Working at an opioid treatment center, I get questions frequently from patients who are concerned about their positive urine drug tests. Overall, the tests are pretty good, but false positives can, and do, occur. Every different lab tests the urine samples with different reagents, or chemicals, so the doctor at your opioid treatment center should know what can cause a false positive at your particular lab.
First, a little about cocaine. The test for cocaine is very specific. The only thing that causes a positive for cocaine is cocaine. Despite similarities in the name, Novocain and lidocaine don’t cause a drug test to be positive for cocaine. No, it can’t be absorbed through the skin enough to give a positive, and if you are so close to cocaine that you’re handling it, I would say that counts as a positive anyway. Yes, it can be absorbed through mucosal lining – oral, vaginal, rectal – and again, that’s a true positive.
Benzodiazepines are a different story. I’ve worked at clinics where diphenhydramine (Benadryl) causes false positive results. That is, the patient didn’t take benzos, but the diphenhydramine made their test positive, so it looked like they are using benzos.
I tell patients to avoid diphenhydramine, which can be difficult, since it’s in most of the over the counter sleep aids. But diphenhydramine does interact with the metabolism of methadone, and needs to be avoided.
I had a patient test positive repeatedly for benzos, and she swore she wasn’t taking them. I believed her, and had her gather all the medications she had at home, prescription and over the counter. When we looked at them, she had a bottle of some kind of herbal stress-relief medication. On a hunch I asked her to stop this pill. Within two weeks her urine drug screen was negative.
I’m convinced this herbal remedy either contained a benzo, or a substance that caused a positive for benzos. There’s no FDA oversight with these herbal remedies, so the contents may or may not actually be what’s listed on the label.
So if you are testing positive for benzos, and know you haven’t taken any, consider stopping any herbal medicines that you are taking.
Posted by Melatonin Dosage ` on October 12, 2010 at 6:19 am
Herbal remedies take a long time to effect but at least they are way safer than conventional drugs“,
Posted by janaburson on October 12, 2010 at 12:16 pm
Actually, no, they aren’t. We have no safety data on herbal remedies, since they aren’t controlled by the FDA. Many herbs are fatal when injested, in fact.
Posted by UV Paint : on October 23, 2010 at 3:52 pm
herbal remedies are the best! i have some sprains and some indigestion and herbal remedies cured it-;.
Posted by Varistor on December 16, 2010 at 6:55 am
i used to do herbal remedies when having some muscle pains and they are really quite effective ;.:
Posted by timespentalone on December 28, 2010 at 2:34 am
Was this Valerian Root? It is an herbal remedy that has similarities to benzodiazepines in that it acts on the GABA alpha receptors…I am not a big believer in herbal “remedies”, but I ended up taking Valerian Root quite a bit these past few months (I am on MMT). I had no idea that it could cause a false positive until it happened to me – it was my first positive for anything ever in 6 months of treatment and they immediately cut my dose from 110mg down to 60mg in about 10 days. It was horrible. I did retest and it came back negative, and the nurse/counselor/doctor have all acknowledged that it was a false positive; however, I am still only at 80mg and they are not allowing me to go back up. I have been in treatment over 6 months and have done everything right including never being late on payments, never missing an appointment with my counselor, never missing a day, and no positive UAs, etc. I was amazed that after one FALSE positive, they would do this to me. I am committed to recovery and I do absolutely understand that the staff deals with addicts every day and therefore have reasons to not trust me, but why drop me so fast? And not let me go back up? And they also haven’t allowed me to have take-homes back. Is this normal? I have been dealing with a lot of BS at the clinic – they lost my blood tests, they did a tuberculosis test 3 times because they lost those results, the nurse told the doctor I was pregnant before an appointment one time and the doctor freaked out until I corrected her (don’t know why that happened), they have forgotten to record my payments (good thing I save receipts!)…I mean, am I incorrect in thinking that this is absolutely unacceptable for a medical facility?
I was stable on 110mgs – I would get sick in the mornings but it wasn’t something that I couldn’t deal with, and I don’t expect everything to be perfect…I know I have to work hard at this. However, I’m now at a dose that I am not comfortable at in the least – I feel sick from early afternoon on, and by nighttime it gets bad. And the cravings are back full force. I am taking extreme amounts of loperamide (I’m sure you know, this is an opioid that does not cross the BBB) to cope with the physical symptoms. I have PTSD and the mental problems are also extremely hard to overcome…I’ve been having panic attacks very frequently. I have told the clinic this and they don’t seem to care, they just brush me off.
Wow, sorry to unload here…I know this is an old post so I don’t even know if you’ll read this. I really do love your blog; I just discovered it and have been going through the archives. Just had to comment on this one and share my experience with the false positive – Valerian Root CAN cause this to happen, everyone, so be careful! If you have time to give me some feedback on my story that would be great and so much appreciated, as I am still in a bad position. I was thinking of contacting NAMA or the State Methadone Authority but I am so scared to be on bad terms with the clinic.
Thanks for being an advocate for MAT, it really does save lives…addicts are people too.
Posted by janaburson on December 28, 2010 at 10:54 pm
Actually, Valerian root was on the label. But when we did a more specific test (GC/MS), it turns out that her urine sample contained diazepam. I suspect this herbal compound had diazepam added to it during manufacture. There’s essentially no analysis or oversight on these type of compounds.
Either that, or she wasn’t being honest, and actually had taken Valium.
As for your troubles with your clinic…most clinics do have grievance procedures. When a good clinic receives a patient grievance, the clinic takes time to re-evaluate treatment decisions, to make sure the patient has had fair treatment. After all, no one is infallible, and sometimes other treatment team members can see mistakes made in a patient’s care. There’s no guarantee that you’ll get the decision you want, but it is a way to ask staff to re-consider decisions that have been made.