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Methadone and UDS???

Discussion in 'Medical Toxicology (MD, DO, PharmD)' started by kbrown, May 8, 2006.

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  1. kbrown

    kbrown chicken

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    A UDS won't pick up methadone cuz it's not an natural opiate, rather a synthetic opiate. Anyone know how to detect it? Can you tell me what test(s) you can order to catch it? In an overdose, does it respond to Narcan nicely?
  2. Dr.Evil1

    Dr.Evil1 Senior Member

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    Our UDS over here tests specifically for methadone. I believe that what is in the UDS is instution specific but I believe that most will have a specific assay for methadone.

    As for response to Narcan you would still respond since Narcan is a competitive antagonist at all the opoid receptor sites. Without a UDS you could do a "narcan challenge test" in which you give 0.2 mg of Narcan IV and then watch for signs of withdrawl in chronic opoid dependence.
  3. southerndoc

    southerndoc life is good Moderator Emeritus Lifetime Donor

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    We also test for methadone.
  4. kbrown

    kbrown chicken

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    thanks guys. last q, since the t1/2 is so long with methadone, could you still pick up a +ve UDS 2 days out??? i was thinking that the t1/2 is 24h, is` that right?
  5. southerndoc

    southerndoc life is good Moderator Emeritus Lifetime Donor

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    The half-life is 24 hours. Sensitivity varies by lab, but most labs can detect it up to 12 days out.

    Lots of methadone questions in two forums...
  6. Tenesma

    Tenesma Senior Member

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    UDS has nothing to do with wether it is a naturally occuring opioid vs synthetic... most opioids currently used are synthetic derivatives of thebaine and those are picked up just fine. It has to do whether your toxicology lab is specifically looking for it, and since methadone hasn't really been a drug of abuse until recently in most areas of the country most labs don't test for it... contact your lab (i think i told you this in another forum) and find out what their testing criteria are and what extra testing you can order in order to make sure it doesn't get missed. if a UDS comes back negative for a specific narcotic, it doesn't necessarily mean that it isn't there... it just means that it wasn't at a detectable level based on the pre-set limits. So you just have to ask the lab to run a chromatography on the sample to detect the opioid you are looking for... get friendly with those toxicology guys and you will learn a lot....

    same thing goes for fentanyl... hard to detect, and therefore you need expensive equipment. Therefore most labs (except for medical examiners) don't look for fentanyl because the request is too infrequent to justify the 100,000 piece of equipment they need to purchase....

    your questions about methadone are starting to worry me by the way
  7. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    I have to agree - everything said here and in the gen res forum is stuff you can EASILY find online or in a textbook. I myself wouldn't put so much personal information (like why you want to know) or show so much interest in things that you could VERY simply keep private.
  8. 12R34Y

    12R34Y

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    Have to admit. A little curious about the methadone questions myself.

    what gives? :confused:
  9. kbrown

    kbrown chicken

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    long story short

    my personal trainer's husband is the person in question. long time ago dx'd with spinal stenosis, surgery was unsuccessful according to him, went on oxycontin, then got in car accident and rolled car, more back pain, more oxycontin, doc's stopped rx'ing for him cuz of his increasing need to fill scripts before they should have ran out, went to a "friend" doctor somewhere outside of the town that he lives in, now gets methadone. takes 30mg QID (total 120mg daily). Couple days ago a few tabs went missing, next day his 14y/o son is acting weird at school, eventually gets sent to a youth psych facility, UDS +ve for weed, -ve for opiates, but all of his symptoms were similar to someone who had taken methadone.

    my trainer (his wife) is pissed at him for having this drug in the house, and asked me a few questions about whether or not he was legitimately using this drug, is it prescribed correctly for his condition, and other questions directed toward her son's use of this drug.

    That's what's with all of the questions. Hope that this clears it up for everyone.
  10. EctopicFetus

    EctopicFetus Keeping it funky enough

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    FYI max dose i saw was 160mg daily.. I think 200 is the max per the pharma books, though who knows perhaps the pain medicine guys go beyond that?
  11. Tenesma

    Tenesma Senior Member

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    there is no max dose for narcotics due to tolerance...
    however there is evidence of opioid-induced hyperalgesia w/ higher doses
  12. southerndoc

    southerndoc life is good Moderator Emeritus Lifetime Donor

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    As someone who isn't even a resident yet, I wouldn't answer her questions.

    Even as a licensed physician I would defer her to his physician or her own.

    Free medical advice can still get you in trouble and land you in a court of law. What if she divorces him and wants to subpoena you to testify to help support her case?
  13. kbrown

    kbrown chicken

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    not a likely situation, but thank for your advice. more of just a really upset housewife who just bounces ideas off me. i do know what you mean and should be more cautious. if she had a physician to bounce it off, it wouldn't be a big deal, but like i said, this 'doctor' guy is a 'friend' who mails the script in. i don't think that he has actually ever seen this man as a patient.

    i will take your advice to heart. the last thing i need is a subpeona before i see my first legal patient.

    from a different perspective though, i think that a lot of us (pre-residency) have provided "medical advice" to family without fear of litigation. isn't this okay? most of my classmates have done the same. how is this different? a really close friend seeking justification of their suspicions or frustration. is it that different? i am NOT disagreeing or arguing, rather just asking. didn't you (before you were a southerndoc) give an "educated opinion" on medical matters to friends/family?

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