Nearly every American is familiar with Robitussin® — many households keep a bottle on hand to treat symptoms of the common cold in adults and children alike. What many people may not realize is that the active ingredient in Robitussin®, dextromethorphan, can be consumed in large doses to produce a high. This is known colloquially as “Robo tripping.”
Dextromethorphan (DXM) is widely available over-the-counter, which can create a significant challenge to healthcare providers in the area of addiction treatment. Some patients abuse DXM in attempt to get high while avoiding consumption of other street drugs that are more likely to be detected by a drug screen.
What are the negative side effects of “Robo tripping”?
Some of the most common effects are heart arrhythmia, large blood pressure swings from high to low, hallucinating, dizziness, nausea, vomiting, and confusion.
According to the U.S. Drug Enforcement Administration, abusers of dextromethorphan experience four levels of behavioral effects:
100mg – 200mg
200mg – 400mg
Euphoria & hallucinations
300mg – 600mg
Distorted visual perceptions, loss of motor coordination
|500mg – 1500mg
*Chart cited from https://www.deadiversion.usdoj.gov/drug_chem_info/dextro_m.pdf#search=robo%20tripping
Since testing for DXM is not currently available on point-of-care cups or immunoassay instruments, lab-based testing is the only way to detect abuse. Confirmation testing, also known as definitive testing, is performed using highly-sensitive techniques such as liquid chromatography tandem-mass spectrometry (LC-MS/MS). This methodology can distinguish DXM from other morphine-derived synthetic drugs and is not offered by all laboratories, however it is available through Keystone Lab.
If you are concerned that a family member or patient is abusing DXM, contact Keystone Lab for a consultation.
Lab-based testing can help you detect drug diversion
Today, drug testing has more uses than just identifying illicit drug use in the workplace. Keystone Lab’s medication monitoring program can help healthcare providers identify adherence to (or departure from) prescription drug therapy.
When a patient is prescribed a medication such as an opioid, periodic drug testing helps ensure that the medication is being taken as directed. However, some patients may divert their medications for several reasons: to sell them, trade for a preferred drug, or to give them to family members.
As an increasing number of practices are implementing random drug testing programs, some patients are looking for ways to hide diversion from their healthcare provider. One such way is by scraping small amounts of their pills into urine specimens to cause a positive result for the drug they are selling or giving away (diverting).
Providers who only use point-of-care (POC) cups for drugs screens can be deceived into thinking their patient has been compliant with their treatment regimen. For this reason, all providers should enlist an accredited laboratory such as Keystone for confirmation testing of prescribed drugs.
How does confirmation testing identify incidents of pill-scraping?
Confirmation testing, also known as definitive testing, is performed using highly-sensitive techniques such as liquid chromatography tandem-mass spectrometry (LC-MS/MS). Far more accurate and precise than a POC cup, confirmation testing can also identify metabolites of specific drugs.
If a patient scrapes part of a pill into urine, only the parent drug will be identified and typically at unusually high concentrations. Most notably, the metabolite(s) of that drug will not be detected, suggesting that the drug never passed through the body.
Drug diversion creates significant societal risks and creates a liability for prescribing providers. Contact Keystone Lab today to learn more about how lab-based testing can improve your patients’ healthcare outcomes.
Lab chemist of the Massachusetts state drug lab Annie Dookhan was once referred to as “Superwoman” for the speed in which she ran drug tests. It turns out she tripled productivity by not actually testing every drug sample that came through her lab. Instead, she conjured results and then mixed the samples so they matched her fiction.
Now her fraudulent work calls into question the convictions of tens of thousands of drug cases handled by Dookhan in the Massachusetts state drug lab. In fact, prosecutors in eight Boston-area counties announced they would dismiss 21,587 drug cases tainted by Dookhan’s misconduct.
Accuracy, Reliability…They Matter
Using fraudulent data is worse than using no data at all. Lab technicians like Dookhan forget that at the end of every drug test is a person whose livelihood, whose lives, depend on the results. Labs that value speed and efficiency over accuracy should be your last choice for drug testing. There’s just too much at stake.
