assistance with result interpretation, consider the following resources:. Refer to the ARUP Drug Plasma Half-Life and Urine Detection Window chart for specific testing information, including plasma half-life, urine detection windows, drug metabolites, and common trade and street names.
Urine and blood specimen serum or plasma tests are available to detect most drugs commonly prescribed for pain management and other legitimate indications, as well as many illicit substances. Urine is typically preferred for adherence and drug exposure testing; serum or plasma is an acceptable alternative. There is no evidence that drug testing in alternate specimens eg, hair, saliva is more effective than urine testing for monitoring adherence, such as in the management of patients with chronic noncancer pain CNCP.
Typically preferred matrix for adherence and drug exposure testing. High risk of adulteration of sample by patient to avoid detection of noncompliance. Observed specimen collection generally not performed. Dilution varies as indicated by creatinine concentrations , making false-negative results possible. Concentration and time course for detection in saliva more closely approximate concentrations and detection window in blood an advantage over urine testing.
Limited number of drugs detectable in saliva eg, most opioids and amphetamines are observed in saliva, but most benzodiazepines are not. Specimens should be collected for drug testing based on the clinical scenario and routine practices. For example, specimens may be collected for testing when qualifying patients for chronic therapy with opioids or other controlled substances, enrolling patients in substance misuse disorder programs, in situations when aberrant drug behavior is suspected, and in patients who are pregnant.
This testing is intended to confirm the presence of prescribed medications that are detected by the test and to detect the presence of illicit and nonprescribed drugs. Testing approaches are unique in terms of performance characteristics, and the best strategy for testing should align with the goals of testing. Test choices include screen only, screen and definitive confirmation for positive results , and direct, definitive, targeted testing.
The last is typically performed using mass spectrometry MS technology and may be quantitative or qualitative. Initial drug testing methodologies include point-of-care POC screening devices eg, urine cups , laboratory immunoassays IAs , and MS technologies.
Screening by IA is a common methodology for detecting drug presence and may be qualitative or semiquantitative. IAs have several advantages as first-line screening tests, including ease of use, fast turnaround time, and lower costs; however, IAs can produce false-positive and false-negative results. Most available IAs do not readily detect semisynthetic opioids oxycodone, hydrocodone, and their metabolites and synthetic opioids eg, fentanyl, methadone, meperidine, tramadol.
ARUP also offers separate IA screens for synthetic opioids eg, fentanyl, methadone, tramadol, meperidine, tapentadol and semisynthetic opioids eg, buprenorphine. Most benzodiazepines are metabolized and conjugated before elimination through urine.
Most IAs would not detect designer benzodiazepines. Urine IAs are designed to detect the d-isomer psychoactive compound of amphetamine and methamphetamine.
The IA for amphetamines and methamphetamines also often produces high false-positive result rates. Many different compounds can contribute to false-positive immunoassay screen results. The table below provides examples. First-line definitive testing qualitative or quantitative is preferred for monitoring the use of relevant over-the-counter medications, prescribed and nonprescribed drugs, and illicit substances, when the service requirements for testing are well aligned with clinical needs.
Targeted tests for specific drugs or drug classes are available as individually orderable tests that are useful for confirming results obtained at the client site or when only select drugs or drug classes are of interest. Quantitative definitive urine testing is not more useful at detecting outcomes in a clinical context compared with qualitative definitive urine testing; quantitative definitive urine testing should not be used to evaluate dosage of administered drug or adherence to a prescribed dosage regimen.
Benzodiazepines, Urine, Quantitative Alprazolam, alpha-hydroxyalprazolam, chlordiazepoxide, clonazepam, 7-aminoclonazepam, diazepam, lorazepam, midazolam, alpha-hydroxymidazolam, nordiazepam, oxazepam, temazepam. Buprenorphine and Metabolites, Urine, Quantitative Buprenorphine, norbuprenorphine, buprenorphine glucuronide, norbuprenorphine glucuronide, naloxone.
Carisoprodol and Meprobamate, Urine, Quantitative Cocaine Metabolite, Urine, Quantitative Fentanyl and Metabolite, Urine, Quantitative Meperidine and Metabolite Quantitative, Urine Methadone and Metabolite, Urine, Quantitative Legal or forensic purposes.
Testing may be part of a criminal or motor vehicle accident investigation. Drug screening may also be ordered as part of a court case. Why do I need opioid testing?
Symptoms may start as lifestyle changes, such as: Lack of hygiene Isolation from family and friends Stealing from family, friends, or businesses Financial difficulties If opioid abuse continues, physical symptoms may include: Slowed or slurred speech Difficulty breathing Dilated or small pupils Delirium Nausea and vomiting Drowsiness Agitation Changes in blood pressure or heart rhythm.
What happens during an opioid test? During a clean catch urine test, you will: Wash your hands Clean your genital area with a cleansing pad given to you by your provider. Men should wipe the tip of their penis. Women should open their labia and clean from front to back. Start to urinate into the toilet. Move the collection container under your urine stream. Pass at least an ounce or two of urine into the container, which should have markings to indicate the amounts.
Finish urinating into the toilet. Return the sample container to the lab technician or health care provider. Other opioid tests require you to give samples of your blood or saliva. During a saliva test: A health care provider will use a swab or absorbent pad to collect saliva from the inside of your cheek.
The swab or pad will stay in your cheek for a few minutes to allow saliva to build up. Some providers may ask you to spit into a tube, rather than swabbing inside your cheek. Will I need to do anything to prepare for the test?
Are there any risks to the test? What do the results mean? Is there anything else I need to know about opioid testing? Treatments for anyone who is abusing opioids may include: Medicines Rehabilitation programs on an inpatient or outpatient basis Ongoing psychological counseling Support groups. Atlanta: U. Baltimore: The Johns Hopkins University; c Signs of Opioid Abuse; [cited Apr 16]; [about 2 screens].
Treating Opioid Addiction; [cited Apr 16]; [about 2 screens]. Washington D. C: American Association for Clinical Chemistry; c— Drug Abuse Testing; [updated Jan 16; cited Apr 16]; [about 2 screens]. Opioid Testing; [updated Dec 18; cited Apr 16]; [about 2 screens]. Mayo Foundation for Medical Education and Research; c— How opioid addiction occurs; Feb 16 [cited Apr 16]; [about 3 screens].
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