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  • Hey Shoreline, question about methadone and driving

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    Old 06-12-2004, 09:18 PM   #1
    rlcowboy
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    Hey Shoreline, question about methadone and driving

    Hey man I hope all is doing well with your new pump, I know you are having to tapper off the Methadone so I just hope that goes ok for you. I was wondering if you could answer a question for me and my Dad. My dad says that it is against the law to drive while I'm on methadone, but I take methadone because it has no side effects at all, so I hope I can get the ok from my PM doctor on Wed. to drive, what do you think about this?
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    Old 06-14-2004, 10:02 AM   #2
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    Re: Hey Shoreline, question about methadone and driving

    Hey Cowboy, This is a topic that gets debated often, Yes we become acommadated to the side effects and feel as if we are not too impared to drive.

    However the if your pulled over for any reason and a police officer sees that your pupils are smaller than normal or suspects in any way that you are impared he can arerst you for driving under the influence, It's not just meth, It's any prescription drug that causes CNS supression. If you were in an accident and taken to the hospital they would likely run a tox screen and find opiates, you would then be charghed with DUI or DWI, whatever your particular state calls it.

    As comfortable as we may feel driving, if stopped, and a road side sobriety test determines you are impaired, which is totally subjective, you will be charged. You will be jailed and you will pay the same price as the person that drinks a liter of jack and gets behind the wheel.

    A woman in california was charged and convicted with DUI and involentary manslaughter when she was involved in an acciddent that killed her husband, due to the prescriptions for Vicodin and flexerill she was presently taking. Even driving under the influence of OTC medication that makes you drowsy is grounds for DUI.

    IF the meds says it may impair driving or don't operate heavy machinery etc, you are guilty if cought. If you cross a line lighting a cig, If you accidently drive over the curb if front of a police officer, you can be stopped, a roadside sobriety test will be performed and you will be charged.

    A freind at another forum was run over by a lady that that was taking prescription drugs, After 30 or so surgeries to save the leg he had it amputated a few months ago, about the same time the case went to court and the woman was found to have CNS depressants of some sort in her system and is now serving time in prison, not jail, prison. I think she was taking Vicodin and Xanax as prescribed, but these drugs are considered CNS depressants and it's the same thing as drinking. Her defense was she had been taking these meds for several years and felt she was completely acomadated to all side effects, the court system found differently.

    The only chance I can think of is that meth isn't a drug they normally check for in a standard drug panel test. When testing for opiates they usually test for the metabolites from opioids, products derived from opium, Morphine, Heroin and codeine, however more advanced tests can find meth.

    Your best bet is to undertand the drug testing system, most of the test administered are presumptive only and must be confirmed by further testing, specifically by GC-MS
    "gas chromatographic-mass spectrometry"
    If a lawyer is worth is salt, he needs to understand the testing system and can refute the results of a UA or BLod test "immunoassays" without confirmation. It actually says on the packaged test that the results are purely presumptive and confirmatory testing must be done.

    Most people that have been terminated or denied employement due to positive UA's have been done so by presumptive testing only, However people don't understand the chemistry and methods involved to bring suites against the employers for denying or fireing someone for an unconfirmed test.
    The next posts are some tech info, about oxycocodne and other Keto opiate testing but the same applies to methadone when it comes to confirming presumptive UA's or blood tests.
    Take care, Dave

    Last edited by Shoreline; 06-14-2004 at 10:27 AM.

     
    Old 06-14-2004, 10:14 AM   #3
    Shoreline
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    Re: Hey Shoreline, question about methadone and driving

    Summary:
    Most laboratories use commercially available immunoassays to screen for opiates in urine. They do not normally confirm presumptive positive screening tests. These immunoassays were designed to detect use of the opiates - heroin, codeine and morphine but not other opiates such as hydromorphone, hydrocodone and oxycodone, etc. Clinicians and other users of laboratory services are often unaware that opiate screening methods are unable to reliably detect oxycodone use/abuse. Because of the potent analgesic effects of oxycodone, this drug is often used in pain clinics.