Wolfe is a forensic certified lab, meaning our tests meet the highest standards, including a strict chain of custody. Our results are consistent and defensible in court. Don’t settle for less and don’t trust results based on how quickly they arrived. Precision is what matters most. Your lab must be trustworthy.
Read the “How a lab chemist went from ‘superwoman’ to disgraced saboteur of more than 20,000 drug cases” in the Washington Post.
If you’re reading this blog you likely know that drug testing can be used to screen for illicit drug use, but it can also be used to monitor for adherence to prescribed treatment. In short, a drug test can give you a simple answer or if it’s an advanced test with an in-depth interpretation it can tell you a story. One of the stories it can tell is, is the patient using a technique to divert their medication?
What is Pill Scraping?
When a patient intends to divert their medication and still convince their provider they are taking it, they may scrape a bit of the pill into the urine sample. In this case, the patient wants a false positive. How does an advanced test show a patient is pill scraping? The report shows the compound being tested for but not the metabolite that proves it was ingested.
Why Quantitative Testing?
Quantitative testing can also confirm specific opioids (hydrocodone or morphine?) and identify poor conversion of prodrugs. That with confirming metabolites gives a health care professional more information that the simple yes or no of an immunoassay test. It gives more of the story, more data with which to make a decision for further care.
Quantitative testing is an invaluable tool for compliance monitoring. If you’d like to find out more, call 844-551-2857.
This week New York Magazine called the Opioid Epidemic This Generation’s AIDS Crisis. The article points out that 52,000 people died of drug overdoses in 2015, which is more deaths than the peak year for AIDS, 51,000 in 1995. Unlike AIDS in 1995 though, there’s no reason to think the worst is over. The author believes this new epidemic has played a role in the decline of life expectancy in the US. The last time the life expectancy in this country declined was in 1993, because of AIDS. This article goes beyond the numbers to focus on the isolation of opioid addiction and states that cuts to Medicaid spending will only make things worse. AIDS treatment saw ever increasing funding and the solution for many who suffered from this disease was pharmaceuticals.
Which brings us to this…
Companies have created painkillers that are tougher to abuse and cities have increased the availability of Naloxone for first responders to stop an overdose in process. Now scientists are focused on painkillers that don’t create feelings of euphoria. One company is Nektar Therapeutics, which is currently studying a new drug candidate that enters the brain too slowly to cause the feelings of euphoria that many painkillers are known for. You can read more about this research here in Business Insider.
Those who work in addiction monitoring probably won’t be shocked by these numbers. But cities across the country continue to be overwhelmed by the number of heroin overdoses they must respond to. Recently, Louisville, Kentucky received 52 calls for overdose in 32 hours. That’s more than one call and hour. And it was double the amount from the week before.
According to the story on CNN, doctors are administering higher doses of Naloxone because the heroin is getting stronger all the time. With ever more addicts taking ever stronger heroin, it’s a huge worry for first responders, for hospitals, for any system that must absorb the cost of the disease. In the meantime, addiction treatment based on real data is vital. Health workers and caregivers need to know what the facts are in order to choose the best course of action.
We enter the new year faced with some sobering statistics. First, that Opioid addiction is at an all-time high. Opioid deaths have now surpassed those of car accidents. Opioid addiction is hitting rural areas the hardest. And perhaps the saddest of all, neonatal abstinence syndrome (NAS) has increased fivefold across the country over the last decade. In others words, more babies are born addicted and going through withdrawal than ever before.
According to new research published in JAMA, babies going through withdrawal increased from 1.2 to 7.5 per 1,000 hospital births among rural infants and 1.4 to 4.8 per 1,000 births among urban infants.
Perhaps the most surprising aspect of this study is the disparity between infants born in rural vs. urban hospitals. NAS is hitting rural areas the hardest and rural hospitals are straining to deal with so many cases of opioid-addicted babies.
The Role of Drug Testing Pregnant Women
The issue creates complications for OB/GYNs who are beginning to screen patients for opioid use. Many have turned to risk-based screening and some advocate for universal screening. While controversial, advocates of universal testing say it’s fairer than targeting only high-risk populations. And frankly, opioids are high-risk for every demographic.
