False-Positive RIA for Methamphetamine Following Ingestion of an Ephedra-Derived Herbal Product

Levisky, Joseph A.; Karch, Steven B.; Bowerman, David L.; Jenkins, Werner W.; Johnson, Deborah G.; Davies, Derrick

doi:10.1093/jat/27.2.123

Cited by 7 publications

(4 citation statements)

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“…Although some cases of fatalities have been reported in khat users [14,39,40] The results of immunoassay showed that samples were positive for amphetamine type stimulants. These results may be due to cross-reaction of cathinone and cathine with related compounds such as amphetamine or phenylpropanolamine [35]. Therefore, confirmatory analysis by LCMS/ MS was done and showed that samples were positive for khat active components, cathinone and cathine, as indicated in Figure-2.…”

Section: Resultsmentioning

confidence: 97%

“…For immunoassay analysis, aliquots of blood, vitreous humor and homogenates were screened for drugs of abuse using Randox Evidence analyzer. In immunoassay analysis, all samples were given false-positive results for amphetamines as cathine and cathinone are known interferences of this test [35]. Test results for other drugs of abuse were negative for all samples.…”

Section: Sample Preparationmentioning

confidence: 99%

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Postmortem Distribution of Cathinone and Cathine in Human Biological Specimens in a Case of Death Associated with Khat Chewing

Attafi¹,

Albeishy²,

Oraiby³

et al. 2018

AJFSFM

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Chewing khat leaves has been associated with several adverse health effects, and there are very few case reports of cardiotoxicity, stroke and death resulting from this. In addition, postmortem distribution of cathine and cathinone, active components of khat, are not yet fully clear. This postmortem case report aimed to identify and determine the concentration of cathine and cathinone in different body organs and green chewed plants found in the mouth of the deceased. Immunoassay and non-targeted GC-MS analysis showed that samples were only positive for amphetamine type stimulants. LC-MS/MS quantitative analysis confirmed that samples were positive for cathinone and cathine. The results showed that cathinone concentration was 0.03, 0.03, 0.06, 0.07, 1.85 and 31 μg/ml in brain, liver, blood, vitreous humor, stomach and chewed green plant, respectively. Whereas, the concentration of cathine was 0.31, 3.28, and 141 μg/ml in kidney, stomach and chewed green plant, respectively. Cathine and cathinone concentrations were found to be changed with respect to site of sampling. The results suggest that stomach and chewed green plants are considered as good samples to show the concentration for both cathine and cathinone at the time of death of the khat chewer. This paper reports a postmortem case whose death was suspected to be khat overdose. The deceased, a young

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Section: Resultsmentioning

confidence: 97%

Section: Sample Preparationmentioning

confidence: 99%

Postmortem Distribution of Cathinone and Cathine in Human Biological Specimens in a Case of Death Associated with Khat Chewing

Attafi¹,

Albeishy²,

Oraiby³

et al. 2018

AJFSFM

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“…Recent reports add to existing descriptions of ephedra-induced psychiatric adverse effects, including psychosis [49,50]. Use of Ephedra group alkaloids may also produce false-positive urine drug screening for amphetamines when analysed using radioimmunoassay techniques [51]. Other herbs such as hypericum, Siberian ginseng and valerian do not appear to produce false positive urine drug tests using enzyme immunoassay analyses [52].…”

Section: Safety Issues Relevant To Substance Usementioning

confidence: 99%

Natural and complementary therapies for substance use disorders

Dean

2005

Current Opinion in Psychiatry

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Several pharmacological and psychosocial treatments for substance use disorders are solidly evidence-based and improve both individual and public health outcomes. At this stage, there remains insufficient evidence to support the use of natural and complementary therapies as a primary intervention for substance use disorders. Further clinical trials are required to clarify the potential role of particular agents.

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“…Ephedra alkaloids, even when used in the recommended amounts, can cause positive urine screening tests for methamphetamine (129,130), sometimes yielding surprisingly high concentrations.…”

Section: Workplace Drug Testingmentioning

confidence: 99%

Ma Huang and the Ephedra Alkaloids

Karch¹

Herbal Products

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Ephedra has been used as a natural medicine for thousands of years by numerous cultures with very little concern about toxicity. Its most recent popularity is related to its purported "weight loss" or "performance enhancing" attributes. In spite of that in 2004, concerns over safety resulted in the banning of all over-the-counter (OTC) sales of ephedra-containing dietary supplements by the Food and Drug Administration.All ephedra plants contain phenylalanine-derived alkaloids, including ephedrine, pseudoephedrine, methylephedrine, and trace amounts of phenylpropanolamine. Previously marketed herbal supplements typically stated total ephedra alkaloid content, although actual levels of individual alkaloid varied depending on raw material and production runs.A double-blind, placebo-controlled trial by Boozer et al. examined issues of long-term safety and efficacy of ephedra, demonstrating its ability to reduce body weight and body fat while improving blood lipids without significant adverse events. Although other studies have documented a favorable adverse effect profile for appropriately administered doses of ephedra-containing supplements, there have been numerous anecdotal reports of adverse effects. Abuse and misuse of ephedra-containing products likely contributed to spontaneously reported adverse effects and increased concerns over safety.As with other sympathomimetic agents, theoretical drug interactions with ephedra alkaloids are possible. Despite this potential, only a handful of adverse drug interactions have been reported. This is especially pertinent when considering the extensive use of both ephedra-containing supplements and ephedrine-or pseudoephedrine-containing OTC products. The most notable interaction exists between nonselective monoamine oxidase inhibitors and ephedra-or ephedrine-containing products. KarchWith the ban of ephedra-containing dietary supplements and severe restrictions in access to ephedrine-containing OTC products, the landscape of clinical use associated with agents of this nature has been dramatically changed forever. Interest in further clinical study will likely be severely limited.

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False-Positive RIA for Methamphetamine Following Ingestion of an Ephedra-Derived Herbal Product

Cited by 7 publications

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Postmortem Distribution of Cathinone and Cathine in Human Biological Specimens in a Case of Death Associated with Khat Chewing

Postmortem Distribution of Cathinone and Cathine in Human Biological Specimens in a Case of Death Associated with Khat Chewing

Natural and complementary therapies for substance use disorders

Ma Huang and the Ephedra Alkaloids

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