#1
Old 11-28-2010, 11:30 AM
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Drug tests and opiates

I know that excessive consumption of poppy seeds can lead to false positives of opiate usage. But has drug testing developed to the point where individual opiates--vidodin, morphine, ect.--can be determed, or would they all be simply appear as opiates?
#2
Old 11-28-2010, 12:04 PM
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I'm sure they could find out in an actual lab with blood work. But most drug tests are run as quickly and cheaply as they can using urine, so they test for the metabolites of most of the drugs, and only classify between classes.

Oh, and as for opiates, a lot of the opiates have the same metabolite, for example, Codeine and Heroin both are transformed into Morphine, so have the same metabolites as morphine does. So I doubt they could tell them apart.
#3
Old 11-28-2010, 02:13 PM
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Actually, yes, they can distinguish between opiates on SOME urine tests - which are expensive. Most places aren't going to drop three figures on a piss test, though back when I worked a clinic full of drug abusers we did have situations where it was done. Most of the time when you're giving a cup full of piss for the test the test performed is relatively inexpensive and not that sensitive. So it will just come up "opiates". Whether or not the tester wants to re-test or not, or with the same or different test, is up to them.

Back in the day we had one test so sensitive it could distinguish different brands of drugs from each other - yep, not only could we tell whether or not you were doing heroin or coke, we could tell if you were using Tylenol or generic acetaminophen, and if so, which generic form of it. But, of course, that was also our most expensive test. Seldom used it.
#4
Old 11-28-2010, 02:28 PM
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Quote:
Originally Posted by Broomstick View Post
Back in the day we had one test so sensitive it could distinguish different brands of drugs from each other - yep, not only could we tell whether or not you were doing heroin or coke, we could tell if you were using Tylenol or generic acetaminophen, and if so, which generic form of it. But, of course, that was also our most expensive test. Seldom used it.
How?? Since they all will contain para-acetylaminophenol as their active ingredient, what are you testing for that will distinguish them?
#5
Old 11-28-2010, 03:00 PM
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Inactive ingredients. Different brands have different formulations for inactive ingredients. The test really did find everything in the sample. The technique is gas chromatography-mass spectrometry

The test also determined the proportion of all the different substances found, so, for example, if two brands were using the same ingredients but in different proportions that would be a way to determine the difference.

In some instances you'd see on a report "substance Y of either brand A, B, or C" where the test couldn't make an exact determination due to identical recipes, or where different brands were all buying from the same supplier and just slapping their own label on the bottle.

Of course, no test is perfect, but this is about as close as we get these days. However, as I said, it was not cheap. We needed a specific reason to have a sample tested with this, it's far too expensive for mass screening.
#6
Old 11-28-2010, 04:20 PM
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Our drug tests in the ER come back 'opiates +/-' which is all we need to know. The CSI crew might have some more specific needs. For example a basic blood alcohol level is all we need for medical or legal (in a drunk driving sense), but the coroner can draw fluid from the eyeball, and compare the alcohol level there with the blood level and tell whether it was still going up or was falling when the pt died.
#7
Old 11-29-2010, 06:45 AM
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The more expensive tests are, as Broomstick says, used by drug treatment centres.

Usually for the scenario where you want to find out if your patient is supplementing their prescibed medication with street bought stuff.

In that case it is useful to find out if their +opiate is just methadone, or Methadone and Heroin, or Methadone, Heroin, Codeine, Oxycontin and Tramadol.

Sometimes people dependent on benzodiazepines have controlled reducing regimes- then you want to test to find out if they are supplementing their Diazepam with Temazepam or Zopiclone.

As codeine containing perparations are available OTC perfectly legally here quite a high proportion of our population will test positive for opiates, never mind popy seed bagels and whatnot.


