Urine thebaine determination by liquid chromatography tandem mass spectrometry after poppy seed consumption.

Laboratories are challenged to distinguish whether a positive urine morphine result is due to heroin use or possible poppy seed consumption. Thebaine is an opium alkaloid that has been shown to be present in the urine of individuals who have consumed poppy seeds, as well as those who have used opium. It is not present in heroin. We present a sensitive, specific liquid chromatography tandem mass spectrometry (LC-MS/MS) assay for thebaine. We show that thebaine is detectable after consumption of two different poppy seed-containing products for up to 72 h in urine. We discuss limitations of the assay and suggest how the test might best be used.

An automated assay for salivary amylase: A validity marker for oral fluid.

Oral fluid is a matrix well suited to use in teletherapy. However, in cases where direct observation is not possible, validity of the specimen is in question. We have adapted a commercial salivary amylase assay for use with the Quantisal™ oral fluid collection system. We have demonstrated acceptable analytical performance and determined a cutoff to distinguish valid from invalid oral fluid specimens. We determined that washing a donor's mouth with water was unlikely to a produce a falsely invalid result if the normal 10 min passes between drinking or eating and oral fluid collection. We conclude that the measurement of salivary amylase is useful for the determination of oral fluid specimen validity in cases where direct observation of the specimen collection is not possible. This feature would be most important in a teletherapy setting, which often does not include a video component. This study describes how an assay for salivary amylase may be used to establish possible substitution. This assay does not rule out adulteration.

Carfentanil Use in a Patient Undergoing Treatment for Substance Use Disorder.

Carfentanil is a synthetic opioid approximately 10,000 times as powerful as morphine. It is not approved for human use. However, cases of death associated with carfentanil have become more frequent in recent years. In this report, the case of a patient with a positive urine test for norcarfentanil (a metabolite of carfentanil) is described. The analytical method leading to the detection is summarized. This is a rarely reported case of survival of carfentanil use. It is unique in the published literature of an account of a norcarfentanil-positive patient concurrently enrolled in a substance use disorder treatment program. To the authors' knowledge, this is the first documented case of a carfentanil exposure in the state of New York.

A new automated assay for the detection of synthetic urine in drug testing.

Urine drug testing can be subject to attempts to dilute, adulterate, or substitute the specimen. Substitution may involve the use of commercially available synthetic urine. Current laboratory methods to detect specimen validity often fail to detect these products. We evaluated a new automated assay designed to detect synthetic urine. We determined that the assay met performance requirements and accurately identified five commercially obtained products as synthetic urine while not identifying known normal urine as synthetic. However, in a group of 843 patient urine samples, 40 of the 46 urine samples identified as "synthetic" were samples with creatinine <50 mg/dL. Fourteen of the 40 were actually positive for drugs of abuse. We conclude that the test is analytically valid but clinically limited. We recommend that it be used in conjunction with other indicators of synthetic urine. We suggest a scheme that would achieve this, and reporting terminology that would reflect the limits of the analysis.

Use of an Acetyl Derivative to Improve GC-MS Determination of Norbuprenorphine in the Presence of High Concentrations of Buprenorphine in Urine.

Certain patients being treated with Suboxone™ or Subutex™ can exhibit very high buprenorphine and low norbuprenorphine concentrations in urine. Very high buprenorphine can interfere with buprenorphine-D4 used as an internal standard, causing errors in norbuprenorphine determination by gas chromatography-mass spectrometry (GC-MS). We used a modified method of Wu et al. to introduce norbuprenorphine-D3 as a separate internal standard for norbuprenorphine. This allowed us to accurately measure norbuprenorphine in neat urine specimens when buprenorphine is present in extremely high concentrations. Laboratories measuring buprenorphine and metabolite by GC-MS may face this problem if their clientele includes patients being treated with other medications that interfere with the cytochrome p450 CYP 3A4-mediated conversion of buprenorphine to norbuprenorphine.