EDDP: The Methadone Metabolite

EDDP: The Methadone Metabolite

What is EDDP?

I often get asked about EDDP – primarily, “what is EDDP?”, and “should I care about EDDP?”. EDDP – the abbreviation for the chemical compound 2-ethylidene-1, 5-dimethyl-3, 3-diphenylpyrrolidine – is a major metabolite of methadone. While methadone is not a widespread drug of abuse these days, it is certainly something you would not want to not test for. Hopefully, the information about EDDP in this blog post will help you decide if testing for EDDP would be beneficial.

As you may know, some drug tests are designed to react to the parent substance: in other words, the substance that was ingested, while some panels are designed to detect the metabolite: what the body changes that substance into as the body’s metabolism processes it into waste. As for substances, some are (at least partially) excreted in the exact same form that was ingested. For example, with methadone, in most cases, the body will excrete at least some methadone in the urine. Also, as with most substances, the body will excrete at least some amount of metabolite in the urine – in this case, we mean EDDP.

Should I Care About EDDP?

There are 3 primary reasons to care about, and test for, EDDP. Before we get there, it is important to note that there is a non-trivial percentage of people in the world who are “extensive metabolizers” of methadone; this means that while most people will excrete the parent compound in their urine, some will almost completely metabolize the methadone into EDDP. Since a standard methadone panel does not react to the EDDP, it gives us three risky scenarios: 1) You have a patient/participant using methadone illicitly and a simple methadone test is not detecting this. 2) You have a patient/participant who is supposed to be taking their methadone, but suspect they are instead spiking their specimen with methadone to give the illusion they are taking it, and 3) Same scenario as number two, except the patient/participant is taking their methadone as prescribed, yet is causing suspicion by producing a negative methadone test.

Another, lesser, benefit of testing EDDP, is that all methadone instant tests currently available will cross-react with Doxylamine – a substance found in the over-the-counter medications Nyquil and Unisom (amongst others). The EDDP panel has a much higher threshold for cross-reactivity for Doxylamine than the methadone panel.

So, EDDP may not necessarily be crucial to all programs, but it is good to know what it is, and if you should care about it. As always, please fell free to comment here or reach out to us should you have any questions or would like any additional information on the subject.

 

 

Tips for Keeping a Safe Work & Testing Space in the Age of Social Distancing

Tips for Keeping a Safe Work & Testing Space in the Age of Social Distancing

As many of us are looking toward going back to normal, or at least back to work, special considerations must be made if we are going to prevent a new spike in COVID-19 infections. In addition to some tips on keeping a clean workplace, we will also talk about some testing methods that help with social distancing. Of course, a lot of the tips here you’ve been hearing for months and are just common-sense precautions, but hopefully having everything compiled here together will be useful and even helpful!

Keep Yourself Clean

This one seems fairly obvious; it is well known that the first step in preventing the spread of coronavirus (or any virus, for that matter) is to keep your hands clean. Washing your hands thoroughly for 20 seconds with any bar or liquid hand soap is an excellent first step toward preventing the spread of viruses; handwashing should be done frequently. Another way to prevent infection is to avoid touching your face, especially openings like mouth and nose. Of course, hand shaking or other casual contact that we often take for granted should be avoided.

Keep Your Environment Clean

Another big help in preventing infection is to keep the air and area around you clean. The best way to do this is to wear a mask that covers both your nose and mouth. This is more about preventing your spreading infection than preventing your getting infected. While an N95 mask is probably the best as it catches 95% of airborne particles, a simple 3-layer surgical mask goes a long way in mitigating the risk of contagion. Even lesser-protective cloth masks and other homemade coverings are helpful…every little bit helps! Even with a mask on, it is still important to cough and sneeze into the crook of your elbow (this is always a good idea). Also, it is important to stay home or otherwise avoid contact with others if you are experiencing any symptoms of infection or fever. Lastly for your environment, good social distancing (keeping 6 feet away from others) will help greatly.

Keep Your Work Area Clean

As the coronavirus can live on surfaces (especially non-porous surfaces like desks, etc.), it is important to clean and disinfect surfaces regularly, including, but not limited to: desktops, keyboards, doorknobs, faucets (kitchen and bathroom), and any other commonly shared office equipment (printers,  photocopiers, and touchscreens, as examples). Floors and common areas should also receive extra cleaning and disinfecting. Some have suggested using disposable utensils if there is a shared break room/kitchen or other place it is common for coworkers to take meals or snacks.

