Pembroke
Bluelighter
I haven’t posted here in quite a while, so while I searched for an answer on this I apologize if I’m just not finding it. I have a clinical question that I cannot find an answer for. I’ve checked not only traditional sources like looking at articles, going through my pharmacology texts, and even asking colleagues and contacting some old professors; I’ve additionally checked google, Erowid, and a few other community-sourced sites with no luck. I remembered that there were quite a number of professionals on this site before, so I thought to give it a go here!
To the matter at hand: I have a patient on methadone maintenance therapy who has been stable and has not testes positive on random urinalysis for over a year. They tested positive this last week, but at a level that the counselor calls a “remnant”. I haven’t seen the secondary spect results yet in full, as the patient contested and so the sample was sent out for more conclusive testing.
The counselor is in support of this reading being the result of the hot weather and the patient’s workout routine, reporting that a level this low likely was diffused from fat breaking down. She has not seen or been reported any signs of relapse in this particular patient. It is worth mentioning that I have had cause to question this particular counselor’s level of professionalism and competence in the past and so am potentially biased, but I find her to be easily manipulated and just not very good at her job. I mention that only because it is a factor in my questioning here.
I have encountered a number of articles which discuss this phenomenon occurring in patients who were heavy users of cannabis in the past, where years later they may test positive for a miniscule amount of THC while in heavy training for a marathon or equally rigorous activity, but I cannot find any sources which definitively state the same is possible for heroin or fentanyl, or any opiate, really. Both opiates and opioids are known to have some level of lipophilicity, which suggests that it is possible, in theory, for the same thing to occur with opiate drugs. That said, saying it is theoretically possible does not provide a level of certainty that is sufficient to call this test an invalid fluke. I am going to have to present this information to this patient’s parole officer and they will be relying on my opinion on the matter to determine if this is a violation of the patients terms, and I am in a pickle. If this is likely a result of the patient breaking down fat, then I do not want to be responsible for their freedom and/or custodial situation being compromised; I equally do not want to risk misspeaking and risking the safety of a child in this person’s custody. I am kind of a prison abolitionist so if it were just that matter I wouldn’t be so conflicted, but the safety of the child is a great concern.
Does anyone know the answer to this? Do you know of studies or articles I could review which are specific to heroin and fentanyl? Or is the best practice in this circumstance to extrapolate the information from what is stated in the articles and studies which teated this hypothesis against false positives in marijuana cessation?
Thank you in advance for reading and pointing me in the correct direction! You are appreciated.
To the matter at hand: I have a patient on methadone maintenance therapy who has been stable and has not testes positive on random urinalysis for over a year. They tested positive this last week, but at a level that the counselor calls a “remnant”. I haven’t seen the secondary spect results yet in full, as the patient contested and so the sample was sent out for more conclusive testing.
The counselor is in support of this reading being the result of the hot weather and the patient’s workout routine, reporting that a level this low likely was diffused from fat breaking down. She has not seen or been reported any signs of relapse in this particular patient. It is worth mentioning that I have had cause to question this particular counselor’s level of professionalism and competence in the past and so am potentially biased, but I find her to be easily manipulated and just not very good at her job. I mention that only because it is a factor in my questioning here.
I have encountered a number of articles which discuss this phenomenon occurring in patients who were heavy users of cannabis in the past, where years later they may test positive for a miniscule amount of THC while in heavy training for a marathon or equally rigorous activity, but I cannot find any sources which definitively state the same is possible for heroin or fentanyl, or any opiate, really. Both opiates and opioids are known to have some level of lipophilicity, which suggests that it is possible, in theory, for the same thing to occur with opiate drugs. That said, saying it is theoretically possible does not provide a level of certainty that is sufficient to call this test an invalid fluke. I am going to have to present this information to this patient’s parole officer and they will be relying on my opinion on the matter to determine if this is a violation of the patients terms, and I am in a pickle. If this is likely a result of the patient breaking down fat, then I do not want to be responsible for their freedom and/or custodial situation being compromised; I equally do not want to risk misspeaking and risking the safety of a child in this person’s custody. I am kind of a prison abolitionist so if it were just that matter I wouldn’t be so conflicted, but the safety of the child is a great concern.
Does anyone know the answer to this? Do you know of studies or articles I could review which are specific to heroin and fentanyl? Or is the best practice in this circumstance to extrapolate the information from what is stated in the articles and studies which teated this hypothesis against false positives in marijuana cessation?
Thank you in advance for reading and pointing me in the correct direction! You are appreciated.
Compassion for drug users is more rare than it should be.