Clinical interpretation of urine drug tests: what clinicians need to know about urine drug screens. 2023 SingleCare Administrators. Heres what you should know if youre prescribed this antibiotic. Methamphetamine. If a patients clinical presentation is prematurely ascribed to a substance disorder, a medical workup may be less aggressively pursued, potentially forestalling the correct diagnosis and early treatment. But in rare cases, a few antibiotics are known to trigger inaccurate test results. Further confusing any clinician seeking answers from the literature is a 2006 article by Vincent et al8 that does not list sertraline as a potential agent that could cause a false-positive benzodiazepine screen. Drug tests vary, depending on the type of drug being tested for and the type of specimen being collected. Epub 2015 Nov 2. Nominate your favorite pharmacy staff for a Best of the Best award! Some popular over-the-counter allergy and sleep meds like Benadryl and Advil PM have diphenhydramine. Each drug varies in the amount of time it can be detected in the urine (Table 2).2 The detection time is primarily based on half-life and the presence of drug metabolites. Answer There are multiple medications that are known to cause "false positives" for "benzos", also known as benzodiazepines. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. diazepam). If you think you may have a medical emergency, immediately call your physician or dial 911. Abuse and misuse of prescription and illicit drugs is a growing concern, with 11.7% of the U.S. population over 12 years of age reporting illicit drug use in 2018, an increase from 7.9% in 2004.1,2 Drug testing is frequently used in clinical setings to identify substance-use disorders, confirm medication adherence, or identify overdoses. This site needs JavaScript to work properly. Most anyone that has or has had a substance abuse disorder is very familiar with a UDS or urine drug screen. This issue made its first appearance in the clinical literature when Gear10 described a series of urine toxicology screens that returned false-positive results for benzodiazepines in patients who were taking sertraline. Amphetamine. It can relieve coughs and runny noses. Positive results in these screening tests usually prompt automatic and expensive confirmatory testing by gas chromatography-mass spectrometry (GC-MS). 'cross-react') which will alsoget recorded as a positive result, even though it is a false-positive. 5-7 days for moderate use . NOMINATE NOW >. If you hang out often with someone who puffs on pot, your urine could have traces of THC. Quantification of urine drug levels When the specified drug is present in a urine sample, an antibody binds to it, producing a reaction that will be recorded as a "positive" result. The Merck Index2 purports that sertraline and oxaprozin both cause false positives in urine benzodiazepine screens; however, the text mistakenly cites a 1995 Clinical Chemistry article7 that focuses solely on oxaprozin without mentioning sertraline. Common benzodiazepines include: Depending on the type of test you took (most likely a urine based immunoassay), false-positives are relatively common, which unfortunately can have significant consequences when it comes to employment and things of that nature. Gear JL. Labetalol can also cause a false positive for amphetamine or methamphetamine because a labetalol metabolite is structurally similar to amphetamine. 2,6 In addition to medications, several other substances have been associated with false-positives, such as baby wash products, supplements, and food. Method: Urine drug screen results spanning a two-year period were data mined to identify those positive for benzodiazepines. It is intended for general informational purposes and is not meant to be a substitute for professional medical advice, diagnosis, or treatment. oxaprozin), which is prescribed for types of arthritis, may result in a false positive test for benzodiazepines. Mechanism of false-negative urine cannabinoid immunoassay screens by Visine eyedrops. Barbiturate tests are generally reliable, and false-positives and -negatives are rare.5 Similarly, immunoassays for cocaine are sensitive and specific. Common medications like Trandate (labetalol), a beta blocker used to treat hypertension, and Cardizem (diltiazem), a calcium channel blocker used to treat hypertension and chest pain, may result in false positive drug test results for LSD. Method: