How long hydromorphone drug test

Urine samples were collected ad lib to best simulate what would be seen in random drug testing. Samples were stored refrigerated or frozen until analysis. Creatinine levels were determined at the Wilford Hall Medical Center Clinical Laboratory using standard clinical laboratory procedures. Enzyme hydrolysis was used. The LC mobile phase for the Phenomenex Kinetex analytical column 2. The total run time was 5 min for each sample.

Two MRM transitions, precursor ion transition 1: quantifier and product ion transition 2: qualifier were used, and the declustering potential DP and collision energy CE were optimized as shown in Table I. To test dilution effects and linearity range, concentrations at 1, 2.

Twelve samples were analyzed to determine the efficiency of the extraction procedure. Drug and internal standards were added to six samples before extraction. To the remaining six samples, internal standard was added after the samples were extracted. The mean and standard deviation were calculated for each set of samples and extraction efficiency determined. The LOD was assessed by testing analyte concentrations at 1 and 2. Six random urine specimens collected from human volunteers were analyzed to check for potential endogenous interferences with the analytes of interest.

Stability of the drug and metabolites in urine was also assessed. Because matrix effect can influence the extent of analyte ionization, an ion suppression experiment was conducted. Drug-negative urine was hydrolyzed and extracted in the same manner as test samples to best mimic matrix complexity.

Once the baseline was stable, injections of drug-free urine extract were made in the same manner as standard acquisitions. Gas chromatography mass spectrometry GC—MS and LC—MS-MS methods for analysis of opiates such as hydrocodone and hydromorphone in urine and blood have been described 16—23 ; however, those methods did not include the analysis of norhydrocodone. In the current study, the LOQ and LOD are significantly lower, making it possible to detect the drug and metabolites for a longer period of time.

The most viable product ions were selected based on their characteristic fragments of the precursor ion and their maximal response. An LC gradient with run time of 5 min was instituted to achieve better separation of the compounds. Retention times were 2. Hydromorphone and norhydrocodone share the same precursor ion, but were separated chromatographically in time.

Hydrocodone and norhydrocodone were not totally separated, but were spectrally distinguishable due to the difference in precursor ion between the two analytes. The hydroxy metabolite exists in both the free and glucuronide-conjugated forms. The samples were subjected to enzyme hydrolysis prior to extraction to provide measurement of total free and conjugated hydromorphone. Dilution integrity, defined as the accuracy of the calculated quantity to the true value of the diluted sample, proved to be However, the ion mass ratios were not always within range.

Six different random urines were evaluated to check for any indication of interference with the ions of interest. No interference was observed at the retention time of peaks for hydrocodone, hydromorphone, norhydrocodone or respective internal standards in any of the negative urines. The relative standard deviation RSD for within-run precision was 5. Injections of drug-free urine along with post-column infused analyte solution were made to evaluate ion suppression. No ion suppression was observed at the retention times of interest for any of the analytes.

Figure 3 demonstrates a typical ion suppression pattern for a blank urine sample. Illustration of ion suppression evaluation.

Hydrocodone was administered to seven healthy subjects. Following administration of the drug, the subjects were asked if they noticed any subjective effect from the drug. Three subjects reported mild to moderate drowsiness 30 min to 2 h following drug administration; one of those subjects also reported dry mouth at 2 h. Subject 4 reported nausea and impaired motor skills approximately 1. As expected, all three analytes were detected in subject urine samples.

The data presented here are on a controlled single dose administration of hydrocodone with no other drug use. In previous studies 14 , 17 , 24 , hydrocodone, hydromorphone and norhydrocodone were detected in human urine; however, those studies consisted of samples from chronic pain patients for whom multiple drug use is common.

Excretion of hydrocodone and hydromorphone in urine from human volunteers following administration of hydrocodone has been described; in those studies, either measurement of the metabolites was not provided or urines were pooled over a four-hour period 6 , The concentration of a drug in urine depends on several factors, including time since use, amount and frequency of use, fluid intake, body fat percentage, and metabolic factors.

