Non-detectable street drugs?

Nurses General Nursing

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Specializes in ER, Med/Surg.

I work in the ER part of the time and we'll see patients, usually younger (20's) but sometimes older that are acting completely intoxicated, yet their triage drug screen will come back negative for everything we test for (opiates, marijuana, Tricyclics, benzos, barbituates, amphetamines, meth, PCP ....there might be a couple more)

Any ideas as to what is on the streets these days? I'm heard that dextromethorphan is something being abused. In large doses it causes paradoxical effects (hyperactivity, etc.)

What have you all seen?

Pat

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Specializes in Perioperative, ACU, Hospice.

What about huffing? Lots of kids doing this nowadays and I'm not sure if there is testing for it...?

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Maybe they are first time users and the drug hadn't had time to metabolize and be expelled in the urine yet before they had the bad side effect.

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I work in the ER part of the time and we'll see patients, usually younger (20's) but sometimes older that are acting completely intoxicated, yet their triage drug screen will come back negative for everything we test for (opiates, marijuana, Tricyclics, benzos, barbituates, amphetamines, meth, PCP ....there might be a couple more)

Any ideas as to what is on the streets these days? I'm heard that dextromethorphan is something being abused. In large doses it causes paradoxical effects (hyperactivity, etc.)

What have you all seen?

Pat

LSD basically does not show up in urine drug tests. There is a very short window after administration during which it can be found, using a test more sensitive than most facilities will have access to. The effective dose is 100 or so micrograms, and most of it seems to head straight for CNS tissue, so there isn't much in blood, let alone urine.

Dextromethorphan might not, though I seem to recall that it will show a false positive for one of the other substances.

Benadryl is a common drug of overdose. Any anticholinergic in large doses can do the trick, but benadryl is readily available. 20 or so of the pills OTC will act as a delerium-inducing hallucinogen. It isn't a very pleasant experience, as short term memory is greatly impaired and there are lots of unpleasant physical side effects. But every now and again, someone will hear the rumor that they can trip off benadryl and will try it. Or people who don't know better will try it for a suicide OD. They end up in ED's, getting cathed for the urinary retention that it causes, all while being very confused and agitated.

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Specializes in Correctional, QA, Geriatrics.

My experience with "huffing" is that none of the volatile chemicals used to huff (glue, paint, gasoline, etc) will show up in urine or blood screenings as a rule. However the fumes coming off the body, hair and breath plus the pin point pupils are the usual dead give away for huffing.

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Specializes in Cardiac, Derm, OB.

Acid usually only detected in spinal tap.

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Specializes in Cardiac, Acute/Subacute Rehab.

I just had a wonderful summer Peds class, and LOTS of interesting Peds clinical experiences.

One was at the State's Child and Adolescent Psych Institute, where I learned on the Adolescent Drug and Alcohol Unit about Triple C's.

Triple's C's, I found out, are Coricidin Cough & Cold...the kind of cold medicine those with high blood pressure take. Apparently, when a # pills are taken (some claimed 16-20, one chart said the kid took 30-35 at a time), they cause hallucinations and something of a dissociation for a period of time.

Oh yeah - they also call them "Skittles" and I don't think they would show on tox screens...could be wrong.

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Specializes in behavioral health.

Perhaps, error, or the cut off for the test is too high. I don't think that all drug tests are fool proof, either.

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What about huffing? Lots of kids doing this nowadays and I'm not sure if there is testing for it...?

this was my first thought.

My dh when he was 18 everyone in ER swore he was on something... lol turns out he has a weird potassium disorder. If I had a dollar for everyone who thought he was some young kid that was high I'd be rich. (but I know this is a rare circumstance)

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does your drug screen check for buprenorphine? i wonder if perhaps that could be something that's not showing up. subutex and suboxone don't come up on just a regular drug test. i guess it has to be specifically looked for. my doctor sent me to get blood work and wanted them to check my buprenorphine level, and somehow it never showed up, and they were looking for it. (maybe they did something wrong when doing the test? made no sense to me!)

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Propoxyphene and Methadone are not tested for on most standard drug screens. They have to be specifically ordered most of the time.

UDS is pretty unreliable in an ER/hospital setting due to the points mentioned previously...not enough time to metabolize, lab cut offs, substances that won't show up, etc.

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UDS is pretty unreliable in an ER/hospital setting due to the points mentioned previously...not enough time to metabolize, lab cut offs, substances that won't show up, etc.

No more truthful statement can be made. They are limited and most of the time do not help you in treatment of the patient. Plus they are often plagued with false positives.

LSD will show up in serum and urine but 95--99 percent of the hospital do not have the capability to test for this.

Dextromethorphan often will not show up on drug screens yet is being abused by teens often. Sometimes though it may cause a false positive for pcp.

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