    In 2001, medical directors of pain management centers in Canada were concerned about oxycodone diversion, i.e. selling on the street, by some of their patients. Because of these concerns, urine drug screens were ordered in several smaller centers. Since the test results might be "negative" for oxycodone screening., individual patients could be wrongfully identified as diverting their prescription drugs to others. To resolve these concerns, urine specimens must be analyzed specifically for oxycodone by GC/MS or another robust methods in order to obtain an accurate indication of oxycodone use by these patients. Further, clinical and forensic laboratories may be unaware that one cannot adequately screen for oxycodone use by commercially available opiate immunoassays. In areas where oxycodone abuse is known or suspected, laboratories providing blood and/or urine drug screening services should alert their users about the limitations of their ability to screen for oxycodone. Thus, the emergence of oxycodone as a popular drug of abuse highlights the importance of on-going communication between the laboratory and the end users. The laboratory should update the users on the advantages and limitations of blood or urine drug testing.
    Oxycodone can be extracted from biological fluids by either liquid/liquid extraction or more recently, solid phase extraction techniques. Solid phase extraction techniques utilize C18, C8, or copolymeric columns. For greater sensitivity and detection, enzymatic hydrolysis with beta-glucuronidase can be used to increase the recovery of oxycodone from biological fluids.

    Methods used for the detection of 6-keto-opioids, such as oxycodone, include commercial immunoassays, thin-layer chromatography (TLC), liquid chromatography (LC), automated liquid chromatography (REMEDi), liquid chromatography-mass spectrometry (LC/MS), gas chromatography (GC), and gas chromatography-mass spectrometry (GC/MS). Despite the numerous techniques, only gas or liquid chromatography coupled with mass spectrometry is the acceptable confirmation technique for quantification of opiates - morphine and codeine ( Note - oxycodone is not currently included as one of the SAMHSA analytes ) in urine according to the Department of Health and Human Services (DHHS) guidelines for drug testing of federal employees (12).

    In general, immunoassays are not well suited for the detection of 6-keto-opioids, such as oxycodone, due to the low antibody cross-reactivity of the commercial opiate kits. Cone et al. showed that each of the 6-keto-opioid compounds had concentration-dependent cross-reactivities in commercial opiate immunoassays, and each had the potential to produce positive urine screening results (13). Furthermore, Smith et al. compared several commercial immunoassays to GC-MS and demonstrated that oxycodone present in urine was detected by TDx opiates (TDx; Abbott Laboratories) and the EMIT d.a.u. opiate assay (EMIT; Syva) for 6-24 hrs. However, the quantitative responses from these assays expressed as ng/ml of morphine equivalents were substantially lower than GC/MS determinations (8). As a result, immunoassays are not well suited for monitoring the therapeutic use, compliance, or abuse of oxycodone. Therefore, it might be advisable to confirm any immunoassay screening tests with increased urine opiate concentrations by using a suitable chromatographic method.

    Toxi-Lab ATM thin-layer chromatography (TLC) drug detection system can also be used for the detection of oxycodone in urine specimens. However, therapeutic dosages of oxycodone might be below the detection limit of this system at 1.0 mg/L in 5ml aliquots. However, Gobar et al. demonstrated that oxycodone in urine samples of pain management patients was detected by TLC and then confirmed by GC/MS with cutoff limits of 300 ng/ml for both assays (15). Furthermore, the sensitivity and specificity for both assays were 72.7 and 84.2%, respectively.

    Oxycodone can also be detected and/or quantitated in biological fluids by gas chromatography with FID or NPD detection. Confirmation by GC/MS in the full scan mode shows principle peaks at m/z 315, 230, 70, 258, and 140. GC/MS utilizing selective ion monitoring (SIM) of principle ions will increase assay sensitivity so that detection limits of 10 ng/ml can be achieved. At these detection limits, therapeutic use, compliance, and oxycodone abuse can be monitored.

    In GC/MS, the choice of derivatization agents is one of the most important factors in the accuracy and precision of the method. Many derivatizing agents can be used including acetic anhydride (16), bis-trimethylsilytrifluoroacetamide/trimethylsilyl (BSTFA/1% TMS) (17), heptafluorobutyric anhydride (HFBA) (17), pentafluoropropionic anhydride (PFPA) (17), and MBTFA (18). Problems encountered with some GC/MS methods include instability of derivatives, poor chromatography, unsuitable ions and abundances, incomplete derivatization, derivatization side reactions, inadequate recovery, loss during hydrolysis, extended run times, and interference or coelution of other opiates (19).

    Recently, an improved GC/MS method for the simultaneous identification and quantification of opiates in urine was reported (20). In this method, methoxyamine was used after enzymatic hydrolysis to form methoxime derivatives of the keto-opiates, which were extracted using solid-phase columns and derivatized with propionic anhydride/pyridine. This method demonstrated acceptable precision, the lack of cross-interference from other opioids, short analysis time of about 6.5 min, and a small sample volume of 2.0 ml urine.