Drug Testing

If you plan on continuing urine drug testing, it is even more important to follow the steps I’ve already outlined. Some have decided to switch to sweat path testing to minimize contact with their clients/participants, as the patch is worn continuously for 7-10 days. Some have chosen hair testing for this reason. Another popular method of testing during these times is oral fluids testing; oral fluids testing can be performed remotely via video-chat…from collection to results without the donor having an opportunity to substitute specimen or otherwise adulterate. Please take a moment to read our blog about specimen types for more information on how these differ from urine.

In summary: stay healthy! If not for yourself, stay healthy for your loved ones, and stay healthy the people who rely on you. Whatever the reason you are testing for drugs of abuse, the people you are testing rely on you to be there to help them navigate and get through it – stay healthy for them!

Understanding the Differences in COVID-19 Testing Methods

Understanding the Differences in COVID-19 Testing Methods

 

Testing for COVID-19 is an important step in tracking cases and contagion mapping. It also tells us who needs treatment and isolation. At some point, COVID-19 testing will be needed in order for us to get back to “business as usual” as a country (and as a planet!). That being said, there are many different types of tests out there, not all using the same specimen type, not all taking the same amount of time for results; it’s a lot to wade through and there is too much misinformation out there. I am going to (hopefully) help you make some sense of this by breaking down all of the currently available testing methods. Please keep in mind, this information is evolving rapidly (I had to make changes over the course of the few days this was written!), but this is the best information available at the time of publishing.

 

Laboratory Nasal Swab (Nasopharyngeal Culture) Test

 

This is a molecular test in that it tests for the RNA/DNA (genetic building blocks) of the SARS-CoV-2 (COVID-19) live virus. Since this detects the live virus, a positive test indicates that the body is currently infected with the virus. It’s doesn’t determine when in the timeline the infection is (onset, peak, or outset). Also, important to note: if there is live virus in your body, then you are contagious. The specimen for this test is mucous collected (most-commonly) from the posterior nasopharynx (the upper part of the nasal passage), and it collected by taking a cotton swab and inserting it to the back of the nasal passage. The specimen is processed at the lab with a process called RT-PCR (real-time polymerase chain reaction) which – in very basic terms – is a DNA replication/splicing to check compatibility. If the DNA is able to replicate, then it proves the presence of this particular coronavirus. While we have seen instances of false negative results, they are almost entirely due to poor or erroneous collection techniques. Aside from that, this is an extremely accurate way to detect it. Lastly, because this is a lab test, the results are not immediately available and can take days (or more, depending on the lab).

 

Instant Nasal Swab (Nasopharyngeal Culture) Test – “Abbott ID Now”

 

This one is relatively new, having only received its FDA EUA (emergency use authorization) on March 27th of this year. Like the laboratory test above, it is a molecular test. The specimen is also mucous, but instructions indicate it be collected from the nose, throat, nasopharynx, or oropharynx (back of the throat). The big difference between this and the lab test is that this is a standalone testing unit than can provide a near-instant result (5-13 minutes). The accuracy, while not quite as good as the lab test above, is still an impressive 95% per the manufacturer’s documentation. There are another 2 or 3 devices that are similar to this, and either FDA cleared (or close) that will have results within an hour; I focused on the Abbott device because many of you probably saw it on the news where President Trump had one out on the table during a press conference.

 

Instant Serology Immunoassay

 

Lastly, we have the newest test to be made available – an instant device that works much like the old pipette (eyedropper) style drug and pregnancy tests. Also, like most drug tests devices, the result is available within 15 minutes! It is a serology test, meaning the specimen needed is blood (whole blood, serum, or plasma). This test is different than the others above in that it is testing for the antibody that your body creates when exposed to the virus. This means it will detect whether you currently have or have had the virus; in other words, you may have already cleared the virus from your body and still trigger a positive on this test. As it is a screen, it is less accurate than the molecular tests, with most on the market between 82%-90% accuracy. There are more than 40 manufacturers who have either filed for an EUA (or have notified the FDA of their intent to do so), but as of this writing, only one has approved. There is some confusion as to the collection method for the blood specimen: it is being widely described as a finger stick test – finger stick being a minimally invasive method of pricking the fingertip to draw a bead of blood (diabetics do many times this daily). However, in an effort to discourage home use, any serology test that has been FDA cleared will clearly state that finger stick is not an acceptable method of collection. Unfortunately, there are no COVID-19 tests that are currently available for home use. Lastly, we do have these tests available, so please reach out to your consultant for more information or click here to fill out an order request form.