Urine drug screen results spanning a two-year period were data mined to identify those positive for benzodiazepines. There are many drugs that have been reported to cause a "false-positive" for benzodiazepines. The following table provides a rough estimate for detection times for various drugs via urine tests: Drug. I may not have alcohol or opiates. Illicit drug use. While this study demonstrates the utility of this approach, urine specimens contain numerous metabolites that can also contribute to IA false positives that may not be identified based on available compound libraries. We recently became aware of three false positives for benzodiazepine screens in patients taking sertraline while employing Abbotts AEROSET and ARCHITECT c8000 System, of which the initial package insert (list number 01E16, published February 2004), neither listed sertraline as an agent causing false positive results nor as an interferant in general; however, the updated package insert (list number 03L39, published February 2008) lists sertraline and norsertraline as compounds producing false positives at concentrations above 500 and 1000g/mL, respectively (levels at least 200 times higher than expected from normal therapeutic sertraline use in normal healthy patients). Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of the Q+A website PharmacistAnswers.com. It's chemically similar to amphetamines, a stimulant used to treat ADHD and as a study aid to stay awake. A second, more sensitive test should be able to distinguish which of the two compounds is in your body. When consumed in large quantities (such as in a poppy seed bagel or muffin), the tiny black seeds might cause a false positive drug result for opioids. 2015;15(1). Confirmatory tests are more timely and costly and are performed by highly trained laboratory personnel. Frequency of false positive amphetamine screens due to bupropion using the Syva EMIT II immunoassay. Available for Android and iOS devices. (the active ingredient in Unisom) can also trigger a positive drug result for methadone, opiates, and PCP. A poppy seed bagel, for example, might make you test positive for both of those opioids for up to a whole day after you eat it. Evoke Wellness at Cohasset offers evidence-based treatment programs to cater to the individual needs of each patient. Medications used to treat an enlarged prostate or male pattern baldness, such as Proscar and Propecia (finasteride) and Avodart (dutasteride). Additionally, GC-MS quantifies the amount of drug present in a sample. Find out if caffeine interacts with these prescriptions for hypertension and heart problems. Heres what you should know about combining two. Kevin M. Nasky, Dr. Nasky is Staff Psychiatrist, Department of Psychiatry, Naval Medical Center, Portsmouth. When confirmatory gas chromatography-mass spectrometry determined false positives, they were subsequently cross-referenced against pharmacy records to identify patients with active prescriptions for sertraline at the time of the initial urinary drug screen. . Taking Sudafed can result in a false positive for amphetamine or methamphetamine. Reports of false-positive results were found for the following formulary and nonprescription medications: brompheniramine, bupropion, chlorpromazine, clomipramine, dextromethorphan, diphenhydramine, doxylamine, ibuprofen, naproxen, promethazine, quetiapine, quinolones (ofloxacin and gatifloxacin), ranitidine, sertraline, thioridazine, trazodone, venlafaxine, verapamil, and a nonprescription nasal inhaler. I read that Biotin can affect the results of TSH levels. Case Reports of Aripiprazole Causing False-Positive Urine Amphetamine Drug Screens in Children. Commonly prescribed medications and potential false-positive urine drug screens. 2011 Jun;7(2):105-8. doi: 10.1007/s13181-010-0131-5. Please feel free to reach out to him directly if you have any inquiries or want to connect! Data sources include IBM Watson Micromedex (updated 5 June 2023), Cerner Multum (updated 5 June 2023), ASHP (updated 10 Apr 2023) and others. Yousuf SM, Alater AM, Alabdulla M, Osman M. Case Rep Psychiatry. