SLIDE 14 Drug Window of Detection3 (Days) Medications that Cause False Positives (Common Examples) Confirmatory Testing Available for Screening Test? Amphetamine 1-3 days Bupropion, ciprofloxacin, ephedrine, labetalol, melatonin, metoprolol, phenylephrine, pseudoephedrine, ranitidine, sertraline. Yes Benzodiazepines* 1-7 days (2-30 days for diazepam) Diphenhydramine, gemfibrozil, hydroxyzine, indomethacin, sertraline, trazodone Yes Cocaine 1-3 days
Methadone 3-10 days
Opiates (only codeine, morphine, heroin) 1-3 days Fluoroquinolones, quinine, poppy seeds, rifampin Yes** Oxycodone 1-2 days Codeine, hydrocodone, hydromorphone, oxymorphone Yes
Urine Toxicology Results
Adapted from UCSF Outpatient Handbook, 2014
Urine Toxicology Results
If concern for tampering, order urine creatinine (should be >20) Check what type of screening is the best/cheapest in your area ALWAYS cause opiate screen to be positive? Heroin, morphine, codeine SOMETIMES cause opiate screen to be positive? Hydrocodone, hydromorphone, oxycodone, oxymorphone NEVER cause opiate screen to be positive? Buprenorphine, fentanyl, meperidine, methadone, tramadol Check fentanyl immunoassay or methadone screen Steiger S, Drug Testing FAQ
When to Taper Prescription Opioids (Non-Cancer Pain)?
When risks > benefits
Aberrant behaviors
If multiple agents, convert to morphine equivalents
to calculate total dose
http://opioidcalculator.practicalpainmanagement.com/ Reduce long-acting agents first vs. convert to short-
acting and taper
Tapering Opiates
Slow Taper: reduce dose by 10%/month Minimizes withdrawal sx Rapid Taper Remove 10-15%/week Indications: substance abuse, loss of control over pill use Consider referral for substance abuse
counseling/treatment
Immediate Cessation Overdose, suicide attempt, rx forgery, diversion, other
threats