    Finally, LC/MS has been used to determine the concentration of oxycodone in plasma (21). This method was selective and rapid with a analysis time of 2 min. A small sample volume of 1 ml plasma was alkalinized and extracted with 2% isoamyl alcohol in n-butyl chloride. After evaporation and reconstitution in 15% methanol-85% water containing 0.1% acetic acid, the sample was analyzed by LC/MS. The limit of quantification was 1 ng/mL., and the limit of detection, 33 pg/ml. In addition, this method was linear from 1 to 100 ng/mL. In comparison, an automated LC - REMEDi is capable of screening with a sensitivity of 150 ng/mL. However, the major problem is that oxycodone is eliminated quickly from the blood as a result of its short half-life.

    Overall, the analysis and quantification of oxycodone is increasingly important as its use and abuse becomes more widespread. In addition, pharmacogenetic typing of individuals taking oxycodone may be recommended, because oxycodone is metabolized to oxymorphone by cytochrome (CYP) 450 2D6. This enzyme is polymorphic with a prevalence of three mutations *3, *4, and *5 in about 10% of the general population (22). In fact, 95% of individuals classified as poor drug metabolizers have one or more of these mutations. They are more likely to experience severe toxicity or therapeutic failure. Thus, pharmacogenomics, in the near future, might become an integral part of pain management to individualize oxycodone and other drug therapy with minimized adverse reactions.

    References
    1. Baselt, R.C., Disposition of Toxic Drugs and Chemicals in Man, Fifth Edition, Chemical Toxicology Institute, Foster City, CA, 2000, pp. 644-645.

    Here is some more basic drug testing info.
    Laboratory Methods
    Laboratory detection of morphine and codeine is performed by immunoassay. Confirmation is by gas chromatography/mass spectrometry (GC/MS).

    Cutoff and Detection Post Dose
    The detection limit of the initial screen is 300 ng/ml, with a sensitivity of 20 ng/ml. This is sufficient to detect heroin use for approximately 24-48 hours post dose and codeine for somewhat longer. Positives are confirmed on GC/MS at a cutoff level of 300 ng/ml.

     
    Old 06-14-2004, 10:16 AM   #4
    Shoreline
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    Re: Hey Shoreline, question about methadone and driving

    Office of the Armed Forces Medical Examiner, Armed Forces Institute of Pathology, Washington, DC 20306-6000.

    Opiate testing for morphine and codeine is performed routinely in forensic urine drug-testing laboratories in an effort to identify illicit opiate abusers. In addition to heroin, the 6-keto-opioids, including hydromorphone, hydrocodone, oxymorphone, and oxycodone, have high abuse liability and are self-administered by opiate abusers, but only limited information is available on detection of these compounds by current immunoassay and gas chromatographic-mass spectrometric (GC-MS) methods. In this study, single doses of hydromorphone, hydrocodone, oxymorphone, and oxycodone were administered to human subjects, and urine samples were collected before and periodically after dosing. Opiate levels were determined in a quantitative mode with four commercial immunoassays, TDx opiates (TDx), Abuscreen radioimmunoassay (ABUS), Coat-A-Count morphine in urine (CAC), and EMIT d.a.u. opiate assay (EMIT), and by GC-MS. GC-MS assay results indicated that hydromorphone, hydrocodone, oxymorphone, and oxycodone administration resulted in rapid excretion of parent drug and O-demethylated metabolites in urine. Peak concentrations occurred within 8 h after drug administration and declined below 300 ng/mL within 24-48 h. Immunoassay testing indicated that hydromorphone, hydrocodone, and oxycodone, but not oxymorphone, were detectable in urine by TDx and EMIT (300-ng/mL cutoff) for 6-24 h. ABUS detected only hydrocodone, and CAC failed to detect any of the four 6-keto-opioid analgesics. Generally, immunoassays for opiates in urine displayed substantially lower sensitivities for 6-keto-opioids compared with GC-MS. Consequently, urine samples containing low to moderate concentrations of hydromorphone, hydrocodone, oxymorphone, and oxycodone will likely go undetected when tested by conventional immunoassays.
    ....................................
    Hey cowboy,
    Hopsital drug testing is never confirmed by GC-MS, It has to be sent to a forensic lab to for confirmation by more advanced testing methods than available at your local hospiatal. A non confirmed test should be easily thrown out of court since it's a recognized standard of need to confirm any UA "Immunoassay testing" with gas chromatographic-mass spectrometry

    Be careful driving, Dave

     
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