#1: Importance of the Prescribed Medications List
Recently Faye (ILDP’s executive administrator for those that do not know) received a phone call from an irate patient who claimed the addiction clinic where she attends told her the lab report stated she was positive for Benzodiazepines. Faye was able to calm the patient down enough to transfer her to me.
As I pulled up the requisition form, I noticed the only prescribed drug reported by the clinic was Suboxone. (Suboxone comprises of Buprenorphine, Norbuprenorphine, and Naloxone.) The test results revealed the patient positive for Buprenorphine and Norbuprenorphine (no Naloxone), as well as Amphetamines. No Benzodiazapines were present.
I quickly reviewed this patient’s historical documentation and she had never tested positive for Benzodiazapines. I did notice approximately 9 months ago the patient had positive results for Buprenorphine, Norbubprenorphine and Naloxone. The other 12 tests since then have been positive only for Buprenorphine and Norbuprenorphine with the most recent also being positive for Amphetamine.
Every requisition from the clinic stated the patient was prescribed Suboxone. So is this patient not taking Suboxone properly?, Benzodiazapines as the staff had asked? or Amphetamines? Should they be dismissed from the clinic for not taking drugs prescribed? As the famous Lee Corso, on Saturday game day says, “Not so fast, my friend!”
After calming the patient down she stated that she had just had a baby. Ah Ha! Clue number 1. She had been pregnant the last 9 months. Why does this matter, you ask? The reason is most providers will change a pregnant woman from Suboxone to Subutex so they are not exposed to Naloxone. Remember, we were only seeing a positive Buprenorphine and Norbuprenorphine for the past 9 months without the Naloxone (Narcan) that should have been there if the patient was taking Suboxone. The patient confirmed she had been switched to Subutex when she told the provider she was pregnant.
Clue number 2 occurred when the patient told me she had recently been put on Sertraline (Zoloft). Zoloft is a drug that commonly causes a false positive for Benzodiazapines on a screening analyzer or a cup test. There is a good chance she was positive on the clinic’s analyzer for Benzodiazapines but negative when confirmed at the lab.
Finally Clue number 3 the patient also told me she was prescribed and taking Adderall. Thus the positive Amphetamine result. This patient’s drug results were correct and she is taking her prescribed medications. The Requisition form sent with the patient sample should have indicated SUBUTEX, ADDERALL and ZOLOFT on the prescribed medication list.
You can see why it is important to make sure the prescribed medications are current whenever a sample is sent and also why clinical decisions should never be made just off of a patient’s screening test. We are always here to help and answer questions. As always we thank you for your business.
Lance C Benedict
President/CEO Industry Lab Diagnostic Partners