False-Positive Amphetamine/Ecstasy (MDMA/3,4-Methylenedioxymethamphetamine) (CEDIA) and Ecstasy (MDMA/3,4-Methylenedioxymethamphetamine) (DRI) Test Results With Fenofibrate

Kaplan, Yusuf Cem; Erol, Almıla; Karadaş, Barş

doi:10.1097/ftd.0b013e3182690127

Cited by 8 publications

(4 citation statements)

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“…False positive results are quite common with urine drug screens because drugs with similar chemical structures to those being targeted with immunoassay can cause cross-reactivity. Prescribed and over-the-counter drugs that may cause a false positive amphetamine result include bupropion, 7 dimethylamylamine (DMAA), 8 fenofibrate, 9 labetalol, 10 metabolites of chlorpromazine and brompheniramine, 11 phenylephrine, 12 promethazine metabolite(s), 13 pseudoephedrine, 14 and the trazadone metabolite, meta-chlorophenylpiperazine ( m -CPP). 15 The immunoassay drug test is prone to misleading results and should be followed up by a confirmatory drug test.…”

Section: Background/rationalementioning

confidence: 99%

An Evaluation of the Clinical Tools Used to Monitor Illicit Methamphetamine Use Among Chronic Pain Patients: A Cross Sectional Retrospective Study

Schalk

Lewis

2023

Hosp Pharm

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Purpose: Illicit drug use continues to be a concern for adults on opioid therapy for chronic pain. Prescribers use tools such as urine screening and confirmatory testing with mass spectrometry to monitor adherence to chronic opioid therapy contracts. Design: A cross sectional retrospective study was conducted using electronic medical records. Methods: Data was analyzed from 6558 urine samples of adult outpatients receiving opioid therapy at an urban pain specialty clinic who consented to urine drug tests. Results: From October 18, 2021, to October 21, 2022, 569 were positive amphetamine with immunoassay testing. 310 (54%) of those samples were absent amphetamine with or without methamphetamine while 259 (45.5%) were true positive amphetamine proven by confirmation testing. Analysis of confirmatory testing results identified 281 samples positive for amphetamine with or without methamphetamine. 71 samples confirmed positive for methamphetamine with or without amphetamine. 37 (52.1%) of those methamphetamine samples screened positive for amphetamine and 34 (47.9%) samples screened negative for amphetamine. 48 of the methamphetamine samples were sent for chiral confirmation testing. 45 (93.8%) samples were positive for D-methamphetamine while 3 (6.2%) samples were positive for L-methamphetamine. Only 5 (11.1%) of the 45 patients whose samples were positive for d-methamphetamine reported the use of illicit drugs before their urine sample was tested. Discussion: Confirmatory testing with mass spectrometry can detect illicit drugs, such as methamphetamine, with high sensitivity and specificity and should be used with all samples given the low sensitivity of screening immunoassay. It is of utmost importance that opioid pain medicine prescribers know the many possible interpretations of these results so that they are equipped to make appropriate clinical decisions to ensure the safety of the patient, prescriber, and practice.

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Section: Background/rationalementioning

confidence: 99%

An Evaluation of the Clinical Tools Used to Monitor Illicit Methamphetamine Use Among Chronic Pain Patients: A Cross Sectional Retrospective Study

Schalk

Lewis

2023

Hosp Pharm

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“…It is believed that fenofibrate, or a metabolite of it, has a molecular structure bearing similarity to amphetamine which may produce false-positive UDS readings. [8][9][10][11] In these research articles, mass spectrometry was used as a gold standard to confirm or refute presumptive positive results based upon the initial UDS.…”

Section: Introductionmentioning

confidence: 99%

Variability amongst urine toxicology amphetamine readings with concurrent administration of fenofibrate

Dadlani¹,

Farrar²,

Jones

2017

Australas Psychiatry

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It is evident that different pathology laboratories may utilise different commercial urine drug-screen immunoassays in their toxicology analysis, with variability in the test specificities. Despite the relatively high prevalence of substance misuse in the population of psychiatric inpatients, there exists a need for increased vigilance towards the possibility of false-positive amphetamine results owing to likely cross-reactivity of fenofibrate with the test reagents. In cases where there is uncertainty when correlating clinically, or where false positives are suspected, gold-standard urine-sample analysis by mass spectrometry should be considered, particularly when the consequences for patients may include restrictive measures.

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“…However, IA drug screens have limited sensitivity and specificity due in part to capture antibody cross-reactivity with structurally similar interfering compounds, producing false-positive results. Specifically, amphetamine (AMP) IAs demonstrate broad antibody cross-reactivity with non-targeted compounds that are structurally or physically related to phenethylamines (1,2) [e.g., ranitidine (3), pseudoephedrine (4), phenylephrine (5), trazodone metabolite (6,7), fenofibrate (8), bupropion and metabolites (9,10), labetalol (11) and dimethylamylamine (DMAA)] (12).…”

Section: Introductionmentioning

confidence: 99%

One Hundred False-Positive Amphetamine Specimens Characterized by Liquid Chromatography Time-of-Flight Mass Spectrometry

et al. 2015

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Some amphetamine (AMP) and ecstacy (MDMA) urine immunoassay (IA) kits are prone to false-positive results due to poor specificity of the antibody. We employed two techniques, high-resolution mass spectrometry (HRMS) and an in silico structure search, to identify compounds likely to cause false-positive results. Hundred false-positive IA specimens for AMP and/or MDMA were analyzed by an Agilent 6230 time-of-flight (TOF) mass spectrometer. Separately, SciFinder (Chemical Abstracts) was used as an in silico structure search to generate a library of compounds that are known to cross-react with AMP/MDMA IAs. Chemical formulas and exact masses of 145 structures were then compared against masses identified by TOF. Compounds known to have cross-reactivity with the IAs were identified in the structure-based search. The chemical formulas and exact masses of 145 structures (of 20 chemical formulas) were compared against masses identified by TOF. Urine analysis by HRMS correlates accurate mass with chemical formulae, but provides little information regarding compound structure. Structural data of targeted antigens can be utilized to correlate HRMS-derived chemical formulas with structural analogs.

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False-Positive Amphetamine/Ecstasy (MDMA/3,4-Methylenedioxymethamphetamine) (CEDIA) and Ecstasy (MDMA/3,4-Methylenedioxymethamphetamine) (DRI) Test Results With Fenofibrate

Cited by 8 publications

References 0 publications

An Evaluation of the Clinical Tools Used to Monitor Illicit Methamphetamine Use Among Chronic Pain Patients: A Cross Sectional Retrospective Study

An Evaluation of the Clinical Tools Used to Monitor Illicit Methamphetamine Use Among Chronic Pain Patients: A Cross Sectional Retrospective Study

Variability amongst urine toxicology amphetamine readings with concurrent administration of fenofibrate

One Hundred False-Positive Amphetamine Specimens Characterized by Liquid Chromatography Time-of-Flight Mass Spectrometry

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