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

Marin, Stephanie J.; Doyle, Kelly; Chang, Annie C. Y.; Concheiro, Marta; Huestis, Marilyn A.; Johnson-Davis, Kamisha L.

doi:10.1093/jat/bkv101

Cited by 17 publications

(17 citation statements)

References 16 publications

(15 reference statements)

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“…Limitations of currently employed immunoassay screening techniques have been well documented in literature. In one such study by Marin et al, 3571 urine samples that screened positive by immunoassay (EMIT ® II) for the presence of amphetamine type substances produced 389 false positive results (11.9%) when confirmed by LC-MS-MS. 34 A recent study also reviewed the utility of immunoassay-based drug screening in the compliance monitoring of patients treated for chronic pain. It was noted that immunoassay techniques for opiate detection showed 21% false negative results when compared to LC-MS-MS, indicating that immunoassays can be inadequately sensitive for medication compliance.…”

Section: Application To Toxicology Screeningmentioning

confidence: 99%

Quadrupole Time-of-Flight Mass Spectrometry: A Paradigm Shift in Toxicology Screening Applications

Allen¹,

McWhinney²

2019

CBR

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The screening of biological samples for the presence of illicit or legal substances is an important frontline tool in both clinical and forensic toxicology. In the clinical setting, drug screening is a useful tool for the clinician in improving patient care and guiding treatment. Analytical approaches for the screening of drugs in biological samples are extensive and well documented, though many rapid screening techniques often lack appropriate sensitivity and specificity, requiring careful clinical interpretation. The continuous emergence of new psychoactive substances presents a considerable analytical challenge in maintaining up-to-date methods for the detection of relevant drugs. Adapting and validating methods for the detection of new substances can be a complicated and costly undertaking. There is also a considerable lag time between the emergence of new drugs and the release of commercial assays for detection. Quadrupole time-of-flight mass spectrometry (Q-TOF-MS) has gained considerable attention over the last decade as an analytical technique that is capable of meeting the challenges of a rapidly changing drug landscape. Exhibiting both high sensitivity and specificity in drug detection, Q-TOF-MS also allows methods to be rapidly updated for newly emerging psychoactive agents. The coupling of Q-TOF-MS with techniques such as liquid or gas chromatography can provide both rapid and comprehensive screening solutions that are gaining popularity in the clinical laboratory setting.

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Section: Application To Toxicology Screeningmentioning

confidence: 99%

Quadrupole Time-of-Flight Mass Spectrometry: A Paradigm Shift in Toxicology Screening Applications

Allen¹,

McWhinney²

2019

CBR

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“…'False positive' drug screening results for amphetamine have also been associated with use of other drugs and herbal foods (Baron et al 2011;Dadlani et al 2018;Liu et al 2015;Marin et al 2016;Olsen et al 1992;Papa et al 1997;Pavletic and Pao 2014;Vorce et al 2011). This also includes case reports for common drugs, e.g.…”

Section: Adhd Medication and The Risk Of 'False Positives' Using Immumentioning

confidence: 99%

Patients in medical treatment for attention deficit/hyperactivity disorder (ADHD): Are they at risk in drug screening?

Jensen

Breindahl

2018

ADHD Atten Def Hyp Disord

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The use of medicines to treat attention deficit/hyperactivity disorder (ADHD) has increased worldwide, including the use of amphetamine-based medicines or prodrugs that metabolise to amphetamine in vivo. At the same time, drugs-of-abuse testing by non-specific, point-of-care immunoassay methods ('quick tests') has increased. This article discusses the risk of 'false positive' results or post-analytical misinterpretations of results when immunoassays are used to analyse biological samples from ADHD patients. A rapid evidence review was conducted to identify studies that have focused on the risk of 'false positive' test results in immunoassay testing of patients treated with atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil. There is only evidence to suggest that bupropion should cause 'false positive' immunoassay results. However, there is a lack of systematic, updated evaluations and validations of cross-reactivity patterns for immunoassays in the literature. Advanced laboratory methods can distinguish the use of medicines from illicit amphetamine by stereospecific analysis of dextro-and levoamphetamine; however, these analytical services are not commonly available for routine drug testing. The present situation calls for more awareness, proper education and information on these critical ethical issues in drug testing, both for clinicians, other healthcare professionals involved in drug testing and for patients in medical treatment for ADHD. The pitfalls of immunoassays due to cross-reactivity and insufficient specificity/sensitivity can have serious negative consequences for patients safety with regard to incorrect laboratory drug-testing results. Consequently, confirmatory laboratory analysis should always be performed for 'presumptive' positive immunoassay screening results.

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“…One major concern with UDS testing is false positives. In a retrospective study, roughly 11% (389 of 3,571) of samples tested positive for amphetamines or ecstasy on the initial immunoassay test but were confirmed negative by liquid chromatography-mass spectrometry, thus indicating a false-positive test [ 7 ]. This can occur through cross-reactivity of multiple commonly prescribed prescription medications, whose metabolites can lead to false-positive test results in conventional automated immunoassay UDS testing [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

A Case of Esmolol-Induced False-Positive Amphetamine Urine Drug Test

Adashek¹,

Khadilkar²,

Enciso³

et al. 2021

Cureus

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False-positive urine drug screens can occur and lead to implicit bias. Confirmatory testing with gas chromatography/mass spectrometry can be performed. A morbidly obese patient with newly diagnosed atrial fibrillation spent multiple days in the cardiac intensive care unit (ICU) due to a false-positive test for methamphetamine. The patient was planned to undergo direct cardioversion with conscious-sedation anesthesia. His care was delayed because anesthesia was not comfortable administering sedatives in the setting of a positive urine drug screen for presumed methamphetamine use. Knowing that esmolol can cause a false positive on urine drug screen is imperative for delivering the best patient-centered care.

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

Cited by 17 publications

References 16 publications

Quadrupole Time-of-Flight Mass Spectrometry: A Paradigm Shift in Toxicology Screening Applications

Quadrupole Time-of-Flight Mass Spectrometry: A Paradigm Shift in Toxicology Screening Applications

Patients in medical treatment for attention deficit/hyperactivity disorder (ADHD): Are they at risk in drug screening?

A Case of Esmolol-Induced False-Positive Amphetamine Urine Drug Test

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