 

In Closing

 

I hope I have shed some light on the available tests that are out there. Again, since this is changing so fast, do not hesitate to check in with us if you need to take any steps based on the information here – just to be sure. Our next post will be about some tips and tricks on how to keep a clean and safe working environment as we start trying to get back to work or as some of you continue to do so already. If you have any tips or information on how you are performing testing in a world where social distancing is becoming the new norm please comment and share. The best thing we can do right now is work together in fighting this invisible enemy.

Understanding 6-AM & 6-MAM: The Metabolite of Heroin

Understanding 6-AM & 6-MAM: The Metabolite of Heroin

One question I am asked fairly often is regarding the primary metabolite of Heroin; known as 6-AM or 6-MAM. These are synonymous for 6-Acetylmorphine and 6-Monoacetylmorphine (actually all 4 mean exactly the same thing!). For the sake of brevity, in this post I will call it by its most popular moniker: 6-MAM.

 

Heroin itself has an extremely weak affinity to the μ-opioid receptors, meaning that Heroin itself will essentially not produce any euphoric or pain-relieving effects. However, once it enters the bloodstream, it is immediately metabolized into 6-MAM, which is what actually causes the effects of the drug. Heroin is also metabolized quickly into the less-active 3-Monoacetylmorphine (3-MAM), and less quickly into Morphine. Some forms of Heroin do contain some 6-MAM (most notable would be Black Tar Heroin), but for the most part it is only detectable once the Heroin has been metabolized in the body. As an aside: with regards to drug screening, we are really only concerned with active metabolites, since immunoassays rely on an active chemical reaction to function at all!

 

 

 

 

*Metabolization of Heroin to 6-MAM

 

Because 6-MAM is unique to Heroin, many are asking about the availability (as well as the quality and reliability) of an instant test for it so they can make sure they are detecting any Heroin use. While it is available, and the reliability and accuracy are outstanding on the 6-MAM instant test, I typically counsel against testing 6-MAM for a few reasons:

  1. 6-MAM is only detectable in urine for a short time, with barely a 12-hour window of detection.
  2. While 6-MAM has a very short window of detection, the Morphine that is also created as a metabolite takes much longer to purge from one’s system, giving us about a 3-day window of which it can be detected on a standard Opiate panel.
  3. From what we are hearing, so much of the Heroin on the streets these days contains very little (if any) Heroin at all, and it is mostly Fentanyl mixed with other filler. 

So, if you absolutely need to know that the positive Opiate that you are seeing came from Heroin use (as opposed to Morphine or Codeine use), then the 6-MAM panel can provide that information. However, do realize that the window of detection is going to severely limit your ability to detect this substance.

 

A Word on Specimen Types

A Word on Specimen Types

Today we are going to discuss the different specimen types that can be used to test for drugs. We do offer testing for all the specimen types that I will cover. It is helpful to know what to expect from each specimen type in regard to window of detection (both onset and outset), susceptibility to adulteration, collection woes, and general benefits or shortcomings. So, take a few minutes to read and decide for yourself if you are testing the specimen type that works best for your program or facility.

 

Blood

Blood is probably one of our least favorite specimen types. Firstly, it is relatively hard to collect, requiring a trained medical practitioner at least. The second reason it is at the bottom of the list is its short window of detection; substances can only be detected when they are in the bloodstream (while the donor is under the influence). This is actually a plus when we are talking about workplace injuries (as an example) when we want to find out if someone is impaired at the time, but we (collectively) are more likely to be concerned with recent prior drug use. Lastly, there are essentially no onsite/instant tests for drugs of abuse that use blood as a specimen type. However, on the plus side, it is impossible to adulterate a blood specimen.

