Quinolones and False-Positive Urine Screening for Opiates by Immunoassay Technology

Baden, Lindsey R.

doi:10.1001/jama.286.24.3115

Cited by 71 publications

(45 citation statements)

References 32 publications

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“…The medico-legal consequences of testing in the workplace encourage great attention towards control of false positive results. Commonly prescribed drugs such as fluoroquinolone antibiotics have been reported to produce false positive results in some opiate immunoassays [19]. While confirmatory testing can correct for these false positive immunoassay results, this comes at significant cost since the confirmatory testing is a highly labor-intensive process unlike automated immunoassay testing.…”

Section: Urine Screening For Opioidsmentioning

confidence: 99%

Laboratory Testing for Prescription Opioids

Milone

2012

J. Med. Toxicol.

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Opioid analgesic misuse has risen significantly over the past two decades, and these drugs now represent the most commonly abused class of prescription medications. They are a major cause of poisoning deaths in the USA exceeding heroin and cocaine. Laboratory testing plays a role in the detection of opioid misuse and the evaluation of patients with opioid intoxication. Laboratories use both immunoassay and chromatographic methods (e.g., liquid chromatography with mass spectrometry detection), often in combination, to yield high detection sensitivity and drug specificity. Testing methods for opioids originated in the workplace-testing arena and focused on detection of illicit heroin use. Analysis for a wide range of opioids is now required in the context of the prescription opioid epidemic. Testing methods have also been primarily based upon urine screening; however, methods for analyzing alternative samples such as saliva, sweat, and hair are available. Application of testing to monitor prescription opioid drug therapy is an increasingly important use of drug testing, and this area of testing introduces new interpretative challenges. In particular, drug metabolism may transform one clinically available opioid into another. The sensitivity of testing methods also varies considerably across the spectrum of opioid drugs. An understanding of opioid metabolism and method sensitivity towards different opioid drugs is therefore essential to effective use of these tests. Improved testing algorithms and more research into the effective use of drug testing in the clinical setting, particularly in pain medicine and substance abuse, are needed.

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Section: Urine Screening For Opioidsmentioning

confidence: 99%

Laboratory Testing for Prescription Opioids

Milone

2012

J. Med. Toxicol.

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“…When enzyme immunoassay techniques are used for urine screening, a falsepositive result for opiates in a patient taking levofloxacin may lead to erroneous clinical decisions and inadvertent litigation. [1][2][3][4] Baden and colleagues found that even a single dose of levofloxacin can interact with the enzyme immunoassay screening test, and the false-positive result for opiates can remain positive for 24 hours or more depending on the clearance of levofloxacin from the system. In their study involving six healthy volunteers, the researchers tested the crossreactivity of 13 different quinolones with five commercial opiate screening assays.…”

Section: Discussionmentioning

confidence: 99%

“…Levofloxacin, ofloxacin and pefloxacin most consistently caused false-positive results. 1 Fluoroquinolones are not the only medications that may cross-react with enzyme immunoassay urine screening tests. Others include commonly used over-the-counter medications such as ibuprofen and dextromethorphan (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Urine opiate screening: false-positive result with levofloxacin

Shafiq¹,

Mutgi²

2010

Canadian Medical Association Journal

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A 96-year-old woman with moderate to severe dementia was admitted in acute delirium. According to her next of kin, the patient had been reporting generalized weakness for the last few days, and her appetite had decreased. The day before admission, she began having visual and auditory hallucinations.At the time of admission, the patient was delirious and in moderate respiratory distress, with rapid shallow breathing and an oxygen saturation level of 88% on room air. Bilateral basilar crackles on inspiration and right-sided rhonchi were heard on auscultation. Her blood pressure was 140/75 mm Hg, her heart rate was 110 beats/min with a normal sinus rhythm, and her temperature was 37.2°C. The initial results of imaging and laboratory investigation were all normal, including a computed tomography scan of the head, chest radiographs, complete blood count with differential count, thyroid function tests, and serum levels of electrolytes, liver enzymes, amylase, lipase, cardiac enzymes, vitamin B 12 , erythrocyte folate, iron, ammonia and alcohol. The results of her blood gas tests were normal except for a partial pressure of oxygen of 60. The results of Gram staining and culture of blood, urine and sputum samples were negative for bacteria. The results of urine toxicology screening were negative for opiates and benzodiazepines. Twelve-lead electrocardiography did not show evidence of acute coronary syndrome or arrhythmias. Empirical treatment with broad-spectrum antibiotics, including piperacillintazobactam and vancomycin, was started for suspected aspiration pneumonia.Three days later, the patient's mental status and respiratory distress were worse. Levofloxacin was added to the treatment to provide coverage for atypical bacteria. A neurology consultation was obtained to rule out a neurologic cause for the patient's worsening mental status. Magnetic resonance imaging of the brain and electroencephalography were done, but neither showed acute neurologic pathology. We diagnosed metabolic encephalopathy secondary to underlying pneumonia.According to social services, the patient owned a home where she and a relative had been living together for several years. The patient had been receiving nursing care and other services in her home. Home health care staff had suspected physical abuse of the patient, and as a result, the court had appointed a lawyer as the patient's legal guardian. Given the change in the patient's mental status and upon learning about the alleged physical abuse, we were concerned about possible foul play and repeated the urine toxicology screen. To our surprise, the results were positive for opiates. A system-wide investigation was undertaken to find the possible source of the opiates. No evidence was found that an opiate-containing medication had been administered to the patient since the time of admission, and the nursing staff ruled out medication error.While searching the literature for information on possible false-positive urine screens for opiates, we found an article by Baden and colleagues, 1 whi...

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“…Rifampicin, a drug usually used in the treatment of tuberculosis, interferes with opiate immunoassays (Daher 2002). Other drugs that contribute to false-positive urine screens for opiates are the quinolone group of antibiotics (Baden 2001) and cardiac drugs such as verapamil (Lichtenwalner 1998).…”

Section: Opioidsmentioning

confidence: 99%

Testing for illicit drug use in mental health services

Abraham¹,

Luty²

2010

Adv. psychiatr. treat

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SummaryTesting for illicit drug use is used in pre-employment checks, the criminal justice system, sports medicine and for screening and confirmatory purposes in patients with physical and mental illnesses. The types of drugs tested for and the methods used vary depending on the indication. This article focuses primarily on blood, urine and oral fluids, which are specimens more commonly used in mental health settings, although hair and sweat are increasingly used in medico-legal cases and in child protection issues. The main drugs and their metabolism are discussed to gain a better understanding of the methods used and for accurate interpretation. Methods to ensure validity during sample collection are explored. False-positive and false-negative tests are common and possible confounders are discussed.

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Quinolones and False-Positive Urine Screening for Opiates by Immunoassay Technology

Abstract: Greater attention to the cross-reactivity of quinolones with immunoassays for opiates is needed to minimize the potential for invalid test interpretation.

Cited by 71 publications

References 32 publications

Laboratory Testing for Prescription Opioids

Laboratory Testing for Prescription Opioids

Urine opiate screening: false-positive result with levofloxacin

Testing for illicit drug use in mental health services

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