Non-detectable street drugs?

  1. 0 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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    About Pat_Pat RN

    Pat_Pat RN has '8' year(s) of experience and specializes in 'ER, Med/Surg, Infusion'. From 'Indiana'; 39 Years Old; Joined Aug '06; Posts: 391; Likes: 311.

    22 Comments so far...

  4. Visit  frankiebaby profile page
    0
    What about huffing? Lots of kids doing this nowadays and I'm not sure if there is testing for it...?
  5. Visit  GOMER42 profile page
    0
    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.
  6. Visit  correctlywrong profile page
    1
    Quote from Pat_Pat
    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.
    GOMER42 likes this.
  7. Visit  txredheadnurse profile page
    0
    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.
  8. Visit  CRIMSON profile page
    0
    Acid usually only detected in spinal tap.
  9. Visit  LuvMyGamecocks profile page
    0
    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.
  10. Visit  iwanna profile page
    0
    Perhaps, error, or the cut off for the test is too high. I don't think that all drug tests are fool proof, either.
  11. Visit  MIcrunchyRN profile page
    1
    Quote from frankiebaby
    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)
    GOMER42 likes this.
  12. Visit  Nidawi profile page
    0
    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!)



  13. Visit  ERNurse752 profile page
    0
    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.
  14. Visit  Noryn profile page
    0
    Quote from ERNurse752

    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.
  15. Visit  Morettia2 profile page
    0
    this is one I have been waiting to share..I am an RN and I work in Newark Nj and my Aunt is also an RN. She is an ER Nurse manager in the Philly area. She gave me this flyer that the local PD was posting all over ther Er about Jenkem last year, which is literally, huffing the noxious gas from human waste. It causes, all kinds of awful problems, I would think that huffing my own poop wpuld right??
    But all joking aside here is the bulliten she handed me last year
    http://67.19.222.106/crime/graphics/jenkem.pdf

    I hope the web site works. I had just graduated nursing school when she gave me this. I was so grossed out by reading what our own feces can do to us.....


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