 

Hair Follicle

 

Hair follicle specimen are not as difficult to collect as blood; there is no medical knowledge necessary. Hair testing also has no gender concerns with witnessing collection. As with blood, however, it is only available as a laboratory test. Another shortcoming with hair is the limited number of drugs that are being tested (only tests: AMP, COC, THC, OPI, OXY, PCP). While hair provides a very long window of detection - detecting drugs for up to 90 day after use - it also has a long onset, meaning drugs will not begin to be detected until about 7 days after use. As for adulteration, there are many products on the internet that claim to “detoxify” your hair to remove any drugs that may be present, but I have not found any evidence that these products are effective. 

 

Sweat Patch

 

Sweat patch testing is a relatively new offering and it is somewhat unique in its window of detection. The patch is typically worn for 10 days (or more), and drugs take about 2-3 days to come to the surface of the skin, so if positive it would most likely be from use 2-3 days before the patch was applied, or used in the first 7 (out of 10) days the patch was worn. The downside here is that if a participant knows the patch is coming off Monday, they could use drugs Saturday or Sunday without the use being detected.  It is a very simple specimen to collect with no gender concerns as it is placed on the arm. There is no known method of adulteration for the sweat patch. As with hair, it is only available as a laboratory test, and also like hair, it is a limited range of drugs that are detected, adding only MET to the list of detectable hair substances.

 

Surface/Powder

 

This one is sort of the oddball here; it is not a test for drug use, it is a test to see what substance a person may have in their possession. It will also test surfaces for possible contamination by drugs (i.e. a person’s desktop or computer keyboard). This is most often used by law enforcement in the field (it is sometimes called a “field test”), perhaps testing a baggie found on a person or in their vehicle. It can also be helpful for corrections or any other residential facility where drug residue might be found in someone’s cell, or other space where only a limited number of people might have access. Much like a drug test, however, it must be a “target” substance – in other words you must use the right test to get a positive or negative hit on that particular substance. Since so many illicit (or misused) drugs can be a “white powder”, you might not happen to have tested for the correct white powder!

 

Saliva

 

Saliva testing has become more popular as the accuracy and precision of the instant/onsite saliva tests have improved immensely over the years. One appeal of saliva testing is that there are no gender concerns for witnessed collections, not even a bathroom is needed; it is also a fairly simple collection and testing procedure. However, while it is much easier to collect (and less invasive) than blood, it shares the same limitation of the window of detection; drugs will not be detectable in saliva for more than 24 hours after use. As with blood, this window of detection makes the most sense when impaired driving and workplace injuries are the concern.

 

Urine

 

Urine remains our favorite specimen type. While there are gender concerns for witnessed collections, and adulteration is more possible than with other specimen types. The window of detection, the huge number of substances able to be tested, and relatively lower cost still outweigh the negatives. Witnessed collections can be a challenge, but not one too challenging to be more than a mild inconvenience in most cases. Adulteration is a concern, but modern adulterant testing is thorough enough to be an excellent deterrent. On the other hand, the window of detection shows recent use, going back days (or weeks, depending on the substance), which fits almost universally with what we are trying to determine. There are instant tests available for more than 25 drugs of abuse and lab tests available for more than 40; this is a huge improvement over any of the other specimen types listed. Lastly, the cost is going to be the lowest out of all the specimen types, making it more feasible to follow a regular testing schedule.

The Great Poppy Seed Debate: A Quasi-Scientific Endeavor

The Great Poppy Seed Debate: A Quasi-Scientific Endeavor

Eric Malis

A Quasi-Scientific Hot Pastrami on a Kaiser Roll

There’s always been a lot of debate about poppy seeds and whether their ingestion can or will cause a positive result on an opiate panel; many of us have even seen the famous episode of the Seinfeld TV show where Elaine was almost fired due to a positive drug test caused by poppy muffins. There have been plenty of scientific papers published where sophisticated laboratory equipment is used to determine the opiate make-up of poppy seeds, and their concentrations. But what does really mean to those of us performing drug tests every day? Well, I wanted to take slightly-less-than scientific approach to see what this looks like in the real world. I did take some proper steps to ensure that my results were not completely unscientific (waiting a week between attempts as to not have any residual form the previous, for example).

