[lemmiwinx]

Hi all,

I just recently got back on to rotations after a jacked up incident at a site in october; the terms were that they were going to let me back on rotations beginning in march provided I renewed my TB test and drug screen by January 31st. I did this on the 27th; however, I got a call around lunchtime from the school telling me my urine sample was dilute and had to do my drug test over -- today by 5:00 p.m. While making it to the site to retest wasn't a problem, I am somewhat worried that I might fail the retest because last night (1/30) at about 10 p.m. I ate two bagel dogs (hot dogs wrapped in a poppyseed bagel). I got the call about 1 p.m. Today and tested at about 3:45 p.m. I don't know the results since I just took this today, and don't use any drugs, I just drink a lot of water. Am I probably OK?

[DrBill100]

Poppy seeds can definitely register on drug tests at both the screen and confirmation levels. "..Typically, poppy seed bagels, muffins, Danish, and Streusel contain morphine in amounts of 1, 2, 6, and 6 mg per piece, respectively, so that consumption of a single muffin, Danish, Streusel, or 2 bagels can produce a positive opiate EIA at the 300 ng/mL* morphine level of detection and the test can remain positive for 24 hours after ingestion" (Tenore, 2010, p. 442).

*not all screens use a 300 ng cutoff. Federally regulated tests use 2000 ng.

Ref:
Peter L. Tenore MD, FASAM (2010): Advanced Urine Toxicology Testing, Journal of Addictive Diseases, 29:4, 436-448 [see section denoted Poppy seed, beginning at p. 442]

[lemmiwinx]

Thanks DrBill,

I'm not sure exactly what cutoff they are using, but I don't think this is a regulated test (or at least that's what the receipt says). I expressed this concern to the examiners giving my test and their response was 'oh, it shouldn't be any problem; it would take handfuls and handfuls of poppyseeds to fail a urine test because of it.' still, I find that hard to believe because of stories I read similar to mine where the person only ate 2 or 3 bagels and still tested positive for opiates.

[DrBill100]

80% of drug tests are non-regulated and use the 300 cutoff. That makes it essential that those involved in testing and interpreting same are properly informed. If you were advised that poppy seed must be consumed in significant quantity that is wrong. There are many studies on this matter, dating across several decades. The reference above (Tenore) is one of the more recent, concise and easy to read.

Please keep us posted on the results and should you need further confirmation just ask.

[lemmiwinx]

Thank you DrBill, I will be sure and let you know how everything goes.. I hope this doesn't mean having to go round two with the school, I just got all of the testing and being placed on suspension in October dealt with :/ if it does, I may need to seek an attorney. At the confirmation level would they be able to tell the difference between poppyseed ingestion and opiate abuse?

[DrBill100]

At the confirmation level would they be able to tell the difference between poppyseed ingestion and opiate abuse?

They could not. Poppy seeds are a direct product of the opium poppy, Papaver somniferum. Not a cross-reaction or false positive. The positive result derives from the actual presence of morphine. The only contraindicator would be in quantitation of the morphine. Opiate abuse would lead to greater amounts of the analyte v. the relative low levels present from ingestion of food. That of course requires expert interpretation of the test. Too often absent. It's lucky that you advised someone of your concerns. If I were you I would make a written notation of that action including the individual's name and time of occurrence.

The foregoing assumes the worst case scenario. While poppy seeds can result in a positive it is more likely that such will not occur. But it is always advisable to be prepared.

What should occur, in the event of a confirmed positive, is that a Medical Review Officer (MRO) would contact you prior to the reportation. At that point you could explain the circumstances and hopefully the positive would be reclassified by the MRO and reported as negative.

[lemmiwinx]

DrBill,

If they contact you before just assuming and reporting it, that is good to know! I will let you know what happens; preparing for the worst, but hoping for the best in the mean time

[DrBill100]

Please understand that the procedure I outlined is how drug testing is supposed to be conducted as established by research, standard protocol and MRO practice guidelines.

In the non-regulated field these guidelines are often ignored. Drug tests are often reported with no more than a "presumed positive" based on the initial screening procedure absent even confirmation.

That can be determined by the lab report. Let's just hope it doesn't come to that.

[lemmiwinx]

Got my results back and it was negative; glad nothing came of it! :)

[DrBill100]

So glad to hear that. Saves you a world of problems! Good luck to you in your program and career.

[STILLSTUNNED]

I had eaten a poppysee muffin on a Monday morning for breakfast. I had an appointment with the pain doctor at 2:00. I was asked to do a urine test at 2:30. My 2 dosages that I had taken of my medication 7:30 and 12:30 did not show in my urine so I was deemed as one of those people who must overuse their medications.
So the doctors sent my urine to be analyzed further. A few days later the report my urine test showed "tracings" of morphine.

I began to doubt my sanity!! I was then dropped from my pain contract. No refills to help me find another doctor etc. - just goodby. I was on a very high dosage, so I really suffered. I felt so abandoned. Is't there some law to prevent doctors from cutting you off just like that.

I had to go to a detox center at $2000.00 a day.

I AM JUST SO TOTALLY INNOCENT AND DIDN'T DESERVE THIS ABANDONMENT AND TREATMENT (OR LACK OF).

[DrBill100]

I had eaten a poppysee muffin on a Monday morning for breakfast. I had an appointment with the pain doctor at 2:00. I was asked to do a urine test at 2:30. My 2 dosages that I had taken of my medication 7:30 and 12:30 did not show in my urine so I was deemed as one of those people who must overuse their medications.
So the doctors sent my urine to be analyzed further. A few days later the report my urine test showed "tracings" of morphine.

I began to doubt my sanity!!!! I was then dropped from my pain contract. No refills to help me find another doctor etc. - just goodby. I was on a very high dosage, so I really suffered. I felt so abandoned. Is't there some law to prevent doctors from cutting you off just like that.

I had to go to a detox center at $2000.00 a day.

I AM JUST SO TOTALLY INNOCENT AND DIDN'T DESERVE THIS ABANDONMENT AND TREATMENT (OR LACK OF).

Your experience is all too frequent. It is particularly prevalent in the pain medicine practices and manifests time and again when patients are prescribed semi-synthetic opioids such as Oxycodone, Hydrocodone, etc.

The two noted drugs, for instance, are fast acting and do not register on standard opiate panels, even at a cutoff 0f 300ng. They must be specifically tested for. Add to that the fact that only about 12% of MDs, even those that regularly order drug test, understand the pharmacokinetics of the specific drugs they prescribe, and you have a prescription for disaster. An additional factor is that many of these tests are unconfirmed, Immunoassay only, and a false positive rate of 5-10% and false negative of 10-15% is expected at this screening level.

These issues are regularly addressed in professional journals over the last 10 years. But nothing has improved.

Reference:

WebMD
Reisfield, 2007, Jnl of Opioid Management
Standridge, 2010, American Family Physician