I worked in an emergency department where the consultant was totally against urine drug screening- he believes if you couldn't use your clinical skills to tell who was high or drug seeking, you shouldn't be working in his department, and as forensic drug testing is not necessarily in the best interests of your patient it should be left to the police.
The only time we were supposed to use them was on unconscious people when we couldn't rule out drugs as a cause.
Fun times.
#8
Old 11-29-2010, 07:07 AM
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Quote:
Originally Posted by outlierrn View Post
Our drug tests in the ER come back 'opiates +/-' which is all we need to know. The CSI crew might have some more specific needs. For example a basic blood alcohol level is all we need for medical or legal (in a drunk driving sense), but the coroner can draw fluid from the eyeball, and compare the alcohol level there with the blood level and tell whether it was still going up or was falling when the pt died.
What's specific to the ocular fluid that makes it a better indicator of level of intoxication than blood (or any other bodily fluid)?
#9
Old 11-29-2010, 10:31 AM
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Quote:
Originally Posted by irishgirl View Post
I worked in an emergency department where the consultant was totally against urine drug screening- he believes if you couldn't use your clinical skills to tell who was high or drug seeking, you shouldn't be working in his department, and as forensic drug testing is not necessarily in the best interests of your patient it should be left to the police.
The only time we were supposed to use them was on unconscious people when we couldn't rule out drugs as a cause.
Fun times.
I can sort of see this, truth be told we do lots of drug screens that don't tell us anything we don't know or can actually use.

Quote:
Originally Posted by FoieGrasIsEvil View Post
What's specific to the ocular fluid that makes it a better indicator of level of intoxication than blood (or any other bodily fluid)?
Not better, just slower (I think), blood>ocular=still getting drunker, blood<ocular=starting to sober up. It's more of a timing thing.

Last edited by outlierrn; 11-29-2010 at 10:32 AM.
#10
Old 11-30-2010, 08:23 AM
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The drug tests I use can tell the difference between all types of opiates and benzodiazepines and they only cost $22. I can tell the difference (usually) between poppy seeds, heroin, vicodin, etc...

I think one of the reasons they're that cheap is because of the volume of tests we do, and also because we charge $22 for all the tests whether they are positive or negative. The negatives subsidize the cost of the positives, which are more expensive, as GCMS is only used to confirm the positives.
#11
Old 11-30-2010, 08:31 AM
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Quote:
Originally Posted by Hirka T'Bawa View Post
Oh, and as for opiates, a lot of the opiates have the same metabolite, for example, Codeine and Heroin both are transformed into Morphine, so have the same metabolites as morphine does. So I doubt they could tell them apart.
In a urine drug screen heroin will show up as morphine, 6-monoacetylmorphine, and codeine. If you see the 6-monoacetylmorphine you know for sure it is heroin. Codeine will (usually) show up as codeine and morphine, although sometimes, depending on the timing, will just show up as morphine.

You can also determine the specific drug sometimes from the ratios of one metabolite to another, although I am not the expert on that. Our toxicologist can get pretty specific at times from looking at the ratios.
#12
Old 06-02-2013, 06:00 AM
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Originally Posted by sugaree View Post
I know that excessive consumption of poppy seeds can lead to false positives of opiate usage. But has drug testing developed to the point where individual opiates--vidodin, morphine, ect.--can be determed, or would they all be simply appear as opiates?
Most drug tests that I have taken and the ones I have seen taken in felony court have a shit load of things it tests for and all opiates are in one category and once you test positive it doesn't tell the levels that you have. Now if the urine gets sent to a lab I think they can possibly test the difference between heroin and other opiates and maybe even the specific one but most normal tests and ones that are just done at court clump them all in one category.

A way to get away with it... My boyfriend and I did heroin and he knew he had a drug test and an asshole of a judge and we meant to stop three days before to get it out of his system ad just take suboxone but we just ended up getting high so what we did the night before the test was go to the emergency room claiming he was having a debilitating migraine and that he was in so much pain unable to open his eyes and they gave him a shot of morphine and sent him home with some vicodens so the next day at court when he failed for opiated he had doctors stuff saying he was given morphine and then he had the bottle with the pills in it so they let him stay free
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