There are many ways for patients to circumvent testing. These include adding adulterants to urine at the time of testing, urine dilution through excessive water ingestion, consumption of substances that interfere with testing, and substitution of a clean urine sample. Several chemicals can be added to a urine sample to interfere with urine drug testing. Household chemicals, including over-the-counter eye drops containing tetrahydrozo-line; bleach; vinegar; soap; ammonia; drain cleaner; and table salt, can produce a false-negative test.

A variety of commercial products that are available online may also be used. Some substances are detectable because of changes they produce in the appearance, specific gravity, or pH of the urine. Dilution of the urine through excessive water consumption or diuretics can decrease the urine drug concentration and make a negative test result more likely. Therefore, excessively dilute samples should be rejected. In situations where observed voiding is mandated, urinary substitution techniques and devices can be quite sophisticated and difficult to detect.

An artificial penis with an electronic, temperature-controlled urine reservoir can be purchased online. Patients may attempt to evade detection by voiding before testing, then refilling their bladder with clean urine using a catheter.

Federal testing procedures will catch some, but not all, tampering attempts. Summaries of the most important factors are listed in Tables 3 16 and 4. Remove anything in the collection area that could be used to adulterate or substitute a urine specimen. Request the display and removal of any items in the patient's pockets, coat, hat, etc.

Require all other personal belongings e. Instruct the patient to wash and dry his or her hands preferably with liquid soap under direct observation and not to wash again until after delivering the specimen. Place a bluing agent in the commode and turn off the water supply to the testing site.

Information from reference Unusual appearance e. Information from references 15 and The CMRO is a physician who is responsible for receiving, reviewing, and evaluating results generated by employers' drug testing programs. The CMRO is also responsible for the accuracy and integrity of the drug testing process by determining whether there is a legitimate explanation for unexpected test results and protecting the confidentiality of the drug testing information.

When performing non—legally mandated tests, physicians should be familiar with the specific drug screening statutes and regulations in their own state. State regulations might address chain of custody requirements, patient privacy, which specimens may be screened, and how results may be used or shared.

Reference laboratories routinely offer medical review officer services and telephone consultation with a laboratory toxicologist. When in doubt, the rules and best practices of the U. Department of Transportation provide a legally defensible framework for most jurisdictions. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. At the time the manuscript was written, Dr.

Zotos was completing a geriatric medicine fellowship in the Department of Family Medicine at the University of Tennessee College of Medicine—Chattanooga. Address correspondence to John B.

Reprints are not available from the authors. Behavioral monitoring and urine toxicology testing in patients receiving long-term opioid therapy. Anesth Analg. Treatment selection in substance abusers with pain. Adv Pain Manage. Department of Justice. Drug Enforcement Administration. Dispensing controlled substances for the treatment of pain. September Accessed January 16, Predicting opioid misuse by chronic pain patients: a systematic review and literature synthesis.

Learn the best ways to manage stress and negativity in your life. United States Drug Enforcement Administration. Curr Ther Res Clin Exp. Updated June 24, J Anal Toxicol. Management of acute and post-operative pain in chronic kidney disease. Wakim JH. Alleviating Symptoms of Withdrawal from an Opioid. Pain Ther. Fatal overdoses involving hydromorphone and morphine among inpatients: a case series.

CMAJ Open. National Library of Medicine. Updated January 23, Hydromorphone overdose. Updated June 2, National Institute on Drug Abuse. Benzodiazepines and Opioids. Updated March 15, Food and Drug Administration. Dilaudid Prescribing Information.

Updated December American Addiction Centers. The Effects of Mixing Hydromorphone and Alcohol. Updated June 1, Hydromorphone use for acute pain: Misconceptions, controversies, and risks.

J Opioid Manag. Updated March 10, Once you take Dilaudid and get it into your bloodstream, your liver starts working to remove it from your body. After the liver breaks the medicine down, it leaves your body in urine. Dilaudid is processed and broken down by the liver before it can be eliminated from the body.

When this occurs, the remaining byproducts are released in the urine. Just Believe Detox and Just Believe Recovery offer detox services and partial hospitalization and residential programs for the person seeking to quit opioid use. We employ a highly skilled team of professionals who render services to those we treat with care and expertise. These services include, but are not limited to, the following:. We are committed to ensuring that each individual we treat will receive the care, support, education, and tools they need to navigate a drug-free life and foster long-term wellness and happiness!

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