A study by Scott Wexelblatt MD, a neonatologist at Cincinnati Children’s Perinatal Institute, led between 2012 and 2013 found 5.4% of all mothers had a positive drug test on admission and 3.2% of the mothers tested positive for opioids. “Opioids are what we worry about most,” he explained. “Among newborns exposed to opioids in utero, between 55 percent and 94 percent develop withdrawal signs—and 30 to 80 percent of those need pharmacologic treatment.”
Wolfe is proud to work with OB/GYN doctors who screen for opioid use and support mothers and babies who need help combatting addiction. If you’d like to find out how we can help, give us a call at 844.551.2857.
We don’t have to tell you what a big problem opioid addiction is. You have patients with legitimate health issues that require some kind of pain relief. You have patients who’ve become addicted and seek ever more opioids to satisfy their craving for the drug. Then you have diverters, patients who seek pain medication they can sell on the black market. Here are 5 signs the patient in your examining room might be a diverter:
1. Impatience. Diverters often have strange stories about why they need the medication right away. Perhaps they are just about to catch a flight somewhere and need the medication immediately. Or they are on their way to an important appointment. Diverters show up at the end of the day, close to or just after visiting hours. They create a sense of urgency that may keep a doctor from asking questions or doing more research on the patient’s condition.
2. Reluctance to Cooperate. If creating a sense of urgency doesn’t work, a patient intending to divert medication might refuse a physical exam or give permission to access past medical records. These patients tend to leave the office suddenly if it looks like they won’t get their way.
3. An unusually high or low understanding of medications. Not every patient who has knowledge of their condition and the medication to treat it are diverters, but it’s another sign that they might be. Patients that have an almost textbook description of the medication or a patient who mispronounces or feigns ignorance about the medication is suspect.
4. Specific Drug Request. Again, a patient may know what’s worked in the past and ask for a specific medication. Diverters tend to request a specific drug and balk if a physician tries to offer a generic version or something other than what was requested.
5. Strange Symptoms. Diverters tend to exaggerate or feign symptoms. They have been known to drop blood from a pricked finger into a urine sample. If something seems not quite right, it usually isn’t.
If you’re interested in finding out how medication monitoring can inform your prescriptions, give us a call at 844.551.2857.
Trusted Answers for Your Medical Specialties
Medication Monitoring provides empirical evidence of a patient’s adherence to, or departure from, the pain treatment protocol. Want to reduce your vulnerability to regulatory examination and get some peace of mind? Medication monitoring is the way to go.
Keystone supports the treatment of drug addiction by helping physicians monitor the elimination of drugs both prescribed and illicit from the patient’s system. We use LC/MS/MS because it’s sensitive and specific and because it’s the most advanced technology in the industry.
Workplace safety matters. That’s why Keystone offers a complete line of lab-based drug and alcohol tests to help you make informed decisions about your current and prospective workforce.
Keystone Lab services improve patient outcomes and lessen insurance claim costs by providing support for improved pain treatment.
I’ve written a series of posts about sexual abuse in both public and private schools. It’s something I think about now as I send my own son back to school at the end of this month. He is in someone else’s hands for 7 hours a day and I have to believe that the staff at his school has done its due diligence to protect him from predators.
Schools should be worried about it too. A sexual assault can do unspeakable damage to the student, the student’s family and to the school community. As word spreads, a school’s reputation is damaged. Why didn’t they know what was going on? Don’t they screen who they hire to teach our children? These are valid questions. A parent-school relationship is based on trust.
Another school reaches a settlement
This month 28 formers students reached a financial settlement with St George’s School in Rhode Island, the New York Times has reported. The exact terms of the settlement have not been disclosed. What we do know is that seven former teachers were accused of sexual abuse over 30 years. Seven teachers. This doesn’t happen by accident. Sexual predators are looking for ways to become authority figures to children. And when one employer becomes suspicious, the abuser simply moves to another school. Two of the seven accused at St. George’s are still working in a setting with children, the Times reported in January.
Every school, church or organization needs to ask itself, if every employee has been screened. Wolfe’s background screening can dig up employment records and criminal history whether the applicant has lived in Los Angelos or Kuala Lumpur. It’s a step in the employment process that can save years, decades of heartache for everyone. Have you screened your staff? If you need more information about background screening, give us a call at 800.230.2991.