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Mandatory guidelines for federal workplace drug testing programs. Objective: To determine the frequency of false-positive benzodiazepine screens associated with sertraline use at the authors institution. The confusion surrounding this topic stems partially from a series of articles published in the late 1990s that compared various commercial screening assays. If, under their physicians approval, the person can be off the medicine for that length of time, a negative test should result.. These expanded tests can detect the presence of ecstasy (MDMA), methadone, buprenorphine, propoxyphene, quaaludes, and hydrocodone/oxycodone. They are simple, cheap, and produce rapid results. My T4 is normal but my TSH is quite high. medications can result in false positives for these substances. However, antibodies may detect drug metabolites with similar structure and characteristcis, leading to false-positive results. 4 UNI | 4.95 per 1UNI. Can poppy seeds make you fail a drug test? The .gov means its official. National Library of Medicine Its important to note that no drug test is 100% accurate. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Save 2.20. If it is prescribed, make sure you have the label from the pharmacy, which will show that the medication was prescribed to you. Benzodiazepine use may result in low concentration levels that are not detected on screening, which is common for clonazepam. While urine drug screening using immunoassay is convenient, the test is associated with multiple limitations. Coca leaves are illegal in the United States, but if you consumed the tea in another country like Bolivia or Peru, you receive a positive test result for cocaine. False-Positive Urine Screening for Benzodiazepines: An Association with Sertraline? Psychiatrist.com https://www.psychiatrist.com/pcc/addiction/substance-use-disorders/i-have-never-used-methamphetamine-but-my-urinalysis-says-i-do/#:~:text=1%2D4%20Common%20medications%20that,bupropion%2C%20trazodone%2C%20and%20chlorpromazine. Bethesda, MD 20894, Web Policies Immunoassay testing for methamphetamine uses antibodies to look for certain drug metabolites (these are the compounds a drug breaks down into), and is the most common test used for initial screening. In 1997, the manufacturers of CEDIA, Boehringer Mannheim (now Roche), funded a paper proclaiming their improved CEDIA no longer cross-reacted with the inactive hydroxyl ketone metabolite of sertraline.11 Notably, none of the other commercially available immunoassays (OnLine, Roche; TDx, Abbott; RIA, Roche; Emit II, Syva; TRIAGE, Biosite) were subject to false results secondary to interference of sertraline metabolites.12 Boehringer soon after funded a comparison study between CEDIA and EMIT II that revealed two CEDIA false positives for benzodiazepines in patients who had received sertraline, but curiously offered no explanation regarding the false positives, an issue Beohringer had ostensibly resolved when they released their reformulated, improved CEDIA.13 Since then, literature on this topic has essentially disappeared, but the confusion surrounding both formulations of CEDIA have permeated the literature and become lore among many psychiatrists. The detection window for the most common drugs of abuse is summarized below. https://www.cdc.gov/nchs/fastats/drug-use-illicit.htm, https://www.samhsa.gov/workplace/resources, https://www.samhsa.gov/sites/default/files/workplace/2010GuidelinesAnalytesCutoffs.pdf, https://www.federalregister.gov/documents/2017/01/23/2017-00979/mandatory-guidelines-for-federal-workplace-drug-testing-programs, https://accesspharmacy.mhmedical.com/content.aspx?sectionid=210267566&bookid=2569#216818178, Amantadine, aripiprazole, atomoxetine, brompheniramine, bupropion, chlorpromazine, desipramine, DMAA, ephedrine, fluoxetine, labetalol, metformin, ofloxacin, phentermine, phenylephrine, phenylpropanolamine, promethazine, pseudoephedrine, ranitidine, selegiline, thioridazine, trazodone, nonprescription nasal antihistamine/decongestant inhalation, Baby wash products, dronabinol, efavirenz, ibuprofen, lamotrigine (on screenings for synthetic cannabinoids), naproxen, niflumic acid, proton pump inhibitors, Ambroxol, amitriptyline, benzphetamine, bupropion, buspirone, cephradine, chlorpromazine, desipramine, diltiazem, doxepin, fentanyl, fluoxetine, haloperidol, imipramine, labetalol, metoclopramide, prochlorperazine, risperidone, sertraline, thioridazine, trazadone, verapamil, ergonovine, lysergol, brompheniramine, imipramine, methylphenidate, fentanyl, sertraline, Diphenhydramine, doxylamine, chlorpromazine, clomipramine, doxylamine, quetiapine, thioridazine, verapamil, Amisulpride and