Failed my drug test and I'm pregnant

[ianurse]

Was admitted to antepartum at 26 weeks due to elevated b/p, light spotting, and contractions. Things settled down, but noticed that the nurses treated me strangly. After being kept for about 26 hours, my Dr. came in to release me. He sat on the edge of the bed very somberly and told me I had tested positive for fentanyl. I have been a nurse for 18 years, and have worked in a high school setting for the last 14. I have no known interaction with duragesic patches or anything else that would make me test positive. I am completely freaking out, has this happened to anyone else? I have to be seen in his office again Monday. The hospital app has not updated to see the actual lab and I called medical records and oh course they aren't open until Monday so I 'm not sure what the actual values and type of lab used were.

[brownbook]

Google false positive for fentanyl. The scientific abstracts were beyond my comprehension but apparently false positives can happen.

Let us know how it turns out for you.

[JKL33]

Well, I certainly think this was mishandled.

I'm no OB expert to understand whether there was any real need for the test to have been done in the first place, but it seems reasonable that they should have some defensible index of suspicion before doing that, as well as a solid answer for how this information was to be used in the course of care. Even in the ED we have solid diagnostic reasoning in order to run UDSs these days.

But even more, it was wrong to not bring this to your attention at an earlier point in your admission. If they hoped to get off the hook for re-running the test or testing a new sample or doing more specific testing, I would have a major problem with that. What, exactly, did they do to incorporate (or address) this finding in your course of care? They did nothing, because they didn't have a plan for using that information to begin with.

I would collect myself and then basically let them have it...in a controlled sort of way. They need to be on the hook for helping you to right/correct this situation. They need to be responsible for the costs and fall-out of running an unnecessary test.

I wish you well with getting this straightened out.

[Horseshoe, BSN, RN]

I would demand a re-test and would have a hair follicle test done, even if I had to pay for it myself.

[EGspirit]

I'm just a bit confused. When I worked in psych, where we did a drug screen on everyone, they test for opiates, not for any particular opiate on a drug screen. I don't even know if there is a test for just Fentanyl as opposed to hydrocodone, or morphine, etc. Why would they even test for such a specific drug (assuming it's possible to do so)? Why would they test you specifically for Fentanyl?

That said: If you have not taken any opiates, then someone screwed up somewhere and sent the wrong urine for the wrong patient.

Update: I just looked it up, I guess they can test specifically for fentanyl. It's not tested for on a screening test, but if there's a positive for opiates, they can do a more thorough test.

Of course, it's only detectable for about 48 hours after use, so getting retested on Monday won't necessarily mean anything. But a hair test would be good. Get a hair test done. If you haven't used, then someone sent the wrong urine with your label, and there may never be any way to prove that.

But if you say you haven't, and you have a hair follicle test done as soon as possible, that would be good proof that you haven't used. Don't get a home test, but rather go to a Labcorp. CVS and Walgreens may even do them. You may be able to get it done this weekend. I would if you could.

This sucks.

[morte, LPN, LVN]

one possible is trazodone.

and fent should not produce a positive on the opioid screen, they would have to test separately.

[subee, MSN, CRNA]

Fentanyl expensive to test for, hence must be specified and you don't work in high risk area so can't imagine anyone ordering it for you. Let us known how this all comes out. If you are not satisfied this this mistake hasn't been redacted from your chart, get a lawyer. Sorry for this aggravation for you.

[klone, MSN, RN]

A few thoughts.

If a pregnant woman presents to the ED or OB with certain symptoms (such as preterm labor or abruption), many facilities will automatically do a UDS. A UDS can be performed without a woman's consent if its used ONLY for purposes of informing medical decision-making and treatment.

However, if you're conscious and capable of providing informed consent, most places SHOULD notify you that they are doing it, and/or obtain your consent beforehand.

A Supreme Court decision from early 2000s (Ferguson v. Charleston) states that hospitals or providers cannot run a drug test without your consent if its results will be reported to government authorities (this includes police as well as CPS/DHS).

This is just providing you a little information/background on the law. Regarding it being positive and you haven't taken anything, I have no opinion.

[KatieMI, BSN, MSN, RN]

A very strange story.

UDS can surely be run on anyone and some ERs now just automatically do it for every patient, but standard UDS only detects "opiates" in general. Tests which detect particular drugs exist, but they are expensive and are not typically used in hospitals. Furthermore, they are not necessary, as actions can be taken out of concerns about potential danger for a dependent person (such as newborn) after the "overall" UDS alone.

I never saw "confirmatory" tests being considered in situations when positive UDS alone deemed to justify that phone call. Authorities usually appear before any "confirmatory" test is done. BTW, it is their, not provider's, responsibility to tell the patient what is going to happen next. I, as a provider, cannot go in the room and tell the patient that, since he was found in his car overdosed from pain pills with two of his little ones strapped in backseat, I am going to take his kids to foster care, then call his employer and then take his driver's license. I can only call appropriate authorities and tell the patient that I am going to do so and explain my reasoning. Moreover, I can only call the authorities who are responsible for actions/prevention of situations which are potentially or actually life-threatening. I can contact CPS or police, but it would be illegal for me to call licensing authorities or employers, or, say, immigration. And in no way I can act "strange" toward a patient in such situation. That would be just unprofessional.

I would definitely request independent re-test. The volume of patients who go through any ER in any given day can be high and mistakes with labs do happen sometimes. Plus, fluoroquinolones and diphenhydramine (which is common Benadryl OTC) can cross-react with opioids in immunoassay tests:

False-Positive Interferences of Common Urine Drug Screen Immunoassays: A Review | Journal of Analytical Toxicology | Oxford Academic

[bebbercorn]

I completely agree with KatieMI. Ask for confirmatory testing. They can do so through NMS labs.

[wondern, ASN]

Praying for you and your baby. Please let us know how this turns out.

[Guest957596]

Hope it works out for you!