Reliability of Urine Strip Test For Confirmation of Methadone Poisoning in Children
Journal of Pediatric Nephrology,
Vol. 4 No. 2 (2016),
4 July 2016
Introduction: Methadone is a drug with biologic effects similar to morphine which acts via interacting with major classes of receptors κand µ. It has a half-life of 25 to 50 hours. Ingestion of this substance causes serious symptoms such as bradycardia, apnea, decreased level of consciousness, and death. Rapid diagnosis and treatment is life-saving. The methadone urine test is an easy to perform test which could detect the substance rapidly. This study was conducted to determine the reliability of the positive methadone urine test in the first and second days of poisoning in children below the age of 13 who have been poisoned with it.
Materials and Methods: A total of 50 children below 13 years of age were enrolled in the study from April 2013 to April 2014. They were referred to Loghman Hakim Hospital with a history of incidental methadone ingestion and clinical symptoms congruent with methadone poisoning such as apnea, drowsiness, decreased level of consciousness, and bradycardia and miosis. Methadone urine strip test was performed on the first and second days. Five parameters (age, gender, dose of ingested methadone, urine SG, and urine pH) were tested and recorded for each patient.
Results: This test is an accruable test for the detection of methadone (P value<0.05). Findings suggested that as little as 2 mg of methadone administration could lead to a positive urine test. The highest frequency of positive test was observed when the test was given between 6 to 12 hours after methadone ingestion and the lowest frequency was obtained in the first 6 hours after poisoning. It is suggested that the test result can be false negative if it is carried out in less than 6 hours after methadone consumption.
Conclusions: According to the results of this study, the methadone urine drug screen test has high accuracy for detection of methadone in the urine. In addition, if the initial test result is negative in the first 24 hours, we recommend that the test should be repeated 24 hours after the ingestion; thus, two negative results in the first 48 hours of ingestion can rule out methadone poisoning by a probability of 98.5%.Keywords: Poisoning; Urine Test; Methadone; Child.
- Reliability of urine strip test for confirmation of methadone poisoning in children
How to Cite
Kintz P, Evans J, Villain M, Cirimele V. Interpretation of hair findings in children after methadone poisoning. Forensic science international. 2010;196(1):51-4.
Cruciani RA, Sekine R, Homel P, Lussier D, Yap Y, Suzuki Y, et al. Measurement of QTc in patients receiving chronic methadone therapy. Journal of pain and symptom management. 2005;29(4):385-91.
Sticherling C, Schaer BA, Ammann P, Maeder M, Osswald S. Methadone-induced Torsade de pointes tachycardias. Swiss Med Wkly. 2005;135(19-20):282-5.
Haddad L, Winchester J. Clinical management of poisoning and drug overdose. WB Saunders. Philadelphia; 1990.
Iribarne C, Berthou F, Baird S, Dréano Y, Picart D, Bail JP, et al. Involvement of cytochrome P450 3A4 enzyme in the N-demethylation of methadone in human liver microsomes. Chemical research in toxicology. 1996;9(2):365-73.
Dilmaghanian S, Gerber JG, Filler SG, Sanchez A, Gal J. Enantioselectivity of inhibition of cytochrome P450 3A4 (CYP3A4) by ketoconazole: testosterone and methadone as substrates. Chirality. 2004;16(2):79-85.
Deren S. Children of substance abusers: A review of the literature. Journal of Substance Abuse Treatment. 1986;3(2):77-94.
Arena JM. Toxicologic Emergencies: A Comprehensive Handbook in Problem Solving. JAMA. 1982;248(5):598-.
Smialek JE, Monforte JR, Aronow R, Spitz WU. Methadone deaths in children: a continuing problem. JAMA. 1977;238(23):2516-7.
Goldstein A, Brown BW. Urine testing in methadone maintenance treatment: applications and limitations. Journal of Substance Abuse Treatment. 2003;25(2):61-3.
Stitzer ML, Bickel WK, Bigelow GE, Liebson IA. Effect of methadone dose contingencies on urinalysis test results of polydrug-abusing methadone-maintenance patients. Drug and alcohol dependence. 1986;18(4):341-8.
Hawks RL, Chiang CN. Urine testing for drugs of abuse: National Institute on Drug Abuse Rockville, MD; 1986.
Heit HA, Gourlay DL. Urine drug testing in pain medicine. Journal of pain and symptom management. 2004;27(3):260-7.
McPherson RA, Pincus MR. Henry's clinical diagnosis and management by laboratory methods: Elsevier Health Sciences; 2011.
Rogers SC, Pruitt CW, Crouch DJ, Caravati EM. Rapid urine drug screens: diphenhydramine and methadone cross-reactivity. Pediatric emergency care. 2010;26(9):665-6.
Mordal J., Holm B., Mørland J., and Bramness J.G.: Recent substance intake among patients admitted to acute psychiatric wards: physician's assessment and on-site urine testing compared with comprehensive laboratory analyses. J. Clin. Psychopharmacol. 2010; 30: pp. 455-459
Pesce A., Rosenthal M., West R., West C., Crews B., Mikel C., Almazan P., and Latyshev S.: An evaluation of the diagnostic accuracy of liquid chromatography–tandem mass spectrometry versus immunoassay drug testing in pain patients. Pain Physician 2010; 13: pp. 273-281
Walley A.Y., Alperen J.K., Cheng D.M., and Botticelli M., Castro-Donlan C., Samet J.H., and Alford D.P.: Office-based management of opioid dependence with buprenorphine: clinical practices and barriers. J. Gen. Intern. Med. 2008; 23: pp. 1393-1398
S.D. Ferrara*, L. Tedeschi, G. Frison, G. Brusini, and F. Castagna: Drugs-of-Abuse Testing in Urine: Statistical Approach and Experimental Comparison of Immunochemical and Chromatographic Techniques; Journal of Analytical Toxicology, Vol. 18, September 1994
Zacher JL1, Givone DM: False-positive urine opiate screening associated with fluoroquinolone use. Ann Pharmacother. 2004 Sep; 38(9):1525-8. Epub 2004 Jul 13.
- Abstract Viewed: 504 times
- PDF Downloaded: 395 times