Holiday Seasons and Substance Abuse

Dr. Joseph E. Graas, Scientific Director
Dr. Renee Kilmer, Medical Director
Dr. Edward Moore, Medical Director
Dr. Karen Wagersmith, Scientific Director

The holiday season for most people is a time to get together with family and friends, gift giving, and children’s anticipation.  Children grow up to be adults with fond remembrances of customs and celebrations that they reenact with their own children.  Relations are reestablished with aunts, uncles, and friends in distant geographical regions.  The season is a very exciting time for most of us, however, for a subset of the population the holidays are extremely stressful.  This is especially so for people in addiction recovery (or even people who have been in remission for a long time). The impact of addiction is amplified during this festive season, when members of the family arrive to celebrations intoxicated, late, or are even absent all together due to their substance abuse. Many people relapse during the holidays, so it’s crucial that extra support is provided to your patients during this time of year.  In addition, we would like to draw your attention to the following three drug testing issues.

Alcohol and Marijuana Use During the Holidays

The social, recreational, and, for the most part, legal drugs of alcohol and marijuana are at the top of the list when it comes to use and abuse.  Most treatment program’s rules list these two drugs as substances to avoid, but the opportunity for use increases during the holiday season.  Increased vigilance for observable signs and symptoms of these two drugs is warranted for detection and prevention of relapse.

Cold & Flu Season (Amphetamines)

During the wintertime, with all the cold and flu bugs going around, there is an increased frequency of false positive amphetamines class immunoassay results.  This is due to the cross-reaction of the ephedra source drugs with the amphetamines class test. The screening test for amphetamines blocks a certain quantity of over the counter medications, but when this threshold is exceeded the test may be positive.  It is quite common for individuals suffering cold and flu symptoms to use more than the recommended amount of a medication to quickly relieve the symptoms.  This excess is usually sufficient to trigger a positive result in an amphetamines class immunoassay test.  However, patients have sometimes taken advantage of this by using over the counter medications to try and mask the methamphetamine use. To resolve this problem, it is necessary to differentiate the medications from the target drug, methamphetamine, using a confirmation test.  This second test must use a different analytical method and be able to determine whether the substance that was detected was from an over the counter source, amphetamine source, methamphetamine source, or neither.  Additional testing for methylphenidate/ritalinic acid (Ritalin) is also available should the need arise.

Negative Methadone or Methadone Metabolite

It has been our experience during past holiday seasons that there are a higher number of negative results for methadone, methadone metabolite, or both. There seems to be a higher rate of methadone diversion during the holidays. If a patient is receiving and consuming a dose higher than 20-30mg/day, is not pregnant, is not exhibiting signs of withdrawal and does not have any known liver issues, it is expected that the result should be POSITIVE for both methadone and methadone metabolite. One type of abnormal result that suggests the sample has been adulterated to hide diversion is a POSITIVE result for methadone and a NEGATIVE result for methadone metabolite.  With this, you may see the following note on the patient’s report:

High quantity of methadone present in specimen. No methadone metabolite detected. Methadone appears to have been added to specimen.

We hope that this information is helpful to you with your interpretation of results over the coming months.  Best wishes for a safe, healthy, and happy Holiday season to come! As always, we are available to answer any questions you may have.