Unresolved Discrepancies between Cannabinoid Test Results for Infant Urine

Barakauskas, Vilte; Davis, Rebecka; Krasowski, Matthew D.; McMillin, Gwendolyn A.

doi:10.1373/clinchem.2012.190090

Cited by 11 publications

(3 citation statements)

References 8 publications

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“…Long term, prenatal marijuana exposure may have adverse effects on learning, attention and behavior [5]. Three urine specimens in our study screened positive for THC but showed negative confirmatory testing, a phenomenon previously noted in other studies [24, 25]. …”

Section: Discussionsupporting

confidence: 76%

Retrospective analysis of the diagnostic yield of newborn drug testing

Wood

Sinclair

Rysgaard

et al. 2014

BMC Pregnancy Childbirth

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BackgroundThe objective of this study was to identify high-yield screening risk factors for detecting maternal non-medical drug use during pregnancy.MethodsA four year retrospective analysis was conducted at an academic medical center. Detailed chart review of both the newborn and mother’s medical record was performed on all cases for which one or more drug(s) or metabolite(s) were identified and confirmed in meconium or urine.Results229 (9.2%) of 2,497 meconium samples out of 7,749 live births confirmed positive for one or more non-medical drugs. History of maternal non-medical drug and/or tobacco use in pregnancy was present in 90.8% of non-medical drug use cases. Addition of social risk factors and inadequate prenatal care increased the yield to 96.9%.ConclusionsUse of focused screening criteria based on specific maternal and social risk factors may detect many prenatal non-medical drug exposures.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-250) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 76%

Retrospective analysis of the diagnostic yield of newborn drug testing

Wood

Sinclair

Rysgaard

et al. 2014

BMC Pregnancy Childbirth

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“…There is precedence for uncharacterized metabolites in young children cross-reacting with immunoassays. Such a phenomenon has been proposed to explain positive THC immunoassay screens in newborns with known exposure to cannabis in utero, where the immunoassay screen is positive but with a mass spectrometry-based THC confirmatory assay negative for THC metabolites common in adults [42].…”

Section: Discussionmentioning

confidence: 99%

Accidental intoxications in toddlers: lack of cross-reactivity of vilazodone and its urinary metabolite M17 with drug of abuse screening immunoassays

et al. 2019

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Background Vilazodone is an FDA approved medication used to treat major depressive disorder. The authors describe two cases of accidental vilazodone exposure in toddlers who presented with symptoms similar to amphetamine exposure and also with unexplained positive amphetamine urine immunoassay drug screens. Given a lack of published data on cross-reactivity of vilazodone and its metabolites with drug of abuse screening tests, the authors investigated drug of abuse immunoassay cross-reactivity of vilazodone and metabolites using computational and empirical approaches. Methods To ascertain the likelihood that vilazodone would cross-react with drug of abuse screening immunoassays, the authors assessed the two-dimensional (2D) similarity of the vilazodone parent molecule and known metabolites to an array of antigenic targets for urine immunoassay drug screens. To facilitate studies of the commercially unavailable M17 metabolite, it was prepared synthetically through a novel scheme. Urine and serum were spiked with vilazodone and M17 into urine (200–100,000 ng/mL) and serum (20–2000 ng/mL) samples and tested for cross-reactivity. Results Computational analysis using 2D similarity showed that vilazodone and metabolites have generally low similarity to antigenic targets of common drug of abuse screening immunoassays, predicting weak or no cross-reactivity. The M17 metabolite had 2D similarity to amphetamines and tricyclic antidepressants in a range similar to some other compounds exhibiting weak cross-reactivity on these immunoassays. Cross-reactivity testing was therefore performed on two different urine amphetamines immunoassays and a serum tricyclic antidepressant immunoassay. However, actual testing of cross reactivity for vilazodone and the M17 metabolite did not detect cross-reactivity for any urine amphetamines screen at concentrations up to 100,000 ng/mL and for a serum tricyclic antidepressants assays at concentrations up to 2000 ng/mL. Conclusion While the vilazodone metabolite M17 has weak 2D structural similarity to amphetamines and tricyclic antidepressants, the current study did not demonstrate any experimental cross-reactivity with two different urine amphetamines immunoassays and a serum tricyclic antidepressant immunoassay. Vilazodone ingestions in young children present a diagnostic challenge in their similarity to amphetamine ingestions and the lack of routine laboratory tests for vilazodone. Further work is needed to understand the metabolic profile for vilazodone in children versus adults. Electronic supplementary material The online version of this article (10.1186/s12907-019-0084-9) contains supplementary material, which is available to authorized users.

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“…9,11,12 In addition, although gas chromatography-mass spectrometry currently remains a medical, legal, and regulatory gold standard, recent concern has been raised over possible false-negative confirmatory testing for THC, particularly in very young infants who may have intrauterine exposure and atypical drug metabolism. 13 Information regarding the mechanism of interference by pantoprazole in urine drug screening is scant, with all references referring to the pantoprazole package insert that describes pre-Food and Drug Administration approval data. Multiple attempts to obtain further information from the manufacturer did not yield additional information.…”

Section: Discussionmentioning

confidence: 99%

13-Year-Old Girl With Recurrent, Episodic, Persistent Vomiting: Out of the Pot and Into the Fire

Felton

Zitomersky²,

Manzi

et al. 2015

Pediatrics

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Cyclic vomiting syndrome (CVS) is a well-established cause of recurrent vomiting in the pediatric population. Severe vomiting with chronic cannabis use, known as cannabinoid hyperemesis syndrome, has recently been more widely recognized as an etiology of persistent episodic vomiting. In turn, patients presenting with frequent episodes of CVS are now increasingly being screened for cannabinoid use. Because patients with persistent vomiting are also frequently prescribed a proton pump inhibitor (PPI) for their gastrointestinal symptoms, it is important to be aware of the potential for a PPI to cause an interaction that can lead to false-positive urine cannabinoid screening. We describe a case of a false-positive urine cannabinoid screen in a patient with CVS who received a dose of intravenous pantoprazole. The primary reference regarding drug screen interference from PPIs can be found in the pantoprazole package insert that refers to pre–Food and Drug Administration approval data. Although multiple sources on the Internet report the possibility of positive cannabinoid screens from pantoprazole, there are no known published reports of the phenomenon in the medical literature.

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Unresolved Discrepancies between Cannabinoid Test Results for Infant Urine

Abstract: BACKGROUND:False-positive drug screen results for tetrahydrocannabinol (THC) have been observed. This study investigated the rate of unconfirmed positive screen results in infant and noninfant urine samples and evaluated possible reasons for differences.

Cited by 11 publications

References 8 publications

Retrospective analysis of the diagnostic yield of newborn drug testing

Retrospective analysis of the diagnostic yield of newborn drug testing

Accidental intoxications in toddlers: lack of cross-reactivity of vilazodone and its urinary metabolite M17 with drug of abuse screening immunoassays

13-Year-Old Girl With Recurrent, Episodic, Persistent Vomiting: Out of the Pot and Into the Fire

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