Patient chronically on 300mcg of Fentanyl and MSIR 15mg q6h found unresponsive and in respiratory distress at home, was given Narcan by EMS and awoke. Also has Fabrys and a-fib and multiple other medical problems. Urine Drug Screen in the ER was negative for opiates. Was the UDS negative from the Narcan? Lab error? What gives?
Will Narcan make a urine drug screen negative?
- Thread starter Doctodd
- Start date
- Joined
- Apr 7, 2011
- Messages
- 5,313
- Reaction score
- 1,085
Narcan is a mu receptor agonist. If anything it should cause more free opioid and increase metabolites
in the UDS.
Not sure what's happening in this case. Could be the narcan response was serendipity.
in the UDS.
Not sure what's happening in this case. Could be the narcan response was serendipity.
- Joined
- Feb 2, 2008
- Messages
- 2,346
- Reaction score
- 801
ER UDS's are pretty worthless and have low sens for synthetics, they also set the cutoffs high for the ER many times. Repeat UDS now with good lab and confirm. Your average hosp lab is terrible at getting the info we need as pain docs. Since I switched to AIT I get much better results.
- Joined
- Dec 28, 2010
- Messages
- 309
- Reaction score
- 26
Technically, it is a competitive antagonist and not an agonist since it does not activate the mu receptor...I'm just splitting hairs but your main point is correct that if anything there would be more free opioid available in the bloodstream...send off for GC/MS confirmation
- Joined
- May 3, 2005
- Messages
- 4,238
- Reaction score
- 2,293
None of the urine drug screens will pick up fentanyl. However hospitals have thin layer chromatography that may be used to detect it. As above, GC/MS or LC/MS for a quantitative assay.
- Joined
- May 16, 2006
- Messages
- 5,803
- Reaction score
- 2,023
Dipstick should have picked up the morphine on the opiates screen. It will not detect fentanyl as mentioned above.
Narcan will not interfere with GCMS.
Narcan will not interfere with GCMS.
