![]() ![]() The physical exam was unremarkable except for mild limitation of truncal rotation. He was not currently taking any medication for his pain, as his prescription from a previous clinician had run out. The definitive test, using chromatography and mass spectrometry, will identify the drug metabolites in addition to the parent drug - the only proof that the drug has been ingested and metabolized, rather than mixed into the sample after excretion (which happens more often than most clinicians think).ĭylan Tomkins, a 29-year-old Caucasian male, presented to your office one month ago as a new patient with chronic back pain he attributed to a motorcycle accident when he was 19. The test should then be confirmed using definitive methodology. Presumptive testing alone cannot tell you whether your patient ingested it or added it to the urine at collection in order to fool the test.Ī patient who has diverted their prescribed medications may keep one or more pills to “shave” into the urine sample which can lead to a positive presumptive drug class result, consistent with the prescription. A presumptive test should be confirmed using definitive analysis. A presumptive test can only tell you whether the urine sample contains the drug class. Many healthcare providers assume that a presumptive drug test, or screen, is all they need to ensure their patients are taking the prescribed drug, and that a positive test result for the prescribed drug class indicates prescription adherence. It poses risks to those receiving the medication, and risks for patients who should be taking it but are not. Drug diversion is a major source of prescription medication misuse. But access to medications, such as opioids or benzodiazepines, presents an opportunity to sell or trade medications to those who are not authorized to receive them. Many patients receiving a prescription for controlled substances may take their medication as directed. to adulterate someone else’s urine and then submit it for testing as their own, because the patient’s own urine will show presence of illicit or unprescribed medications.ĭetection of pill shaving requires definitive testing.to test positive for a prescribed medication the patient has not taken, often because the patient has diverted it for sale or trade for another substance or is saving it for use later.Pill shaving refers to the practice of scraping or crushing part of a pill to dissolve it in a urine sample. What can you do to rule out pill shaving? No problem, right?ĭetecting the parent drug won’t rule out the possibility that Dylan is “pill shaving” to pass the test, while diverting the bulk of the medication. The results from Dylan’s drug test are back, and they show presence of an opioid-consistent with the oxycodone you’ve prescribed him. ![]()
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