Trazodone, meta-Chlorophenylpiperazine (an Hallucinogenic Drug and Trazodone Metabolite), and the Hallucinogen Trifluoromethylphenylpiperazine Cross-React with the EMIT®II Ecstasy Immunoassay in Urine

Abstract

A series of patients whose urine screened positive for 3,4-methylenedioxymethamphetamine (MDMA) using a commercial enzyme immunoassay test (Ecstasy EMIT II assay), failed to confirm by substance-specific liquid chromatography-tandem mass spectrometry tests for MDMA. Further evaluation of these urine specimens indicates that they were positive for trazodone and its metabolite meta-chlorophenylpiperazine (m-CPP). Independent tests of standards showed significant crossreactivity on the Ecstasy EMIT II assay with trazodone, m-CPP, and the related recreational drug trifluoromethylphenylpiperazine (TFMPP). This is of further forensic significance because m-CPP is emerging as an illicit recreational drug in its own right or as an adulterant in illicit cocaine and MDMA. The hallucinogen benzylpiperazine was also assessed but found not to cross-react significantly with this assay. Patients taking trazodone may get false-positive results on the urine EMIT test for MDMA.

Biochip array technology immunoassay performance and quantitative confirmation of designer piperazines for urine workplace drug testing

“…Trazodone and mCPP concentrations were 82-2827 and 58-2833 μg/L, respectively, in 18 patients' urine samples after trazodone consumption, with a mean trazodone/mCPP molar ratio of 1.2 (0.3-9.8) [19]. Similar ranges for trazodone (4.2-4218 μg/L) and mCPP (2.5-2277 μg/L) and a comparable mean molar ratio [2.4 (0.2-14.8)] were present in our urine specimens.…”

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

“…On the other hand, even after the washout period, we can not totally exclude contribution of trazodone in MDMA results in sixth and seventh urine samples which were 402 ng/mL and 197 ng/mL, respectively. 3 Specimen integrity tests such as creatinine, urine pH, specific gravity were detected within normal limits in all samples which reduces the possibility that the negative results were caused by diluted specimens or adulteration of urine (Table 1).…”

False‐Positive Results Using Immunoassays for Drugs of Abuse Testing

“…Dietzen et al reported that ranitidine if present in urine at a concentration over 43 μ g/mL may produce false -positive test results with an amphetamine screen using Beckman Synchron immunoassay reagents (Beckman Diagnostics, Brea, CA). In addition, another hallucinogen, trifl uoromethyl phenylpiperazine, also cross -reacts with the MDMA assay (25) . Poklis also reported that ranitidine interferes with the EMIT -d.a.u.…”