A 16yo patient is brought in directly from a large “pharm” party with altered mental status, respiratory depression, and pinpoint pupils. You suspect opiate overdose and administer naloxone with improvement in spontaneous respirations. To your surprise, however, the qualitative urine drug screen comes back negative for opiates. Which of the following drugs is the patient unlikely to have taken?
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January 9, 2021 at 1:19 pm
E) Codeine
Qualitative immunoassay urine drug screens typically are positive only for morphine and narcotic drugs that metabolize to morphine such as codeine and heroin. Synthetic and semisynthetic opiates such as fentanyl, tramadol, methadone, oxycodone, hydrocodone, and hydromorphone are less likely to produce a positive test, although sometimes there is enough cross-reactivity with morphine to produce a positive immunoassay test.