So let’s see what I found…

 

Week 1: Poppy Seed Bagel (Local “Bronx-Style” Tuna Salad)

My first go was at a newer local NY Deli near the office that I’ve been meaning to try. I went for lunch and had a poppy bagel with tuna salad (lightly toasted, since you asked); there were not quite as many poppy seeds as on the Kaiser bun in the photo above. My first specimen was an hour after eating and came up negative on one of our MOP300 panels. The next specimen was 2 hours after that and was positive on the MOP panel. My next specimen was about 3 hours after that and was back to negative. The laboratory confirmatory results are as follows:

Specimen 1 Codeine: 154ng/mL Morphine: 331ng/mL Creatinine: 138mg/dL

As you can see, this is just barely above the cut-off for the Opiate panel. Both Codeine and Morphine present, more than likely not as metabolites, but as the parent alkaloids from the poppy seeds.

 

Week 2: Poppy Seed Kaiser Roll (Hot Pastrami with Spicy Mustard)

 

My second attempt was at a local favorite here, this one has been in town since 1974! The bottom of the bun had essentially no seeds, so just what you see pictured. My first specimen was 2 hours after eating and came up positive. My second specimen at 6 hours after eating was also positive. My third specimen at +9 hours was also positive. Unfortunately, that brought me to bedtime – next test will be in the morning so I can have a full 12+ hours awake after eating! Lab results for this group as follows:

Specimen 1 Codeine: Trace Morphine: Trace Creatinine: 184mg/dL
Specimen 2 Codeine: 133ng/mL Morphine: 51ng/mL Creatinine: 139.5mg/dL
Specimen 3 Codeine: Trace Morphine: Trace Creatinine: 71.3mg/dL

In this case, we see that the instant test can sometimes react even when the concentration is below the threshold. This is a common occurrence and is probably regarded as one of the biggest weaknesses of instant tests as a whole (be sure to attend my webinar next month for more on this). Looking at the Codeine/Morphine ratio, we can see that these poppy seeds have a different make-up then the ones from the previous week.

 

Week 3: Poppy Seed Bagel (With a “Schmear” of Cream Cheese)

 

My third round was at a national bagel chain (Einstein’s). I do like a lot of poppy seeds on my bagel, so I was familiar with their offerings. I made sure to eat this for breakfast this time, to give me more waking hours in which to provide specimens. Still only poppy seeds on the top, but they almost completely cover the surface of the top of the bagel; so probably nearly twice as many as you see in the picture of the bun. My first specimen was at about 90 minutes after eating and was positive. My second specimen was at about 4 hours after eating and it was also positive. My third specimen was at 6 hours after breakfast and still positive. My fourth specimen at 7.5 hours was still positive. I finally produced a negative specimen at the 10 hour mark. Lab results for this group as follows:

Specimen 1 Codeine: None Morphine: 286ng/mL Creatinine: 191.7mg/dL
Specimen 2 Codeine: None Morphine: 539ng/mL Creatinine: 144.4mg/dL
Specimen 3 Codeine: None Morphine: 183ng/mL Creatinine: 100.0mg/dL
Specimen 4 Codeine: None Morphine: 88ng/mL Creatinine: 79.7mg/dL

This one is interesting as once again the alkaloid make-up differs from either of the previous 2 weeks; in this case we don’t have any Codeine present. Also, we see again the instant test is giving a positive where the concentration is well below the cut-off. It is worth noting that the instant tests used for this entire experiment were not part of our standard catalog – we had a bunch of samples from other manufacturers that were probably going to expire if we didn’t make use of them, and this seemed a perfect opportunity!

 

So, we can clearly see that it does not take an inordinate amount of poppy seeds the trigger a positive test result. Also, contrary to popular belief, there would be no way for a laboratory to make the determination (at least on most of these results) that the positive was from poppy seeds versus Morphine and/or Codeine use. Many of my judicial customers (probation/parole, drug court, etc.) are able to have their participants sign something acknowledging that consumption of poppy seeds or other poppy foods constitutes a violation – this is to avoid any conflicts down the road. Some of my non-profit addiction treatment facilities who rely on food donations, must sadly decline any donations of poppy foods. So, there are ways to minimize the chances for this to become an issue, but it isn’t the same for everyone, and it isn’t always easy!

 

Some other things to consider:

  • Not just time should be a consideration, but also number of urinations. If I didn’t get up to pee twice in the middle of the night, my next void in the morning of week 2 would most likely have still been positive.
  • Not all poppy seeds are created equal. Some have higher concentrations of different opiates, some are “washed” better and contain less opiates over all.
  • I need to be better hydrated. Some of my Creatinine levels are a little higher than average for my age/gender. This also highlights the importance of considering specimen dilution/concentration when determining any drug test result.