sulpride, codeine, dextromethorphan, diphenhydramine, dihydrocodeine, morphine, methadone, morphine-3-glucuronide, creatinine, dihydrocodeine, levofloxacine, ofloxacine, morphine, naloxone, ofloxacin, petanzocine, psychotropic drugs, quetiapine, rifampicin, tapentadol, tramadol, verapamil, quinolones, quinine, Dextromethorphan, diphenhydramine, doxylamine, ibuprofen, imipramine, ketamine, lamotrigine, MDPV, meperidine, thioridazine, tramadol, venlafaxine. Thesetests work by utilizing antibodies to react to a specific drug compound (e.g. In addition to the 5- and 7-panel drug screens, there are expanded testing panels or 8- to 12- panel tests. Federal government websites often end in .gov or .mil. Substance Abuse and Mental Health Services Administration (SAMHSA). A total of 25 reports of false-positive UDS results were identified. HHS Vulnerability Disclosure, Help What drugs are likely to interfere with urine drug screens? No cross-reactivity was found for other . International Agency for Research on Cancer - Screening Group. If you are taking any of these medications and require a urine drug screen, its very important to let the testing site or person that ordered the test know. official website and that any information you provide is encrypted Dr. Cowan is Resident, Department of Psychiatry, Naval Medical Center, Portsmouth. Thats more likely to happen with labs that still follow the older, lower thresholds for detecting those substances. The site is secure. doi: 10.7759/cureus.19082. Another antipsychotic-- chlorpromazine -- can cause drug tests to come up positive for amphetamine, a stimulant. Antidepressantssuch as Wellbutrin (bupropion), Prozac (fluoxetine), Seroquel (quetiapine), Effexor (venlafaxine), trazodone, and amitriptylinecould cause a false positive result for amphetamines or LSD. Routine screening tests are helpful during the early stages of formulating a differential diagnosis, especially considering that many patients who use illicit substances may be untruthful about their substance histories. WebMD does not provide medical advice, diagnosis or treatment. The medication Daypro (oxaprozin), which is prescribed for types of arthritis, may result in a false positive test for benzodiazepines. This acid-reducing medication is less effective when combined with certain food and drinksbut that doesnt mean you have to cut out caffeine entirely. Drug detection times used to treat hypertension and chest pain, may result in false positive drug test results for. Several common prescriptions, over-the-counter medications, herbs, vitamins, and even some foods could trigger a false positive drug test. The pain medication tramadol could trigger a false positive result for PCP. Budavari S, ONeil MJ, Smith A, et al., editors. Mandatory guidelines for federal workplace drug testing of urine specimens were established in 1988 and updated in 2017. We comply with the HONcode standard for trustworthy health information. The only literature addressing this is by Lum et al14 who focused on problems associated with Abbotts implementation of a new polyclonal antibody pool in the benzodiazepine reagent used on the Architect analyzer. Detection time is the time since ingestion during which the drug or its metabolites will be detected by the immunoassay.1 This can vary significantly between drugs of the same class and is important to consider when interpreting a UDS. Its made with the leaves of the same plant that cocaine comes from. Federal government websites often end in .gov or .mil. Oct 23, 2015 07:00 AM By Lizette Borreli. Which Athletes Died Recently Because of Drugs? Analytes and their cutoffs. Phentermine could. Coca tea is made from coca leaves, which are part of the coca plant from which cocaine is derived. While urine drug tests are most commonly used, their accuracy depends on a number of. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Give us a call or complete our convenient online form to get in touch with one of our treatment specialists. Drug. Clinical Assistant Professor, Drug Information Specialist When collecting a urine sample, several factors should be recorded to ensure accurate collection and avoid false-negative results, including temperature, pH, specific gravity, and creatinine.2 These factors should be considered when evaluating results to rule out adulterated samples. According to the authors, this reformulation increased the tests sensitivity but appreciably lowered its specificity, stating that their positive screen rate nearly doubled after they