Knowledge is power! We have all heard this saying. In the world of drug testing this should be “Accurate knowledge is power.” All of you have patients come in and very convincingly share their “knowledge” of why their test was negative or positive. Without accurate knowledge, you and even the provider can sometimes be convinced of the patient’s story. Everyone has access to the internet and the ton of information, both correct and incorrect, that is out there. Some of your patients spend a LOT of time educating themselves on drug usage and drug testing. Without accurate knowledge when looking at a drug report, it is easy to begin to question yourself when an “internet taught” patient questions the results.
Drug metabolism is the chemical alteration of a drug by the body. Many drugs have a parent compound (analyte) which is chemically altered in the body to form one or more metabolites. If a patient is prescribed an analyte, such as Hydrocodone, Norhydrocodone (one metabolite of Hydrocodone) should be present if the patient is taking the drug as prescribed. Norhydrocodone stays in the system the longest and is an excellent indicator of Hydrocodone use. Hydromorphone (another metabolite of Hydrocodone) may also be present but typically is the first metabolite of Hydrocodone to fall below the cutoff. Hydromorphone can also be a stand-alone drug called Dilaudid. Using your accurate knowledge, let’s look at a case.
A patient is prescribed Hydrocodone. Their confirmation results come back from the lab with Hydrocodone positive, Norhydrocodone negative, and Hydromorphone positive. This patient is okay, right? Be careful. You know that the patient had Hydrocodone in their urine as they should. However, there is NO Norhydrocodone. So they either took the Hydrocodone just before their test and it had not metabolized yet, or they crushed the pill in their urine in an attempt to pass the test. The patient looks you in the face and with all the confidence of a river boat gambler, tells you the presence of Hydromorphone proves they took their Hydrocodone correctly. Due to your intense studying and accurate knowledge, you know that Hydromorphone can also be Dilaudid, therefore you realize the presence of Hydromorphone without the presence of Norhydrocodone, could mean this patient is taking Dilaudid. Perhaps this is a patient that should be randomly tested very soon.
Yes this really did happen. The provider called the lab and I was able to walk him through the exact scenario I just took you through. The lab is always here to help you with situations like this. As you gain more accurate knowledge your confidence in your ability to understand results will grow. As always, thank you for your business.
Lance Benedict
President/CEO Industry Lab Diagnostic Partners
01/25/2019