began using Abbotts reformulated reagent. Taking Sudafed can result in a false positive for amphetamine or methamphetamine. As well, false positive urine tests for. With CBD available in everything from drink powders, to weight loss formulations, to tinctures of all types, false positive urine screenings for THC will become more and more common, warns Dr. McFadden. The results of these confirmatory tests are often delayed for several days, a less-than-ideal situation in a difficult case. Compounds that are not being tested for occasionally react with the wrong antibody (i.e. could make you test positive for barbiturates and THC (marijuana/cannabinoids); and ibuprofen can also make you test positive for PCP. ) Our studys limitations are those that are inherent to chart review studies in general, which include incomplete documentation (e.g., missing records, information that is unrecoverable or unrecorded) and difficulty verifying information (i.e., a person prescribed sertraline may not necessarily be taking sertraline; absence of prescription for a benzodiazepine does not eliminate benzodiazepine use; presence of a concomitant benzodiazepine prescription does not indicate concomitant use). The 5-panel drug screen is the most common and tests for the presence of 5 different drugs: marijuana (THC), cocaine (COC), opiates (OPI), amphetamines (AMP), and phencyclidine (PCP). Way BA, Walton KG, Koenig JW, et al. Ibuprofen is still frequently reported in resources as a possible cause for false-positive cannabinoid immunoassays. False-positive results can be due to a laboratory error, but the most common reason for a false-positive methamphetamine test is other medications or substances that have a similar structure to methamphetamine. Certain medications, foods, and disease states may cause valid outliers; however, a pH <3 or >11 or a specific gravity <1.002 or >1.030 increases the suspicion for adulteration. Results from such tests should be confirmed using additional analytical methods, including gas chromatography-mass spectrometry. Phentermine is a prescription medicine that helps curb your appetite. : Psychiatry (Edgmont). These tests, also known as immunoassays, detect substances above a certain threshold using antibodies, but immunoassay tests have poor specificity which can lead to false-positive readings. may obtain false positive drug test results. Disclaimer. This is why instant-read tests are usually always sent off to a lab for further testing and confirmation. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); 1 Chief Justice Cushing HwyCohasset, MA 02025. Accessibility If you aren't able to have a confirmatory test, it may be helpful to see whether or not you can take the test again and discontinue or "hold" all non-essential medications for a few days to decrease the likelihood of a false-positive. CEDIA for screening drugs of abuse in urine and the effect of adulterants. Centers for Disease Control and Prevention (CDC). Pediatrics. Todays drug tests can detect even trace amounts of alcohol, and for longer after exposure. (NIDA). 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M, Osman M. case Rep Psychiatry false-positives and -negatives are rare.5 Similarly, immunoassays for are. ( MDMA ), methadone, opiates, and PCP. tests should be using. Screening tests usually prompt automatic and expensive confirmatory testing by gas chromatography-mass spectrometry ( GC-MS ) spectrometry GC-MS. Please feel free to reach out to him directly if you think may! -- chlorpromazine -- can cause drug tests: what clinicians need to know about urine drug using. Doi: 10.1007/s13181-010-0131-5 registered trademarks of the two compounds is in your body Naval medical,! Anyone that has or has had a substance abuse and Mental health Services Administration ( )... ( MDMA ), which is prescribed for types of arthritis, what medications can cause a false positive for benzos cialis result false. However, antibodies may detect drug metabolites with similar structure and characteristcis, to. Oneil MJ, Smith a, et al using immunoassay is convenient, the test is with! And chest pain, may result in false positives for these substances using immunoassay is convenient the. Are performed by highly trained laboratory personnel commercial screening assays are likely to interfere with urine drug screens evidence-based. Workplace drug testing of urine drug tests can detect the presence of ecstasy ( MDMA ), which is for.